Inter Press Service » Women’s Health Journalism and Communication for Global Change Thu, 31 Jul 2014 15:44:30 +0000 en-US hourly 1 ‘Zero Tolerance’ the Call for Child Marriage and Female Genital Mutilation Wed, 23 Jul 2014 18:43:04 +0000 A. D. McKenzie Fatema,15, sits on the bed at her home in Khulna, Bangladesh, in April 2014. Fatema was saved from being married a few weeks earlier. Local child protection committee members stopped the marriage with the help of law enforcement agencies. Credit: UNICEF

Fatema,15, sits on the bed at her home in Khulna, Bangladesh, in April 2014. Fatema was saved from being married a few weeks earlier. Local child protection committee members stopped the marriage with the help of law enforcement agencies. Credit: UNICEF

By A. D. McKenzie
LONDON, Jul 23 2014 (IPS)

Heightening their campaign to eradicate violence against women and girls, United Nations agencies and civil groups have called for increased action to end child marriage and female genital mutilation.

At the first Girl Summit in London Wednesday, hosted by the U.K. government and UNICEF, delegates said they wanted to send a strong message that there should be “zero tolerance” for these practices.

“Millions of young girls around the world are in danger of female genital mutilation and child marriage – and of losing their childhoods forever to these harmful practices,” Susan Bissell, UNICEF’s Chief of Child Protection, told IPS.“Millions of young girls around the world are in danger of female genital mutilation and child marriage – and of losing their childhoods forever to these harmful practices” – Susan Bissell, UNICEF's Chief of Child Protection

“FGM is an excruciatingly painful and terrifying ordeal for young girls. The physical effects can last a lifetime, resulting in horrific infections, difficulty passing urine, infertility and even death.”

Bissell said that when a young girl is married “it tends to mark the end of her education and she’s more likely to have children when she’s still a child herself – with a much higher risk of dying during pregnancy or childbirth”.

“Without firm and accelerated action now, hundreds of millions more girls will suffer permanent damage,” she added in an e-mail interview.

At the summit, the United Kingdom announced an FGM prevention programme, launched by the government’s Department of Health and the National Health Service (NHS) England. Backed by 1.4 million pounds, the programme is designed to improve the way in which the NHS tackles female genital mutilation and “clarify the role of health professionals which is to ‘care, protect, prevent’,” the government said.

According to British Prime Minister David Cameron, some 130,000 people are affected by FGM in the United Kingdom, with “60,000 girls under the age of 15 potentially at risk”, even though the practice is outlawed in the country.

The prevention programme will now make it mandatory for all “acute hospitals” to report the number of patients with FGM to the Department of Health on a monthly basis, as of September of this year.

U.N. officials said that the Girl Summit was a significant development because it marked the importance of the issues addressed.

“International leaders came together in one place and said enough is enough,” Bissell said.

While it is difficult to measure the impact of intensified campaigns on the reductions in child marriage and female genital mutilation/cutting over the past few years, the United Nations and other organisations have noted that the numbers of girls affected are in fact decreasing.

In the Middle East and North Africa, the percentage of women married before age 18 has dropped by about half, from 34 percent to 18 percent over the last three decades, UNICEF says.

In South Asia, the decline has been especially marked for marriages involving girls under age 15, dropping from 32 percent to 17 percent.

“The marriage of girls under age 18, however, is still commonplace,” Bissell told IPS.

“In Indonesia and Morocco, the risk of marrying before age 18 is less than half of what it was three decades ago. In Ethiopia, women aged 20 to 24 are marrying about three years later than their counterparts three decades ago,” she added.

Regarding female genital mutilation/cutting, Kenya and Tanzania have seen rates drop to one-third of their levels three decades ago through a combination of community activism and legislation, while in the Central African Republic, Iraq, Liberia and Nigeria, prevalence of FGM has dropped by as much as half, Bissell said.

However, officials stressed that with population growth, it is possible that progress in reducing child marriage will remain flat unless the commitments made at the Girl Summit are acted upon. Flat progress “isn’t good enough”, Bissell told IPS.

Recently released U.N. figures show that, despite the declines, child marriage is widespread, with more than 700 million women alive today who were married as children. UNICEF says that some 250 million women were married before the age of 15.

The highest percentage of these women can be found in South Asia, followed by East Asia and the Pacific which is home to 25 percent of girls and women married before the age of 18, UNICEF says.

Statistics also indicate that girls who marry before they turn 18 are less likely to remain in school and more likely to experience domestic violence. In addition, teenage mothers are more at risk from complications in pregnancy and childbirth than women in their 20s; some 70,000 adolescent girls die every year because of such complications, according to the United Nations.

The statistics on female genital mutilation are also cause for international concern, with the United Nations Population Fund (UNFPA) saying that about 125 million girls and women have been subjected to the practice, which can lead to haemorrhage, infection, physical dysfunction, obstructed labour and death.

According to UNFPA, female genital mutilation/cutting and child marriage are human rights violations that both help to perpetuate girls’ low status by impairing their health and long-term development.

UNFPA Executive Director Dr. Babatunde Osotimehin told IPS that a number of states have adopted legislation against female genital mutilation/cutting but that some perpetrators are still operating with “impunity”.

Participating in the London summit, Osotimehin said that certain governments were facing challenges within their own countries because of long-held cultural beliefs, but like Bissell, he said that the picture is not completely bleak, because civil society and grassroots organisations are amplifying their campaigns.

“Our message for girls who are affected by these practices is that they have support – moral, psychological, physical and emotional support,” he told IPS. “We also want to send a message that those who are affected should advocate to try and stop these practices.”

Meanwhile, U.N. officials said it was significant that the summit saw commitment from the African Union and the deputy prime Minister of Ethiopia, as well as from the United States Agency for International Development (USAID) and the U.K. Department for International Development (DfID). The Government of Canada and several other financial supporters also made commitments.

For the executive director of UN Women, Phumzile Mlambo-Ngcuka, the pledges show support for the message of “zero tolerance” of child marriage and FGM that her organisation wishes to send. They are also a strong signal that the practices can be ended in a generation, she told IPS.

]]> 1
Focus on Child Marriage, Genital Mutilation at All-Time High Wed, 23 Jul 2014 14:41:50 +0000 Julia Hotz Female genital mutilation (FGM) traditional surgeon in Kapchorwa, Uganda speaking to a reporter. The women in this area are being trained  by civil society organisation REACH in how to educate people to stop the practice. Credit: Joshua Kyalimpa/IPS

Female genital mutilation (FGM) traditional surgeon in Kapchorwa, Uganda speaking to a reporter. The women in this area are being trained by civil society organisation REACH in how to educate people to stop the practice. Credit: Joshua Kyalimpa/IPS

By Julia Hotz
WASHINGTON, Jul 23 2014 (IPS)

As Tuesday’s major summits here and in London focused global attention on adolescent girls, the United Nations offered new data warning that more than 130 million girls and women have experienced some form of female genital mutilation, while more than 700 million women alive today were forced into marriage as children.

Noting how such issues disproportionately affect women in Africa and the Middle East, the new report from the United Nations Children’s Fund (UNICEF) surveyed 29 countries and discussed the long-term consequences of both female genital mutilation (FGM) and child marriage.“What we’re really missing is a coordinated global effort that is commensurate with the scale and the size of the issue.” -- Ann Warner

While the report links the former practice with “prolonged bleeding, infection, infertility and death,” it mentions how the latter can predispose women to domestic violence and dropping out of school.

“The numbers tell us we must accelerate our efforts. And let’s not forget that these numbers represent real lives,” UNICEF Executive Director Anthony Lake said in a statement. “While these are problems of a global scale, the solutions must be local, driven by communities, families and girls themselves to change mindsets and break the cycles that perpetuate [FGM] and child marriage.”

Despite these ongoing problems, Tuesday’s internationally recognised Girl Summit comes as the profile of adolescent girls – and, particularly, FGM – has risen to the top of certain agendas. On Tuesday, British Prime Minister David Cameron announced a legislative change that will now make it a legally enforceable parental responsibility to prevent FGM.

“We’ve reached an all-time high for both political awareness and political will to change the lives of women around the world,” Ann Warner, a senior gender and youth specialist at the International Centre for Research on Women (ICRW), a research institute here, told IPS.

Warner recently co-authored a policy brief recommending that girls be given access to high-quality education, support networks, and practical preventative skills, and that communities provide economic incentives, launch informational campaigns, and establish a legal minimum age for marriage.

Speaking Tuesday at the Washington summit, Warner added that there has been “a good amount of promising initiatives – initiated by NGOs, government ministers and grassroots from around the world – that have been successful in turning the tide on the issue and changing attitudes, knowledge and practices.”

Advocates around the world can learn from these efforts, Warner said, paying particular attention to the progress India has made in preventing child marriage. Still, she believes that a comprehensive global response is necessary.

“What we’re really missing is a coordinated global effort that is commensurate with the scale and the size of the issue” of FGM and child marriage, she said. “With 14 million girls married each year, a handful of individual projects around the world are simply not enough to make a dent in that problem.”

U.S. action

The need for better coordination and accountability was echoed by Lyric Thompson, co-chair of the Girls Not Brides-USA coalition, a foundation that co-sponsored Tuesday’s Girl Summit here in Washington.

“If we are going to end child marriage in a generation, as the Girl Summit charter challenges us to do, that is going to mean a much more robust effort than what is currently happening,” Thompson told IPS. “A few small programmes, no matter how effective, will not end the practice.”

In particular, Thompson is calling on the United States to take a more active stand against harmful practices that affect women globally, which she adds is consistent with the U.S Violence Against Women Reauthorization Act of 2013

“If America is serious about ending this practice in a generation, this means not just speeches and a handful of [foreign aid] programmes, but also the hard work of ensuring that American diplomats are negotiating with their counterparts in countries where the practice is widespread,” she says.

“It also means being directly involved in difficult U.N. negotiations, including the ones now determining the post-2015 development agenda, to ensure a target on ending child, early and forced marriage is included under a gender equality goal.”

On Tuesday, the U.S. government announced nearly five million dollars to counter child and forced marriage in seven developing countries for this year, while pledging to work on new U.S. legislation on the issue next year. (The U.S. has also released new information on its response to FGM and child marriage.)

“​We know the fight against child marriage is the fight against extreme poverty,” Rajiv Shah, the head of the United States’ main foreign aid agency, stated Tuesday.

“That’s why USAID has put women and girls at the centre of our efforts to answer President Obama’s call to end extreme poverty in two generations. It’s a commitment that reflects a legacy of investment in girls – in their education, in their safety, in their health, and in their potential.”

Global ‘tipping point’

Of course, civil society actors around the world likely hold the key to changing long-held social views around these contentious issues.

“Federal agencies, in a position to respond to forced marriage cases, must work together and with community and NGO partners to ensure thoughtful and coordinated policy development,” Archi Pyati, director of public oolicy at Tahirih Justice Center, a Washington-based legal advocacy organisation, told IPS.

“Teachers, counsellors, doctors, nurses and others who are in a position to help a girl or woman to avoid a forced marriage or leave one must be informed and ready to respond.”

Pyati points to an awareness-raising campaign around forced marriage that will tour the United States starting in September. In this, social media is also becoming an increasingly important tool for advocacy efforts.

“Technology has brought us a new way to tell our governments and our corporations what matters to us,” Emma Wade, counsellor of the Foreign and Security Policy Group at the British Embassy here, told IPS. “Governments do take notice of what’s trending on Twitter and the like, and corporations are ever-mindful of ways to differentiate themselves … in the search for market share and committed customers.”

Wade noted within her presentation at Tuesday’s summit that individuals can pledge their support for “a future free from FGM and child and forced marriage” via the digital Girl Summit Pledge.

Shelby Quast, policy director of Equality Now, an international human rights organisation based in Nairobi, reiterated the importance of tackling FGM and child marriage across a variety of domains.

“The approach that works best is multi-sectoral… including the law, education, child protection and other elements such as support for FGM survivors and media advocacy strategies,” Quast explained. “We are at a tipping point globally, so let’s keep the momentum up to ensure all girls at risk are protected.”

]]> 0
Stunting: The Cruel Curse of Malnutrition in Nepal Tue, 22 Jul 2014 11:59:26 +0000 Mallika Aryal Sadhana Ghimire, 23, makes sure to give her 18-month-old daughter nutritious food, such as porridge containing grains and pulses, in order to prevent stunting. Credit: Mallika Aryal/IPS

Sadhana Ghimire, 23, makes sure to give her 18-month-old daughter nutritious food, such as porridge containing grains and pulses, in order to prevent stunting. Credit: Mallika Aryal/IPS

By Mallika Aryal
RASUWA, Nepal, Jul 22 2014 (IPS)

Durga Ghimire had her first child at the age of 18 and the second at 21. As a young mother, Durga didn’t really understand the importance of taking care of her own health during pregnancy.

“I didn’t realise it would have an impact on my baby,” she says as she sits on the porch of her house in Laharepauwa, some 120 kilometers from Nepal’s capital, Kathmandu, nursing her third newborn child.

It is late in the afternoon and she is waiting expectantly for her two older daughters to return from school. One is nine and the other is six, but they look much smaller than their actual age.

“They are smaller in height and build and teachers at school say their learning process is also much slower,” Durga tells IPS. She is worried that the girls are stunted, and is trying to ensure her third child gets proper care.

A recent United Nations Children Fund (UNICEF) report shows that Nepal is among 10 countries in the world with the highest stunting prevalence, and one of the top 20 countries with the highest number of stunted children.

“Reducing stunting among children increases their chances of reaching their full development potential, which in turn will have a long-term impact on families’, communities’ and the country’s ability to thrive.” -- Peter Oyloe, chief of USAID Nepal’s Suaahara (‘Good Nutrition’) project at Save the Children-Nepal
UNICEF explains stunting as chronic under-nutrition during critical periods of growth and development between the ages of 0-59 months. The consequences of stunting are irreversible and in Nepal the condition affects 41 percent of children under the age of five.

“Nepal’s ranking […] is worrying, not just globally but also in South Asia,” Giri Raj Subedi, senior public health officer at Nepal’s ministry of health and population, tells IPS.

A 2013 progress report on the Millennium Development Goals (MDGs) done by Nepal’s National Planning Commission (NPC) says while the number of stunted children declined from 57 percent in 2001 to 41 percent in 2011, it is still high above the 30 percent target set by the U.N..

“Stunting is a specific measure of the height of a child compared to the age of the child, and it is indicative of how well the child is developing cognitively,” says Peter Oyloe, chief of party of USAID Nepal’s Suaahara, or ‘Good Nutrition’ project at Save the Children Nepal.

Oyloe adds, “Reducing stunting among children increases their chances of reaching their full development potential, which in turn will have a long-term impact on families’, communities’ and the country’s ability to thrive.”

Child health and nutrition experts argue that, while poverty is directly related to inadequate intake of food, it is not the sole indicator of malnutrition or increased stunting.

Saba Mebrahtu, chief of the nutrition section at UNICEF-Nepal, says the immediate causes include poor nutrient intake, particularly early in life. Fifty percent of stunting happens during pregnancy and the rest after infants are born.

“When we are talking about nutrient-rich food […] we are talking about ensuring that children get enough of it even before they are born,” says Mebrahtu. The time between conception and a child’s second birthday is a crucial period, she said, one of rapid growth and cognitive development.

Thus it is incumbent on expecting mothers to follow a careful diet before the baby is born.

Basic education could save lives

Sadhana Ghimire, 23, lives a few doors down from Durga. Separated by a few houses, their approaches to nutrition are worlds apart.

Ghimire breast-fed her 18-month-old daughter exclusively for six months. She continues to make sure that her own diet includes green leafy vegetables, meat or eggs, along with rice and other staples, as she is still nursing.

She gives credit to the female community health-worker in her village, who informed her about the importance of the first 1,000 days of a child’s life.

In preparation for her daughter’s feeding time, Ghimire mixes together a bowl of homemade leeto, a porridge containing one-part whole grains such as millet or wheat and two-parts pulses such as beans or soy.

“I was only using grains to make the leeto before I was taught to make it properly by the health workers and Suaahara,” she says.

However, making leeto was not the most important lesson Ghimire learned as an expecting mother. “I had no idea that simple things like washing my hands properly could have such a long term effect on my daughter’s health,” she says.

Even seemingly common infections like diarrhoea can, in the first two years, put a child at greater risk of stunting.

“That is because the nutrients children are using for development are used instead to fight against infection,” says Mebrahtu emphasising the need for simple practices such as proper hand washing and cleaning of utensils.

If children are suffering from infection due to poor hygiene and sanitation they can have up to six diarrhoeal episodes per year, she warns, adding that while “children recover from these infections, they don’t come back to what they were before.”

Fighting on all fronts

Food insecurity is one of the biggest contributing factors to stunting in Nepal. Rugged hills and mountains comprise 77 percent of the country’s total land area, where 52 percent of Nepal’s 27 million people live.

Food insecurity is worst in the central and far western regions of the country; the prevalance of stunting in these areas is also extreme, with rates above 60 percent in some locations.

Thus experts recognise the need to fight simultaneously on multiple fronts.

“Our work in nutrition has proven again and again that a single approach to stunting doesn’t work because the causes are so many – it really has to be tackled in a coordinated way,” says UNICEF’s Mebrahtu.

In 2009 the government conducted the Nutrition Assessment and Gap Analysis (NAGA), which recommended building a multi-sector nutrition architecture to address the gaps in health and nutrition programmes.

“The NAGA study stated clearly that nutrition was not the responsibility of one department, as was previously thought,” Radha Krishna Pradhan, programme director of health and nutrition at Nepal’s NPC, tells IPS.

Nepal is also one of the first countries to commit to the global Scaling Up Nutrition (SUN) movement, which recognises multiple causes of malnutrition and recommends that partners work across sectors to achieve nutritional goals.

Thus, in 2012, five ministries in Nepal came together with the NPC and development partners to form the Multi-Sector Nutrition Plan (MSNP).

Public health experts say MSNP is a living example of the SUN movement in action and offers interventions with the aim of reducing the current prevalence of malnutrition by one-third.

Interventions include biannual vitamin D and folic acid supplements for expectant mothers, deworming for children, prenatal care, and life skills for adolescent girls.

On the agricultural front, ministries aim to increase the availability of food at the community level through homestead food production, access to clean and cheap energy sources such a biogas and improved cooking stoves, and the education of men to share household loads.

MSNP’s long-term vision is to work towards significantly reducing malnutrition so it is no longer an impending factor towards development. The World Bank has estimated that malnutrition can cause productivity losses of as much as 10 percent of lifetime earnings among the affected, and cause a reduction of up to three percent of a country’s GDP.

At present the Plan is in its initial phase and has been implemented in six out of 75 districts in Nepal since 2013.


]]> 1
Time to “Drop the Knife” for FMG in The Gambia Sun, 13 Jul 2014 11:23:18 +0000 Saikou Jammeh Circumcisers in the Gambia publicly declaring that they have abandoned the practice of FGM. Credit: Saikou Jammeh/IPS

Circumcisers in the Gambia publicly declaring that they have abandoned the practice of FGM. Credit: Saikou Jammeh/IPS

By Saikou Jammeh
BANJUL, Jul 13 2014 (IPS)

Women’s rights activists in the Gambia are insisting that more than 30 years of campaigning to raise awareness should be sufficient to move the government to outlaw female genital mutilation (FMG).

The practice remains widespread in this tiny West African country of 1.8 million people, but rights activists believe that their campaign has now reached the tipping point.

Two years ago, GAMCOTRAP, an apolitical non-governmental organisation (NGO) committed to the promotion and protection of women and girl children’s political, social, sexual, reproductive health and educational rights in The Gambia, and one of the groups behind the anti-FGM campaign, sponsored a draft bill which has been subjected to wide stakeholder consultations.

Several previous attempts to legislate against FGM have failed, with no fewer than three pro-women laws having had clauses on FGM removed from draft bills. But activists now appear determined to make the final push and hope that when introduced this time round, the bill will go through.“We’ve caused lots of suffering to our women ... if my grandparents had known what I know today, they would not have circumcised anyone. Ignorance was the problem” – former circumciser Babung Sidibeh

The time has now come for final action, says Amie Bensouda, legal consultant for the draft bill. “There can be no half measures. The law has to be clear. It’s proposed by the law that FGM in all its forms is prohibited. This discussion cannot go on forever. The government should do what is right.”

“The campaign has reached its climax,” Dr Isatou Touray, executive director of GAMCOTRAP, told IPS. “A lot of work has been done. I am hopeful of having a law because women are calling for it, men are calling for it. I know there are pockets of resistance but that’s always the case when it comes to women’s issues.”

“In 2010, we organised a workshop for the National Assembly,” she continued. “They made a declaration, pledging to support any bill that criminalises FGM. I am happy to report that, since 2007, more than 128 circumcisers and 900 communities have abandoned the practice. This trend will continue to grow.”

Seventy-eight percent of Gambian women undergo FGM as a ‘rite of passage’. However, after more than three decades of the anti-FGM campaign in Gambia, a wind of change is blowing, sweeping even conservative rural communities.

Sustained awareness-raising programmes have resulted in public declarations of abandonment of FGM by hundreds of circumcisers. Babung Sidibeh, custodian of the tradition in her native Janjanbureh, the provincial capital of Central River Region, 196 kilometres from Banjul, was one of them. The old woman assumed the role after the death of her parents, but she has since “dropped the knife”, as no longer practising FGM is known here.

Sidibeh did so after receiving training in reproductive health and women’s rights. “Soon after we circumcised our children in 2011,” she told IPS, “Gamcotrap invited me for training. I was exposed to the harm we’ve been doing to our fellow women. If I had known that before what I know today, I would never have circumcised anyone.”

With a tinge of remorse, she added: “We’ve caused lots of suffering to our women. That’s why I told you that if my grandparents had known what I know today, they would not have circumcised anyone. Ignorance was the problem.”

Mrs Camara-Touray, a senior public health worker at the country’s heath ministry confirmed to IPS that her ministry has since taken a more proactive role on FGM.

She explained: “The ministry has created an FGM complication register. We’ve also trained nurses on FGM. Until recently, when you asked most health workers about the complications that can arise with FMG, they would say it has no complications. That’s because they were not trained. Since 2011, we’ve changed our curriculum to include these complications. After we put the register in place, within three months, we’d go to a region and see that hundreds of complications due to FGM had been recorded.”

In March, Gamcotrap organised a regional religious dialogue that sought to de-link FGM from Islam. Touray said that the workshop was a prelude to the introduction of the proposed law in parliament.

“Islamic scholars were brought together from Mali, Guinea, Mauritania and Gambia,” she told IPS. “We had a constructive debate and it was overwhelmingly accepted that FGM is not an Islamic injunction, it’s a cultural practice. It was recommended that a specific law should be passed and a declaration was made to that effect.”

However, there is resistance in some quarters. An influential group of Islamic scholars, backed by the leadership of the Supreme Islamic Council, continue to maintain that FGM is a religious injunction.

With a large following and having the ears of the politicians, these clerics have in recent times also intensified their pro-FGM campaign.

“It will be a big mistake if they legislate against FGM,” Ebrima Jarjue, an executive member of the Supreme Islamic Council, told IPS.

“Our religion says we cut just small. We should be allowed to practise our religion. If some people are doing it and doing it bad, let them stop it. Let them go and learn how to do it. If circumcising the girl child when she’s young is causing problems, then let’s wait until she grows up. That’s what used to happen.”

Meanwhile, the Women’s Bureau, the implementing arm of the Ministry of Women’s Affairs, is hesitant about legislating against FGM.

“As far FGM is concerned, the position of the Women’s Bureau is that there’s need for more sensitisation and dialogue to push the course forward,” Neneh Touray, information and communication officer of the Women’s Bureau, told IPS. She declined to comment on whether the bureau thought that the bill was premature.

]]> 2
Pakistan: Where Mothers Are Also Children Fri, 11 Jul 2014 09:17:35 +0000 Zofeen Ebrahim Most South Asian nations struggle with the twin problems of early marriage and teenage pregnancy, making it crucial to tackle both simultaneously, experts say. Credit: Zofeen Ebrahim/IPS

Most South Asian nations struggle with the twin problems of early marriage and teenage pregnancy, making it crucial to tackle both simultaneously, experts say. Credit: Zofeen Ebrahim/IPS

By Zofeen Ebrahim
KARACHI, Pakistan, Jul 11 2014 (IPS)

If 22-year-old Rashda Naureen could go back six years in time, she would never have agreed to get married at the tender age of 16.

“Looking back, I know I was not ready for marriage,” she told IPS. “How could I have been, being merely a child myself?”

With only a third-grade education, Naureen became a mother at 17 and got a divorce soon after she delivered.

According to Naureen’s mother, Perween Bibi, who works for a small daily wage as a cleaning woman in Pakistan, “I have two more daughters [in addition to two sons] and we gave Rashda away in order to have one less responsibility on our hands.”

Nearly 7.3 million teenage girls become pregnant every year -- of these, two million are aged 14 or younger.
But the opposite turned out to be true. Today Bibi and her husband, who is a private chauffeur, must now find a way to provide for their grandson in a family of seven struggling to survive.

Perhaps the most unfortunate part of the story is that Naureen’s pregnancy could easily have been avoided.

“Before marriage my best friend urged me to take contraceptive pills, but I refused to listen to her,” Naureen confessed.

“Even my husband, who had been forced to marry me by his parents, said we should wait, but I didn’t pay any heed; I thought having a child immediately would cement our relationship, and my husband would begin to love me,” she said forlornly.

Dr. Tauseef Ahmed, Pakistan country director of Pathfinder International, a non-profit organisation working to improve adolescent and youth access to sexual and reproductive health services in more than 30 countries, says that early pregnancy is not uncommon among teenage brides.

In fact, having a baby is a way of proving one’s fertility, and the values of adolescent pregnancy are “protected by women and girls themselves,” he told IPS.

According to the United Nations Population Fund (UNFPA), nearly 7.3 million teenage girls become pregnant every year – of these, two million are aged 14 or younger. Meanwhile, an estimated 70,000 adolescents in developing countries die each year from complications during pregnancy and childbirth.

The World Health Organisation (WHO) says stillbirths and newborn deaths are 50 percent more likely among infants of adolescent mothers than among mothers aged 20 to 29.

Infants who survive are more likely to have a low birth weight and be premature than those born to women in their 20s.

The problem is particularly pronounced in Pakistan, a country of 180 million people where 35 percent of married women between the ages of 25 and 49 years were wed before the age of 18, according to the latest figures in the 2012-2013 Pakistan Demographic Health Survey.

Experts say one of the main reasons behind the widespread occurrence of chid marriages and early pregnancies is a lack of education.

Naureen agrees, saying her disrupted education stands out as a glaring “missing link” in her early development

Dr. Farid Midhet, who heads the USAID’s flagship Maternal and Child Health Integrated Programme (MCHIP) in Pakistan, says there is a strong link between teenage pregnancy and female illiteracy.

“Together these contribute to high infant and child mortality and morbidity, high fertility, illiteracy in general, and production of children who are a burden on society,” he told IPS.

He added that this exacerbates poverty, which in turn fuels a vicious cycle of militancy, crime and social unrest.

Pathfinder International’s Ahmed believes a strong conservative current in Pakistani society – where 97 percent of the population identifies as Muslim – also conspires against the girl child, making early marriage and adolescent pregnancy a foregone conclusion for thousands of girls.

“Early marriage and not getting permission to attend school are the two main indicators of conservative forces here,” he stressed, adding that the “fear of backlash from conservative forces” has resulted in a glaring lack of positive initiatives within the public sector to tackle the problem.

This, despite the fact that study after study has shown that countries that improve school enrollment rates for girls also see a decline in adolescent child-bearing.

Asked how to tackle the health crisis caused by teenage motherhood, Zeba Sathar, country director of the Population Council of Pakistan, answered immediately that she would first and foremost invest in girls’ education.

“Globally proven strategies include keeping adolescent girls in schools, using economic incentives and livelihood programmes, offering life skills, informing families and communities about the adverse effects of adolescent pregnancy, and mobilising them to support girls to grow and develop into women before becoming mothers,” Sathar told IPS.

A regional problem

The phenomenon is not exclusive to Pakistan, with several other countries in the region experiencing equally challenging situations.

Most South Asian nations, like Pakistan, struggle with the twin problems of early marriage and teenage pregnancy, making it crucial to tackle both simultaneously, experts say.

But this is easier said than done, as laws surrounding the ‘official’ marriage age are difficult to enforce and complicated by traditional societal values.

According to a 2013 report by the UNFPA entitled ‘Motherhood in Childhood’, India and Bangladesh remain among the countries where a girl is most likely to be married before she is 18.

Pakistan and Sri Lanka, on the other hand, show much lower rates of pregnancies among women aged 15 to 19.

The U.N. Department of Economic and Social Affairs (UNDESA)’s World Population Prospects report states that the adolescent fertility rate among women in the 15-19 age group is 87 per 1,000 women in Afghanistan, 81 in Bangladesh, 74 in Nepal, 33 in India, 27 in Pakistan, and just 17 in Sri Lanka.

India’s eastern state of Bihar had the worst score card for child marriage. Referring to a survey of more than 600,000 households conducted for India’s health ministry between 2007 and 2008, Sathar said nearly 70 percent of women in their early twenties reported having been married by the age of 18.

Bangladesh does not fare any better. One in 10 teens has had a child by the age of 15, while one in three girls gets married by the age of 15.

But numbers, according to Ahmed, do not tell the whole story.

“Early childhood marriages and fertility rates may be four times higher in Bangladesh than in Pakistan, but the former experiences higher aspirations [among women] for better education and gainful employment than Pakistan,” he stated.

Bangladesh’s Population Reference Bureau’s 2013 Data Sheet on Youth states the female labour force participation in Bangladesh is 51 percent, compared to just 20 percent in Pakistan.

Additionally, the percentage of women in secondary education in Bangladesh was 55, while in Pakistan it was just 29.

For women like Naureen, staying in school could have spared her a lifetime of pain.

“I would not have been married and become a mother at such a young age; I would have had time to think about what I was getting myself into… I would have been just a little bit wiser,” she said.

]]> 0
Reproductive Rights to Take Centre Stage at U.N. Special Session Thu, 10 Jul 2014 19:23:02 +0000 Thalif Deen This is part of a series of special stories on world population and challenges to the Sustainable Development Goals on the occasion of World Population Day on July 11.]]> A basket of condoms is passed around during International Women’s Day in Manila. Credit: Kara Santos/IPS

A basket of condoms is passed around during International Women’s Day in Manila. Credit: Kara Santos/IPS

By Thalif Deen

As the United Nations continues negotiations on a new set of Sustainable Development Goals (SDGs) for its post-2015 development agenda, population experts are hoping reproductive health will be given significant recognition in the final line-up of the goals later this year.

At the same time, an upcoming Special Session of the General Assembly in mid-September may further strengthen reproductive rights and the right to universal family planning."Advocates are rallying to ensure that SRHR remains as central to the next set of goals as it is to women's lives." -- Gina Sarfaty

Gina Sarfaty of the Washington-based Population Action International (PAI) told IPS, “We are at a critical juncture for sexual and reproductive health and rights (SRHR).”

As the conversation around the next set of SDGs begins to heat up, she said, “Advocates are rallying to ensure that SRHR remains as central to the next set of goals as it is to women’s lives.

“The stakes are high, and the need for action is paramount,” cautioned Sarfaty, a Geographic Information Systems (GIS) specialist and research associate at PAI.

World population, currently at over 7.2 billion, is projected to increase by 3.7 billion people by 2100. Much of this growth will occur in developing countries, with 64 percent concentrated in just 10 countries, according to PAI.

In eight of these nations – Nigeria, Tanzania, Democratic Republic of Congo, Niger, Uganda, Ethiopia, Kenya and Zambia – an important driver of population growth is persistently high fertility.

The remaining two countries accounting for the world’s increase – India and the United States – are those with already large populations and high net migration.

The ongoing negotiations for SDGs take place against the run-up to the upcoming special session of the General Assembly commemorating the 20th anniversary of the 1994 landmark International Conference on Population and Development (ICPD) in Cairo.

The special session, to be attended by several heads of state, is scheduled to take place Sep. 22 during the 69th session of the General Assembly.

Dr. Babatunde Osotimehin, under-secretary-general and executive director of the U.N. Population Fund (UNFPA), told IPS the principles set at the ICPD in 1994 are as relevant today as they were 20 years ago.

“But we need to act strong and fast to realise the Cairo vision and achieve universal access to sexual and reproductive health and reproductive rights, including family planning,” he added.

The special session presents the perfect opportunity for governments, at the highest level, to recommit to its success and to renew their political support for actions required to fully achieve the goals and objectives of its Programme of Action and achieve sustainable development, he said.

This will also place the Cairo principles firmly in the post-2015 development agenda, said Dr. Osotimehin, a former Nigerian minister of health.

Purnima Mane, president and chief executive officer of Pathfinder International, told IPS the September meeting represents an opportunity for world leaders to assess progress made over the past 20 years against the goals and strategies developed in 1994, identify any remaining gaps in performance that require increased attention and investment, and realign their efforts moving forward.

“This is a very important session for all of us working on sexual and reproductive health since it provides a critical forum for reaffirming and unifying international commitment to ICPD goals and for making an added push to do more on areas and in countries where we are lagging,” she said.

Asked why there wasn’t a follow-up international conference, perhaps an ICPD+20 on the lines of the Rio+20 environment conference in 2012, Mane said the Cairo Programme of Action developed a very forward-looking agenda and set the bar high for the international community 20 years ago.

She said its goals are still relevant and actionable, and the agenda is unfortunately not yet finished.

“My sense is that having a follow-up conference in such an environment was seen as neither strategic nor a good use of resources,” Mane said.

The upcoming special session “is intended to heighten focus on the goals established in the 1994 Programme of Action, stimulate discussion around what we will do to complete the unfinished agenda, re-engage on commitments already made and also push for more.

“I would hope the upcoming U.N. session will highlight the need to include sexual and reproductive health and rights upfront as a core component of the Sustainable Development Goals as the Open Working Group continues to develop its proposal,” said Mane, who oversees sexual and reproductive health programmes in more than 20 developing nations on an annual budget of over 100 million dollars.

Asked about the current status of world population growth, PAI’s Sarfaty told IPS that despite the fact that mortality has declined substantially, women in sub-Saharan Africa currently have more than five children on average, representing a modest decrease from the average of 6.5 children they had in the 1950s.

Compared to Latin America and Asia, she said, a slower pace of fertility decline has characterised sub-Saharan Africa, with stalls and even reversals along the way.

Of 22 countries where recent survey data is available, 10 are transitioning towards lower childbearing while 12 are currently experiencing fertility stalls.

“Therefore, the expectation that fertility will steadily decline in Africa, as the U.N. projects, will not hold without concerted policy and programme effort,” she warned.

The polar opposite fertility scenario is happening in the high income countries with low levels of fertility.

It is estimated that 48 percent of the world’s population lives in countries where women have fewer than 2.1 children on average in their lifetimes, she pointed out.

While fertility rates in these countries may be below replacement level, their need for family planning does not disappear, she declared.

Sarfaty said family planning use continued in Iran, for example, after the government discontinued its funding of family planning programmes in an attempt to encourage higher birth rates.

In addition to being ineffective, restricting access to family planning also restricts the right of a woman to determine her family size, she added.

Meanwhile, in a report released Thursday, the United Nations said the world’s population is increasingly urban, with more than half living in urban areas today and another 2.5 billion expected by 2050.

With nearly 38 million people, Tokyo tops U.N.’s ranking of most populous cities followed by Delhi, Shanghai, Mexico City, Sao Paulo and Mumbai.

The largest urban growth will take place in India, China and Nigeria: three countries accounting for 37 per cent of the projected growth of the world’s urban population between 2014 and 2050.

By 2050, India is projected to add 404 million urban dwellers, China 292 million and Nigeria 212 million.

]]> 1
OPINION: Unleashing African Young People’s Potential Thu, 10 Jul 2014 17:24:30 +0000 Adebayo Fayoyin This is part of a series of special stories on world population and challenges to the Sustainable Development Goals on the occasion of World Population Day on July 11.]]> Girls attend school in South Africa. Healthy, educated young people can help break the cycle of poverty. Credit: UNFPA

Girls attend school in South Africa. Healthy, educated young people can help break the cycle of poverty. Credit: UNFPA

By Adebayo Fayoyin

An African proverb says “a child that we refuse to build today will end up selling the house that we may build tomorrow.”

The moral of this is clear. Unless we invest in our children and young people today, they might become a threat or a burden in the future.As the international community commemorates World Population Day on July 11, Africa’s growing youth population should be recognised as a ‘powerful force for change’ that requires greater investment today.

Judging by the current challenges confronting young people, the extent to which African countries are investing in the youth is unclear.

More young people

According to the Africa Regional Review for the International Conference on Population and Development (ICPD) the continent is experiencing substantial demographic shifts, which have seen about 21 million persons a year being added to the population since 1994.

Africa has the youngest population and will remain so for decades in a rapidly ageing world. By 2050 “the median age for Africa will increase to 25, while the average for the world as a whole will climb to about 38”.

The fertility rate on the continent is decreasing gradually and the new generation of young people will probably have fewer children than their parents. This demographic shift will also mean fewer elderly people and children to support than previous generations.

Undoubtedly, demography will greatly shape Africa’s position in the global markets for labour, trade and capital.

The phenomenon is what economists call a ‘demographic dividend’, which they argue is a one-time window of opportunity to create wealth and economic growth.

The future they want

But failure to invest in this demographic also comes with its own challenges.

Maternal mortality and HIV/AIDS are the two main causes of death among young women aged 15 to 24 years in sub-Saharan Africa.

Nearly everywhere, adolescents are inhibited from freely exercising their right to, for example, comprehensive sexuality education, contraceptives and sexual and reproductive health services.

Young men in South Sudan stand up for women's rights. Credit: UNFPA

Young men in South Sudan stand up for women’s rights. Credit: UNFPA

In many African counties, more than 40 per cent of young women aged 20 to 24 were married by age 18. Also in the countries with high child marriage rates – Niger, Mali, CAR, Guinea, Sierra Leone, Nigeria, Ethiopia, Mauritania, Madagascar, Uganda, Senegal, Malawi, Cameroon and Libya – many girls are married off by age 15.

That is why investment in Africa’s youthful population from multiple angles, and primarily from the public and private sectors, is essential for realising the demographic dividend.

“Healthy, productive and fully engaged”

In his message for the World Population Day commemoration, UNFPA Executive Director Dr. Babatunde Osotimehim says “we know that healthy, educated, productive and fully engaged young people can help break the cycle of intergenerational poverty and are more resilient in the face of individual and societal challenges”

Africa’s largely youthful population makes up the next generation of workers, parents, and leaders and their challenges can no longer be ignored. Getting the best from the increased youth bulge in Africa can only be assured when appropriate health and development plans, policies and programmes are put in place and adequately implemented.

Adebayo Fayoyin is the Regional Communications Advisor for the UNFPA East and Southern Africa Regional Office.

]]> 1
Putting Population Management in Pacific Women’s Hands Thu, 10 Jul 2014 10:09:27 +0000 Catherine Wilson This is part of a series of special stories on world population and challenges to the Sustainable Development Goals on the occasion of World Population Day on July 11. ]]> Pacific Island nations say empowering women is the key to addressing population growth across the region. Credit: Catherine Wilson/IPS

Pacific Island nations say empowering women is the key to addressing population growth across the region. Credit: Catherine Wilson/IPS

By Catherine Wilson
PORT VILA, Jul 10 2014 (IPS)

Populations of many Melanesian countries in the southwest Pacific Islands region are expected to double in a generation, threatening regional and national efforts to improve low economic and human development indicators.

Arnold Bani, executive director of the Vanuatu Family Health Association in the capital, Port Vila, believes that if reproductive health issues are not addressed in the next 10-15 years the result “will be a disaster for the country.”

Vanuatu, an archipelago of 82 islands located west of Fiji, has a population of 247,262 growing at 2.4 percent, compared to a global average of 1.1 percent. Similarly, the growth rate of Papua New Guinea’s population of seven million is 2.1 percent, as it is in the neighbouring Solomon Islands, home to 550,000 people.

“Mostly the extended family provides people’s basic needs and care...So if a woman makes a decision about family planning alone there will be a fight in the family.” -- Helen, a resident of Vanuatu's capital, Port Vila
As the international community prepares to mark World Population Day on Jul. 11, experts here say an important factor will be empowering women in decisions about family planning and, with a high rate of teenage pregnancies in the region, bringing about behaviour changes in the younger generation.

The task is not easy, given strong cultural and social pressures to have large families.

“Mostly the extended family provides people’s basic needs and care,” Helen (not her real name), a mother in Port Vila, where the contraceptive prevalence is 38 percent, told IPS.

“So if a woman makes a decision about family planning alone there will be a fight in the family.”

There are practical reasons for having numerous children, explained Alec Ekeroma, president of the Pacific Society for Reproductive Health in Auckland, New Zealand.

“Large families are akin to an insurance policy for family survival,” he told IPS. “More children will assist with rural subsistence livelihoods, more children means some will survive past infancy, while care for parents is seen as a duty of the children, especially in countries where there are no social services.”

But Helen said that providing for the needs of large families is a struggle in a country where the average monthly income is around 300 dollars.

The nation’s Total Fertility Rate (TFR) has decreased since the 1960s from seven to four, while in Papua New Guinea it is 3.8 and in the Solomon Islands 4.1, in contrast to a TFR of 2.1, which indicates a stable population.

Regional experts believe that contraceptive use, which ranges from 35 percent in Papua New Guinea to 22 percent in Kiribati, well below the global average for less developed countries of 56 percent, must be improved.

A report published by Reproductive Health journal last year claims that increasing contraceptive prevalence in Vanuatu to 65 percent by 2025 would create a sustainable population, reduce high risk births by 54 percent, adolescent births by 46 percent and the average number of unintended pregnancies by 68 percent from 76 to 12 per 1,000 women.

Greater contraceptive use and smaller families could also save women’s lives. There are an estimated 110 maternal deaths per 100,000 live births in Vanuatu, increasing to 120 in Tonga, 130 in Kiribati and an estimated 733 in Papua New Guinea.

But delivering reproductive health services to predominantly widely scattered rural island populations is a challenge given the limited infrastructure, transport services and skilled health care workers in provincial areas.

Low education and the influence of traditional health healers in rural communities are also factors,Rufina Latu of the World Health Organisation (WHO) in Vanuatu added. Even when family planning is available, use can be inhibited by misconceptions, such as fear of side effects or fertility decline, religious opposition and illiteracy. A survey by the Asia South Pacific Association for Basic and Adult Education (ASPBAE) in Vanuatu’s main Shefa province estimates literacy is as low as 27 percent.

Leias Cullwick, executive director of the Vanuatu National Council of Women, said that a major concern for women is gender inequality and the norm of husbands determining the size of families. Fear of widely prevalent gender violence also impacts women’s behaviour.

“Health services data indicate that many women prefer contraception with long-acting depo-provera injections, so that their husbands would not know,” Latu added, claiming that it is not uncommon for husbands to hold the myth that their wives are having affairs if they are using contraception.

Gender inequality is also a factor in Vanuatu’s high adolescent fertility with 66 births per 1,000 women aged 15-19 years. Across the Pacific Islands, one quarter of girls in this age group enter motherhood.

The Vanuatu Ministry of Health confirmed there were national strategies to improve services to adolescents. An estimated one third of urban youth lack basic knowledge about reproductive health and many are reluctant to access reproductive health services, leading to high-risk behaviour.

Engaging young people is an urgent priority given the negative impacts of pregnancies on young girls’ lives, such as low educational attainment, poverty and maternal mortality. The risk of death for mothers aged below 15 years in low and middle-income countries is double that of more mature women, reports the United Nations Population Fund (UNFPA).

Efforts to increase understanding of population issues must include the whole community, Bani advocated, with chiefs and community leaders better informed about family planning to play a role in wider social acceptance.

Latu emphasised that population and reproductive health education for everyone needs to start in early childhood and “family life education should become a compulsory part of school curriculums at all levels.”

“A more enabling environment for women’s empowerment to develop can be better achieved if men and spouses are also engaged” in the task of social change, she added.

Cullwick suggested that male nurses in Vanuatu be trained in male-to-male advocacy about gender equality and family planning.

“With the high rate of illiteracy you cannot print and distribute leaflets, you need a man to talk to others, to generate a dialogue and make them understand what women go through,” she explained.


]]> 0
Conservatives and Nationalists At Centre Stage in Poland Tue, 08 Jul 2014 16:45:29 +0000 Claudia Ciobanu Polish conservatives protesting against a reading of Golgota Picnic in Warsaw. Credit: Maciej Konieczny/Courtesy of Krytyka Polityczna

Polish conservatives protesting against a reading of Golgota Picnic in Warsaw. Credit: Maciej Konieczny/Courtesy of Krytyka Polityczna

By Claudia Ciobanu
WAESAW, Jul 8 2014 (IPS)

A mix of conservative Catholicism and nationalism has become the predominant view in Polish public debate, with some worrying effects.

These were the values around which the opposition to communism led by trade union Solidarity built itself up in the 1980s but, after the fall of communism, opinion makers in the media and politicians continued to depict them as part and parcel of being Polish.

Observers note that the Polish Catholic Church has also grown increasingly conservative since 1989, in apparent contrast to an opening up of the Church worldwide.Conservative Catholicism and nationalism were the values around which the opposition to communism led by trade union Solidarity built itself up in the 1980s but, after the fall of communism, opinion makers in the media and politicians continued to depict them as part and parcel of being Polish.

Last month, the director of a theatre festival in the city of Poznan decided to cancel showings of a play fearing he could not ensure the safety of viewers in the face of threats by conservative and far-right groups. The play – “Golgota Picnic” by Argentinian director Rodrigo Garcia – describes the life of Jesus using striking depictions of contemporary society, including some with a sexual meaning.

Among those asking for play to be cancelled were representatives of Poland’s main opposition party, Law and Justice, the main trade union Solidarity, and the far-right Ruch Narodowy (National Movement), all of which stand for traditional Catholic values. The Church also voiced its opposition to the play.

In itself, protesting against the play was unremarkable (it has also been met with opposition from Catholics in other countries, for example in France), but the Polish response was interesting: even if the festival was largely financed from public sources, the show was cancelled and there was hardly any resistance from public authorities to the decision. The public, however, made itself heard and readings of the play were organised in major Polish cities, with hundreds attending.

Meanwhile, the dynamics surrounding “Golgota Picnic” are being replicated over other issues in Polish society, among which the most striking is women’s reproductive rights. Poland is one of only three countries in the European Union where abortion is prohibited, unless the pregnancy is a result of rape or incest, there is a serious threat to the mother’s health or foetal malformation has been detected.

Abortion had been legal in communist Poland but was outlawed in 1993 after pressure from the Catholic Church. Ever since, attempts to make abortion legal have failed. In 2011, the Polish parliament came close to further tightening the law on abortion by prohibiting it no matter the circumstances.

At the time, it was not only the political forces explicitly standing for Catholic values that endorsed a total ban, but also many members of the governing centre-right Civic Platform, which depicts itself as Poland’s main liberal political force.

De facto, even the current restrictive law is not being implemented. In a series of high profile cases over the years, Catholic doctors in public hospitals have refused to perform abortions even if girls were pregnant as a result of rape, had serious health conditions or malformation had been detected in foetuses.

In May, in an escalation of the situation, over 3,000 Polish doctors, nurses and medical students signed a “Declaration of Faith” in which they rejected abortion, birth control, in vitro fertilisation and euthanasia as contrary to the Catholic faith. Signatories included employees of public clinics and hospitals. One of them was the director of a Warsaw maternity hospital who said he would not allow such procedures to take place in his institution.

The “Declaration of Faith”, which has been endorsed by the Polish Catholic Church, is contrary to Polish law and Prime Minister Donald Tusk has spoken out against it.

State authorities have been carrying out check-ups at those institutions in which signatories of the Declaration work to establish whether the law is being respected, and one fine has been imposed on the Warsaw maternity hospital whose director prohibits legal abortions. Yet more determined measures are still pending.

“Lack of massive resistance [to the Declaration] is not a sign of approval on the part of the general public,” comments Agnieszka Graff, writer and feminist activist. “It is rather a question of resignation: for 20 years we have seen politicians court the Church while ignoring public opinion on matters that have to do with reproductive rights. The pattern of submission has emboldened the radical anti-choice groups.”

Political power in Poland is firmly in the hands of conservatives. Law and Justice, the party with the best chance of winning next year’s parliamentary elections, is staunchly pro-Catholic and nationalist, and has in the past allied in government with far-right politicians. The governing Civic Platform, the choice of many liberals in this country, is bitterly divided between social conservatives and liberals, meaning it cannot enforce the constitutional secularity of the Polish state.

As Graff explains, in this political context, those who oppose the Catholicism-nationalism nexus find it difficult to coalesce into a strong movement. And ultra-conservatives continue to advance.

Far-right elements breeds in this environment and, in an ethnically and racially homogeneous country, their main targets are feminists, the LGBTQ community and leftists (the same groups that the Church condemns). Their strength is most visible in Poland during the annual Independence March on November 11, when tens of thousands of far-right youth take to the streets of Warsaw and other cities wreaking havoc.

According to June polls, the third strongest political force in Poland is the New Right Congress, which has a neo-liberal far-right agenda. The party, whose leader Janusz Korwin-Mikke has declared that women have lower IQs than men and that they enjoy being raped, gathered 7.5 percent of the vote in the May elections for the European Parliament.

“There is no clear demarcation between the Polish extreme right, the populist right and the mainstream right,” notes political scientist Rafal Pankovski of anti-racist group Nigdy Wiecej (Never Again). “The notion of a cordon sanitaire against the far-right does not seem to have been accepted in Polish politics and the media.”

Over recent years, civic mobilisation by progressive forces has nevertheless grown, and political parties with a strong liberal, secular and anti-nationalist message have been forming, but they still lack consolidation. Faced with the constant accusation of being “communists”, leftist forces that might counterbalance the conservative, nationalist and far-right trend are slow to grow in Poland.

]]> 0
Lack of Toilets Keeps Women Out of Politics Fri, 04 Jul 2014 12:49:07 +0000 Stella Paul Women village councilors in Penakota, a village in southeast India, go out into a field to relieve themselves, as there are no toilets in their workplace. Credit: Stella Paul/IPS

Women village councilors in Penakota, a village in southeast India, go out into a field to relieve themselves, as there are no toilets in their workplace. Credit: Stella Paul/IPS

By Stella Paul
MALLAMPETA, India, Jul 4 2014 (IPS)

Nine months after she was elected head of her village council, 36-year-old Krupa Shanti has overseen some significant changes in this rural outpost of Mallampeta, 570 km away from Hyderabad, capital of the southeastern Indian state of Andhra Pradesh.

“Since I took over, 300 people have got their Below the Poverty Line (BPL) ration cards and are receiving subsidised food, and another 200 people have received their voter cards,” Shanti told IPS.

But the village’s first woman leader has not been able to change the one thing that is closest to her heart – the sanitation for the women in her community.

“I have not received the necessary funds to construct a single toilet,” Shanti said, adding that she was extremely frustrated that she and her female colleagues are still forced out into the bushes and fields to relieve themselves.

“I have political rivals now whom I defeated in the election. What if they follow me to the field or the bush and attack me there?" -- Swaroopa Chamtla, a council woman in the village of Chowtapalli
Six hundred km away, in the village of Chowtapalli, Council Head Sandhya Rani complains of losing precious work time due to poor sanitation.

Rani’s office, which she joined in August 2013, is in an old, dilapidated building that has no running water and no sanitation facilities.

“Every time I want to use a toilet, I have to rush home,” she told IPS, barely concealing her anger. “How can a person work in such conditions?”

Still, Rani is luckier than her colleagues; of the nine women on the 10-member village council, she is the only one to own a toilet at home and is spared the shame of having to defecate out in the open.

Many of the women in Chowtapalli had hoped becoming council members would lead to a life of dignity, a dream they now find crushed.

Lack of toilets is a common problem across India, a country of 1.2 billion people that has the dubious distinction of denying adequate sanitation to nearly 60 percent of its citizens.

According to a recent report by the World Health Organisation (WHO), India also tops the list of countries with the highest number of people (58 percent of the population including women and girls) who defecate in the open.

The 2011 census found that nearly 70 percent of rural households, as well as over 18 percent of homes in towns and cities, don’t have toilets.

Census data from the same year showed that more people in India had cell phones (59 percent of households) than toilets (47 percent), a figure that also accounted for dry, open-pit latrines.

The situation is particularly worrying for rural women politicians, who say the cumbersome process of having to relieve themselves in public is prohibiting them from carrying out their duties.

Many are also alarmed by the spate of violent attacks on women across rural India, who are stalked by sexual predators and raped, molested or mutilated when they venture out into the fields at night.

One such incident on May 28 stunned the entire nation, when images of two teenage girls from the village of Katra Shadatganj (228 km southwest of New Delhi), who were raped and hung from trees, began to make the rounds on social and print media.

Since then, at least four other similar cases have been reported in the same region. It subsequently emerged that each of these women came from homes that did not have toilets, and were accosted while attempting to relieve themselves at night.

Now, local councilwomen are beginning to fear for their own lives as a result of inadequate sanitation facilities.

Thotakurra Kamalamma, a politician from the eastern coastal village of Kodi Thadi Parru, says her local council has never had a toilet. Though it didn’t deter her from participating in local politics before, the Katra Shadatganj incident has shaken her to the very core, leaving her fearful of suffering a similar fate, she told IPS.

“I have a daughter. If anything happens to me someday, who will look after her?” asks Kamalamma, who has decided to resign from her post.

Chowtapalli Councilmember Swaroopa Chamtla is also considering quitting – something her husband is also asking for.

“I have political rivals now whom I defeated in the election,” she told IPS. “What if they follow me to the field or the bush and attack me there? It’s happening everywhere, isn’t it?” she said.

The government of India currently provides building materials at subsidised costs, as well as cash grants, to rural families for constructing toilets.

But according to Krupa Shanti, one of the first women to attempt to make the down payment of 10,000 rupees (about 180 dollars) even the government rate is cost-prohibitive for many rural families, in a country where an estimated 30 percent of people live below the poverty line of 1.25 dollars a day.

She also alleged that officials in city government offices are indifferent to the plight of women in villages, and therefore delay approval of funds for toilets.

Independent studies partially support her views; according to a 2011 World Bank report, government funds for sanitation in India were woefully inadequate.

The Bank also found that the country lost an estimated 53.8 billion dollars in 2006 alone as a result of poor sanitation, a figure equivalent to about 6.4 percent of the country’s GDP.

While bodies like the United Nations have called repeatedly for increased participation of women in local-level politics, little attention has been given to the specific challenges posed by a widespread lack of sanitation.

Aparajita Ramsagar, an independent sanitation consultant and former project director for SEWA Bharat, a union of self-employed women, says that during 2010-2011 the government increased reservation of seats for women in village councils from 33 to 50 percent.

“The aim of the increased reservation was to have more women join the political process. But [the government] had not envisaged the increased sanitation needs of women in the councils,” Ramsagar told IPS.

Most officials, however, refute these allegations. According to Narsimha Rama Murthy, senior engineer at the sanitation department of Visakhapatnam, the largest city in Andhra Pradesh, delays in funding are due to lengthy processes governing state finances, rather than an indifference on the part of officials.

“We have to inspect and check the situation before approving petitions [for funding]…One has to follow a process,” he told IPS.

Furthermore, problems arising from a lack of toilets cannot be solved without simultaneously tackling the twin problem of the water supply in rural India.

Sukhantibai Partiti, who heads the Handitola Village Council in the central Indian state of Chhattisgarh, has been trying for six years to implement the government-sponsored Total Sanitation Campaign (also known as Nirmal Bharat Abhiyan), which aims to eradicate open defecation by 2017 – to no avail.

She says this is largely due to limited access to clean water.

“For nearly six months of the year, we depend on a single pond in the village for all our water needs,” the second-time village head, who still does not have a toilet in her own home, told IPS.

“But, while we can carry a few pots of water for cooking and drinking, it is not possible to carry buckets of water to flush a toilet,” she added.

Disappointed at the lack of opportunities available to local politicians, she has decided not to run for a 3rd term in office; she says the indignity of running around looking for a place to relieve herself has made the job untenable.


]]> 4
Here Are the Real Victims of Pakistan’s War on the Taliban Tue, 01 Jul 2014 14:44:54 +0000 Ashfaq Yusufzai An elderly displaced man carries a sack of rations on his shoulder. The Pakistan Army has distributed 30,000 ration packs of 110 kg each. Credit: Ashfaq Yusufzai/IPS

An elderly displaced man carries a sack of rations on his shoulder. The Pakistan Army has distributed 30,000 ration packs of 110 kg each. Credit: Ashfaq Yusufzai/IPS

By Ashfaq Yusufzai
PESHAWAR, Pakistan, Jul 1 2014 (IPS)

Three days ago, Rameela Bibi was the mother of a month-old baby boy. He died in her arms on Jun. 28, of a chest infection that he contracted when the family fled their home in Pakistan’s North Waziristan Agency, where a full-scale military offensive against the Taliban has forced nearly half a million people to flee.

Weeping uncontrollable, Bibi struggles to recount her story.

“My son was born on Jul. 2 in our own home,” the 39-year-old woman tells IPS. “He was healthy and beautiful. If we hadn’t been displaced, he would still be alive today.”

“My wife is expected to deliver a baby within a fortnight, But the doctors say the child will be premature due to the stressful journey we undertook to get here." -- Jalal Akbar, a former resident of the town of Mir Ali in North Waziristan Agency
But Bibi does not have the luxury of grieving long for her little boy.

Soon she will have to dry her eyes and begin the grim task of providing for herself and her two young daughters, who now comprise some of the 468,000 internally displaced people (IDPs) seeking refuge from the Pakistan army’s airstrikes on the militant-infested mountainous regions that border Afghanistan.

Launched on Jun. 15, the army’s campaign was partly motivated by terrorist attacks on the Karachi International Airport that killed 18 people in early June.

Having failed since 2005 to flush out the militants from the Federally Administered Tribal Areas (FATA), the army is now focusing all its firepower on the 11,585-square-kilometre North Waziristan Agency, where insurgent groups have enjoyed a veritable free reign since escaping the U.S. occupation of Afghanistan over a decade ago.

Some political pundits are cheering what they call the government’s “hard line” on the terrorists. But what it means for a civilian population already weary from years of war is homeless, hunger and sickness.

Most of the displaced have collapsed, fatigued from hours of travel on dirt roads in 45-degree heat, in massive camps in Bannu, an ancient city in the Khyber Pakhtunkwa (KP) province.

Already groaning under the weight of nearly a million refugees who have arrived in successive waves over the last nine years, KP is completely unprepared to deal with this latest influx of desperate families.

With tents serving as makeshift shelters, and the blistering summer heat threatening to worsen over the coming weeks, medical professionals here are warning of a full-blown health crisis, as doctors struggle to cope with a long line of patients.

Many traveled for hours on dirt roads, in 45-degree heat, to reach safe ground, with no food or water along the way. Credit: Ashfaq Yusufzai/IPS

Many traveled for hours on dirt roads, in 45-degree heat, to reach safe ground, with no food or water along the way. Credit: Ashfaq Yusufzai/IPS

Muslim Shah, a former resident of North Waziristan, has just arrived in Bannu after a 45-km journey on an unpaved road with his wife and children.

He is being treated at a rudimentary ‘clinic’ in the camp for severe dehydration, and recovering from a stomach flu caused by consumption of contaminated water along the way.

The frail-looking man tells IPS he is concerned for his family’s health in an unsanitary environment, gesturing to a nearby filthy canal where his children are bathing amongst a herd of buffalos.

“We have examined about 28,000 displaced people,” Dr. Sabz Ali, deputy medical superintendent at the district headquarters hospital (DHQ) of Bannu, told IPS.

About 25,000 of these, he said, are suffering from preventable diseases caused by sun exposure, lack of nutrition, and consumption of unclean water.

On Jun. 29, the government relaxed its curfew, giving families a tiny window of escape before resuming its operation Monday.

Families who left in the allotted timeframe are expected to descend on Bannu soon, prompting an urgent need for preemptive and coordinated efforts to avert an outbreak of diseases, Ali asserted.

“Given the soaring temperatures, we fear outbreaks of communicable water and vector-borne diseases, like gastroenteritis and diarrhoea, as well as vaccine-preventable childhood diseases such as polio and measles,” he said.

Seeking some relief from the 41-degree heat, displaced children in Bannu join a herd of buffalos for a bath in a filthy canal. Credit: Ashfaq Yusufzai/IPS

Seeking some relief from the 41-degree heat, displaced children in Bannu join a herd of buffalos for a bath in a filthy canal. Credit: Ashfaq Yusufzai/IPS

Ahmed Noor Mahsud (59) and his family of four epitomise the unfolding crisis.

Mahsud himself is bed-ridden as a result of a heat stroke caused by walking 40 km in sweltering heat, while his sons – aged 14, 15 and 20 – have been suffering with diarhhoea, fever and headaches since they arrived in the camp on Jun. 22.

The family has had very little access to clean water for nearly a week, which is exacerbating their illness.

According to public health specialists like Ajmal Shah, who was dispatched by the KP health department, exhaustion among IDPs has even led to some cases of cardiac arrest.

Out in the desert, families are also at risk of snake and scorpion bites, and could suffer long-term psychological stress as a result of the trauma, Shah told IPS.

About 90 percent of the displaced are extremely poor, having lived well below the poverty line for over a decade due to the eroding impacts of terrorism on the local economy. Few can afford private care and must wait patiently for thinly-spread doctors to make their rounds.


But for people like 30-year-old Jalal Akbar, a former resident of the town of Mir Ali in Waziristan, patience is almost impossible.

“My wife is expected to deliver a baby within a fortnight,” he told IPS anxiously. “But the doctors say the child will be premature due to the stressful journey we undertook to get here. She requires bed rest, but we have been unable to find a proper home.”

The exhausted man fears their eviction will deprive him of his first child.

Another major crisis looming on the horizon is a food shortage, which will only add to the woes of the displaced.

According to a Jun. 30 assessment report by United Nations Office for the Coordination of Humanitarian Affairs (OCHA), “The Pakistan Army has distributed 30,000 ration packs each of 110 kg. The WFP has provided food rations to over 8,000 families while a number of NGOs and charity organisations are also carrying out relief activities.”

Still, those like Ikram Mahsud, a displaced tribal elder, fear that the worst is yet to come.

“We lack good food, and the non-availability of sanitation facilities like latrines, detergent and soap [means] our people are destined to suffer in the coming days,” he told IPS, adding that requests for clean water and sanitation facilities have fallen on deaf ears.

Women and children currently comprise 74 percent of the IDPs, prompting the World Health Organisation (WHO) to point out, in a Jun. 30 report, the urgent need for “mass awareness campaigns among women to promote use of safe drinking water, hygienic food preparation and storage.

“Information regarding benefits of hand-washing before eating and preparation of food, use of impregnated bed nets to avoid mosquitoes’ bites and prevent occurrence of malaria should also be encouraged,” the agency noted.

WHO says it had sent medicines for 90,000 people to Bannu, but experts here feel this will fall short in the face of a spiraling crisis.


]]> 0
Looking to Africa’s LDCs to Learn How to Save the Lives of Millions of Mothers and their Babies Mon, 30 Jun 2014 20:27:42 +0000 Nqabomzi Bikitsha Bosena, 25, sits on the side of a busy road in Addis Ababa, Ethiopia’s capital, with a baby in her arms. Ethiopia is among the countries listed as having made significant progress in reducing child and maternal mortality rates. Credit: Jacey Fortin/IPS

Bosena, 25, sits on the side of a busy road in Addis Ababa, Ethiopia’s capital, with a baby in her arms. Ethiopia is among the countries listed as having made significant progress in reducing child and maternal mortality rates. Credit: Jacey Fortin/IPS

By Nqabomzi Bikitsha

Every year, three million newborn babies and almost 6.6 million children under five die globally, but if the rest of the world looked towards the examples of two of Africa’s least-developed countries (LDCs), Rwanda and Ethiopia, they would perhaps be able to save these children.

At the 2014 Partners’ Forum being held in Johannesburg, South Africa from Jun. 30 to Jul. 2 – hosted by the Partnership for Maternal, Newborn and Child Health (PMNCH), the South African government and other partners - significant commitments in finance, service delivery and policy were announced that could put an end to these deaths. In total, there were 40 commitments from stakeholders, governments and the private sector who are committed to ending child and maternal mortality were revealed at the forum today.

It was noted that while remarkable progress has been made in reducing maternal and child mortality rates globally, over the last two decades the reduction in the rates of newborn deaths has lagged behind considerably.

Africa’s Fast-Track Countries That Have Made Significant Progress in Saving Women and Children

•Reduced under-five mortality by 47 percent between 2000 and 2011 to from 166 to 88 per 1,000 live births
•Although Ethiopia still has one of the highest maternal mortality rates in Africa it has reduced by 22 percent from 871 in 2000 to 676 per 100,000 live births in 2011
•Expanded community-based primary care for women and children through the deployment of close to 40,000 Health Extension Workers
•Achieved near parity in school attendance by 2008/09: at 90.7 percent for girls and 96.7 percent for boys from 20.4 percent and 31.7 percent respectively in 1994/1995

•Achieved under-five mortality reduction of 50 percent between 1992 and 2010 from 151 to 76 per 1,000 live births
•Reduced maternal mortality by 22 percent from 611 to 476 per 100,000 births between 1992 and 2010 (and by 55 percent from 2000 to 2010 from an increase to 1,071 to 476 per 100,000 live births)
•Increased coverage of skilled birth attendance from 31 percent in 2000 to 69 percent in 2010
•In 2013, women constituted 64 percent of parliamentarians, the highest percent in the world
*Sources for all statistics are official national data, and international data, as agreed at country multistakeholder policy reviews.

However, Rwanda and Ethiopia were among 10 countries across the globe listed as having made significant  progress in reducing child and maternal mortality rates, according to a new global action plan launched at the forum.

The Every Newborn Action Plan (ENAP) provides evidence on the effective interventions needed to end preventable stillbirths and newborn deaths. It also outlines a strategy to prevent 2,9 million newborn deaths and 2,6 million stillbirths annually.

These countries invested in high-impact health interventions, including immunisation, family planning, education and good governance.

Tedros Adhanom Ghebreyesus, Ethiopian Minister of Foreign Affairs, told IPS that multi-sectoral investments, and not just direct investments in the health sector, would help reduce maternal and child mortality.

“If we don’t invest in agriculture, water and sanitation as well as the health sector then any gains we make in reducing child and maternal mortality will be futile.

“Community-based health care workers helped reduced Ethiopia’s mortality rates for mothers and children.”

According to the ENAP, newborn deaths account for 44 percent of all under five deaths worldwide, and investments in quality care at birth could save the lives of three million women and children each year.

“Now is the time to focus on action and implementation, to ensure more lives are saved,” said Graça Machel, co-chair of the PMNCH.

“Other countries have made progress and others have not, we need to learn from them, so we keep momentum.”

Accompanying the launch of the ENAP, was the launch of Countdown to 2015 report titled “Fulfilling the Health Agenda for Women and Children”, which serves as a scorecard of gains made in maternal and child health.

According to the report, which studied the progress of 75 countries in child and maternal mortality efforts, substantial inequities still persist.

“The theme of the Countdown report is ‘unfinished business,’” said Machel. “Too many women and children are dying when simple  treatment exists.”

Over 71 percent of newborn deaths could be avoided without intensive care, and are usually a result of three preventable conditions; prematurity, birth complications and severe infections.

Dr. Mariame Sylla, United Nations Children’s Fund (UNICEF) regional health specialist, told IPS that countries needed to learn from one another.

“Community-based approaches, where governments bring health services to the people and people to the services, have shown to be effective,” she told IPS.

“Monitoring of results is also very important to ensure accountability in the health sector.”

Dr. Aaron Motsoaledi, South Africa’s Minister of Health, said “having professional midwives would also help new mothers understand motherhood better and help reduce mortality rates among women and children.”

However,  Ethiopia’s Minister of Foreign Affairs pointed out that “these  efforts are are simple but often hard to deliver.”

“Least-developed countries like Ethiopia were able to make strides in curbing child and maternal mortality through their political will,” Dr. Janet Kayita, health specialist for maternal, newborn and child health for UNICEF, told IPS.

But she pointed out that “Ethiopia’s key to success, was not just about the leadership making the decision to reduce child and maternal mortality rates, but also organising at community level.”

“Ethiopia is one of the few LDC’s to institutionalise quality improvement in the health sector, using the mechanism of rewarding good quality health services and holding accountable those not performing.”

]]> 0
Maternal Deaths Due to HIV a Grim Reality Fri, 27 Jun 2014 08:10:55 +0000 Miriam Gathigah According to an African proverb, “every woman who gives birth has one foot on her grave.” It is time to make this proverb a historical fact and not a present reality. Credit: Mercedes Sayagues/IPS

According to an African proverb, “every woman who gives birth has one foot on her grave.” It is time to make this proverb a historical fact and not a present reality. Credit: Mercedes Sayagues/IPS

By Miriam Gathigah
NAIROBI, Jun 27 2014 (IPS)

An African proverb says that every woman who gives birth has one foot on her grave.

Sadly, this is still true today, especially within the context of the AIDS epidemic.

In spite of the huge advances in the prevention of mother to child transmission of HIV (PMTCT) in Africa, experts are concerned that these have not matched other pillars needed to eliminate maternal mortality caused by HIV and AIDS.

Preventing unintended pregnancies among women living HIV, as well as providing contraceptives for women who need them are some of the missing pillars. Another is making motherhood safer for all women.

Pregnant women with HIV die at much higher rates than women without HIV, Mary Pat Kieffer, senior director at Elizabeth Glaser Paediatric AIDS Foundation in Malawi, told IPS.

The risk of pregnancy-related death is six to eight times higher for HIV positive women than their HIV negative counterparts.

Studies have shown that HIV increases maternal mortality directly from the progression of the HIV disease itself, and indirectly through higher rates of sepsis, anaemia and other pregnancy-related conditions.

This is bad news at a big scale. In South Africa alone, up to 310,000 HIV positive women gave birth in 2012, and 110,000 in Mozambique, says the Joint United Nations Programme on HIV/AIDS (UNAIDS).

While all HIV positive women, whether on antiretroviral therapy (ART) or not, are more vulnerable to sepsis and anaemia because of their compromised immune system, Kieffer says that ART does boost the immune system that protects women from infections.

Another problem is that women become infected with HIV during pregnancy at higher rates compared to women who are not pregnant, alerts Kieffer.

Experts attribute this to biological changes in the woman’s reproductive tract, including the increased blood volume and hormonal changes.

In southern African countries, “as many as five percent of pregnant women who tested HIV negative during their second trimester of pregnancy become infected with HIV later in pregnancy or during breastfeeding,” Kieffer told IPS.

Rethinking PMTCT

While ART for prevention of mother to child transmission of HIV is key to reducing maternal mortality, “fighting HIV is about more than pushing ARVs into health systems,” says Kieffer.

In South Africa, where nearly two out of 10 persons aged 15-49 are HIV positive, in spite of universal PMTCT coverage, HIV still accounted for six out of 10 maternal deaths in 2012, according to UNAIDS.

In Lesotho, with an HIV infection rate of 23 percent, four out of 10 maternal deaths are attributed to HIV related complications. In Malawi it is three maternal deaths out of ten, with an HIV infection rate of 11 percent.

Percentage of Pregnancy-Related Deaths Attributed to HIV
Namibia 59%
Zimbabwe 39%
Zambia 31%
Malawi 29%
Mozambique 27%
Kenya 20%
Côte d’Ivoire 17%
Cameroon 10%
Burundi 7%
Source: UNAIDS Progress Report 2012

Naseem Awl, an HIV specialist with UNICEF in Lesotho, told IPS that “much work remains to be done besides the provision of medicines, and one is ensuring women deliver in a health facility.”

UNICEF statistics show that in Eastern and Southern Africa only four out of 10 pregnant women deliver their babies with the assistance of a skilled health professional.

In Lesotho, while nine out of 10 pregnant women attend at least one antenatal visit, more than half do not deliver in the care of a skilled birth attendant. Mozambique has a similar pattern – and up to 110,000 HIV positive women gave birth here in 2012.

Kieffer believes there is a need to rethink PMTCT, “not just as a way to keep the infant from acquiring HIV but as an essential part of maternal and child health care for all women.”

Sheurges an improvement of health services delivery and health staff attitudes.

“A good number of health workers believe that HIV positive women have no right to get pregnant,” she says. The consequence is that many women show up late for antenatal care or deliver at home.

Protecting young women

Addressing unwanted pregnancies among young women aged 15-24 years is yet another pillar, because they are two to four times more likely to be infected with HIV than men of the same age.

The highest incidence for HIV lies in the 19-24 age group, “when people are sexually active and may not have a single partner. It is also when most women become pregnant for the first time,” says Kieffer.

The two major causes of death for young women are complications of childbirth and HIV, according to the United Nations Population Fund. Because their bodies are not fully mature, they experience more problems with a pregnancy and are at higher risk of HIV infection.

“Young women lack experience with the health system, they may discover their pregnancy late and be afraid to go to the clinic,” Kieffer explains. “They are less emotionally mature and less likely to have a partner that they can rely on for emotional support, either for the pregnancy or the HIV.”

She adds that health workers may not treat young women with care or lack the time to give the extra attention, information and support they need.

Meanwhile, staggering needs for contraceptives present other challenges. In Lesotho, the unmet need for family planning is 23 percent. In Mozambique, 29 percent, says UNAIDS.

Even where contraceptives are available, “ART clinics are overcrowded and overwhelmed, and have resisted putting emphasis on family planning because they did not have the capacity,” says Kieffer.

Dr Chewe Luo, senior adviser on HIV at UNICEF, told IPS that the new ART involving only one pill per day for pregnant women living with HIV will “have a serious impact on AIDS-related maternal and child deaths.”

In addition, the integration of maternal and child health services will result in more women and children reached sooner, and more mothers’ lives saved, she told IPS.

By strengthening all the pillars needed to improve maternal health, the African proverb about mothers having a foot on their graves will become history instead of a grim reality.

]]> 0
Improved Access to Water May Hold the Solution to Ending FGM in Africa Fri, 20 Jun 2014 09:13:28 +0000 Joshua Kyalimpa Female genital mutilation (FGM) traditional surgeon in Kapchorwa, Uganda speaking to a reporter. The women in this area are being trained  by civil society organisation REACH in how to educate people to stop the practice. Credit: Joshua Kyalimpa/IPS

Female genital mutilation (FGM) traditional surgeon in Kapchorwa, Uganda speaking to a reporter. The women in this area are being trained by civil society organisation REACH in how to educate people to stop the practice. Credit: Joshua Kyalimpa/IPS

By Joshua Kyalimpa
KAMPALA, Jun 20 2014 (IPS)

Could it be possible that if women in Africa had access to water, it could save them from undergoing the harmful practice of female genital mutilation (FGM)? It seems that according to yet-to-be released research by Ugandan-based Gwada Ogot Tao, FGM and other forms of circumcision in Africa could be linked to water.

Gwada, who conducted research among 20 ethnic groups across Africa, including Kenya, Zimbabwe, Tanzania, Uganda, Ghana, and South Africa, says that ethnic communities that practice FGM in Africa can be found in areas where the water supply is problematic.

Gwada found that in Kenya, for example, only three of the East African nation’s 63 ethnic groups did not practice any form of circumcision. And these three communities were found in the Rift Valley region, where there are water bodies like lakes and rivers.

The blue lines represent major rivers in Africa with the red circles showing areas where FGM is prevalent. Courtesy: Gwada Okot Tao

The blue lines represent major rivers in Africa with the red circles showing areas where FGM is prevalent. Courtesy: Gwada Ogot Tao

He believes that FGM has become a prevalent cultural practice as a consequence of a lack of water.

FGM involves partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons. The practice, normally conducted by traditional surgeons, causes severe bleeding and is linked to many health issues, including cysts, infections, infertility as well as complications during childbirth.

It’s outlawed in many countries and the United Nations General Assembly adopted a resolution calling upon member states, civil society and all stakeholders to take concrete actions towards its elimination, yet the practice persists. The U.N. predicts that some 86 million young girls worldwide are likely to undergo the procedure in one form or the other by 2030 if current trends continue.

Gwada was commissioned by a local consortium the Citizens’ Coalition for Electoral Democracy in Uganda (CCEDU) that sought to answer governance issues among communities that circumcise and those that don’t. In Kenya, communities that circumcise believe that those that don’t are not capable of leading and this has raised governance issues. Gwada admits he made the discovery by accident.

But he says it’s no surprise that intervention strategies to stop the practice aren’t working because the wrong policies have been employed.

“Every thing is wrong, the policies are wrong, legislation is wrong because they were not informed by what made the communities start the practice in the first place,” Gwada tells IPS.

His research has not been made public but was shared recently with selected stake holders ahead of release.

Caroline Sekyewa the programme coordinator of DanChurchAid, says the research finding is convincing because in the communities that practice FGM, a girl who has gone through the ritual is regarded as “clean”. DanChurchAid is an international NGO that runs education programmes in two communities that practice FGM in Uganda — the Pokot community in Karamoja region, northeastern Uganda and the Sabiny community, who are found on on the foothills of mountain Elgon.

“Its may not necessarily mean that the provision of water is the solution to FGM, largely because culture has hijacked the practice, but the this could inform the intervention strategies towards its elimination,” Sekyewa tells IPS.

She says the organisation will also target policy makers to provide water in the affected areas. In Pokot, a region where FGM is rampant, women walk several kilometres to fetch water and the situation is complicated with insecurity caused by armed cattle rustlers.

An underground water aquaffer has been discovered in the Turkana region on the other side of Kenya, which borders the Pokot. Sekyewa says such a water resource, shared by the border communities, could solve the problem.

Beatrice Chelangat is an ethnic Sabiny from Kapchorwa district of Uganda, close to Kenya’s Turkana region, who has defied the dictates of her FGM-practicing culture and is campaigning against it. Chelangat’s works with civil society organisation, REACH, which conducts sensitisation campaigns about the dangers of FGM.

“There is a common belief among the Dodoma community of Kenya that a woman can catch Candidiasis [yeast infection] and other forms of diseases if they are not cut,” Chelangat tells IPS.

She says the research could be a new weapon in the fight against FGM.

Gwada agrees: “This new finding is going to compel a review of the understanding of the FGM procedures and intervention strategies including policies and legislation.”

]]> 1
ARV Shortages Hit Mozambique’s HIV Treatment Programme Thu, 19 Jun 2014 11:05:52 +0000 Amos Zacarias Chronic shortages of antiretroviral drugs endanger the lives of hundreds of thousands of HIV positive Mozambicans. Courtesy: Amos Zacarias

Chronic shortages of antiretroviral drugs endanger the lives of hundreds of thousands of HIV positive Mozambicans. Courtesy: Amos Zacarias

By Amos Zacarias
MAPUTO, Jun 19 2014 (IPS)

Chronic shortages of antiretrovirals across Mozambique are endangering the health and the lives of tens of thousands of HIV positive people on treatment.

Some 454,000 people are on antiretroviral (ARV) treatment, or just under one-third of the 1.6 million Mozambicans living with HIV in 2013, according to government figures.

“Our patients complain they are not receiving the complete dosage of medicines,” says Judite de Jesus Mutote, president of Hi Xikanwe (“we are together,” in the local Shangaan language), a group that assists people on ARV treatment in Maputo.

For ARVs to be effective, the pills must be taken every day at the same time.  Interrupting treatment has serious health consequences.

“Stopping treatment  increases viral load, causes opportunistic infections, and creates resistance to the drug, with the patient needing stronger and more expensive  medicines, which sometimes the country does not have,”  Jose Enrique Zelaya, head of the Joint United Nations Programme on HIV/AIDS (UNAIDS) in Mozambique, told IPS.

Shortages of essential medicines happen intermittently in Mozambique, but the last six months have been especially critical for ARV supply.

Press reports from across the country, but especially the central and northern provinces, tell of people going several times to the clinic, spending time and money only to return empty-handed or with two weeks supply instead of one month’s, or bribing the clinic’s staff to get the drugs.

Rural patients are most affected. “In rural areas, the distances between health clinics and patient’s homes are long, and the roads, problematic,” confirms Zelaya.

In the central province of Sofala, attacks by an armed rebel group has cut the main highway, forcing commercial traffic to drive in convoys under military escort, further disrupting supplies of essential goods like medicines.

But even Maputo, the capital, has not been spared ARV shortages, as Hi Xikanwe members confirm.

Some patients resort to buying the drugs at high prices in the informal markets, with no guarantee of their quality. Many suspect that ARVs from government clinics find their way into markets.

Salmira Ngoni*, an HIV-positive, 26-year-old mother, endured months of erratic supply at the clinic in Ndlavela, in Matola city, 20 kms north of Maputo. In December, she bribed a pharmacist to sell her 15 ARV pills without a prescription for the equivalent of 10 dollars.

In January, a frustrated Ngoni took a more drastic step: she quit the government clinic and enrolled in the DREAM programme for HIV positive people, run by the Catholic Community of Sant’Egidio. DREAM has not experienced ARV shortages.

Erratic drug supply is not new to Mozambique.

“Basically, the problem lies in poor planning from the health ministry and in the process of distribution according to demands,” says Zelaya.

Mutote agrees: “We are told the medicines are stored in the health ministry’s warehouse but the problem is distribution. They lack transport to health clinics.”

 Source: Ministry of Health, Mozambique

Source: Ministry of Health, Mozambique

A 2010 report by the World Health Organisation (WHO) noted Mozambique’s logistical challenges “in procurement, distribution, and storage of medicines and medical products. Poor infrastructure can cause delays and harm the quality of the drugs mainly because of exposure to heat.”

According to WHO, the country’s deficit of health staff affects “the rational use of medicines due to limited capacity in prescribing medicine at clinical level and in distributing it at pharmaceutical level.”

Mozambique had 5.6 pharmaceutical professionals per 100,000 persons in 2010, said the report, one of the lowest ratios among poor countries.

Alarm bells ring

Drug shortages ebb and fall, but their increasing frequency alarms foreign donors, who contribute a large chunk of the health budget for AIDS.

In April, at a press conference, Dutch ambassador Frederique de Man, the focal point for the Health Cooperation Partners, observed “the need for the public to buy medicines from informal vendors because the health units frequently run out of stocks of medicines or receive medicines that are past their expiry dates”.

De Man urged the health ministry to listen to the complaints of people and NGOs, and improve the drug supply chain.

Worryingly, ARV shortages threaten Mozambique’s plan to scale up Option B+,the treatment option recommended by WHO for HIV positive mothers. Option B+ is lifelong provision of ARV therapy to pregnant women regardless of their CD4 count.

In 2013, nearly 85,000 HIV positive pregnant women were given ARVs to prevent transmission to their babies.  Of these, half were enrolled in Option B+. This means they must get a monthly supply of 30 pills for the rest of their lives.

“It is crucial to keep these women on treatment but it is not easy due to long distances between clinics and communities,” said Guillermo Marquez, HIV specialist with the United Nations Children’s Fund in Maputo.

With 56,000 new infections among women in 2012, the needs for ARV treatment will continue to grow.

Concerning children, 12,600 were newly infected in 2013, according to government figures – an improvement over the previous year’s figure of 14,000 new child infections.

Mozambique aims to reduce the number of HIV infections among children to fewer than five percent by 2015.

But Zelaya doubts this goal can be reached in time. “To achieve it, the medicines must be available, otherwise it is impossible.”

*Name withheld to protect privacy

]]> 1
Obstetric Fistula Haunts Pakistani Women Tue, 17 Jun 2014 19:04:28 +0000 Zofeen Ebrahim Naz Bibi is awaiting treatment for fistula at the Koohi Goth Women’s Hospital in Pakistan. Credit: Zofeen Ebrahim/IPS

Naz Bibi is awaiting treatment for fistula at the Koohi Goth Women’s Hospital in Pakistan. Credit: Zofeen Ebrahim/IPS

By Zofeen Ebrahim
KARACHI, Jun 17 2014 (IPS)

The word on the street was that if there were one place on earth that could treat Mohammad Lalu’s wife, it would be the Koohi Goth Women’s Hospital in Pakistan’s port city of Karachi.

The 50-year-old stone crusher hailing from the remote village of Dera Bugti in the southwest Balochistan province had spent 30 years searching for a facility that would treat his wife, Naz Bibi, who suffers from obstetric fistula.

Sitting upright on a plastic sheet draped over one of the hospital beds, Bibi told IPS, “It took us two days of non-stop travel to get here and we spent 12,000 rupees (roughly 120 dollars) on the bus fare alone.”

It is a princely sum for a family of extremely modest means, in a country where the average income is less than 1,200 dollars a year. But for Lalu and his wife, the expenditure will be worth it if it can cure Bibi of her terrible affliction.

“Obstructed labour is especially common among young, physically immature women giving birth for the first time.” – United Nations Population Fund (UNFPA)
While virtually unheard of in the developed world, obstetric fistula is still common in many Asian and African countries: the World Health Organisation (WHO) estimates that it affects nearly three million women annually.

While country-specific data is harder to find, local experts suggest that anywhere from 4,000 to 5,000 women in Pakistan are suffering from fistula.

Caused by prolonged or stressful labour, the condition arises when the baby’s head puts undue pressure on the lining of the woman’s birth canal, eventually ripping through the wall of the rectum or bladder and resulting in urinary or faecal incontinence.

Medial professionals say young women, whose bodies have not yet matured enough to endure the birthing process, are most vulnerable, as well as those who lack adequate nutrition or live too far away from modern healthcare facilities.

Because fistula causes a woman to lose control over her bodily functions, there is a huge stigma around the condition. Those afflicted by it often smell bed, and are sequestered away from their communities and families, forced to suffer in silence.

This is particularly traumatic for young mothers, who end up spending the better parts of their lives having little to no contact with the outside world.

Lalu told IPS that Bibi’s trouble started soon after she delivered a stillborn baby boy when she was just a teenager during her first marriage.

“I am her second husband,” he said. “Her parents married her to me after her husband left her, but did not disclose she was suffering from this dreadful problem.”

Unlike many other husbands, Lalu did not turn away from his new wife; instead, he has gone to great lengths to find her the necessary treatment. This hasn’t been easy, since fistula can only be managed through reconstructive surgery, which is cost-prohibitive for thousands of women.

Koohi Goth is one of 12 centres set up under the United Nations Population Fund’s (UNFPA) Fistula Project that offers the service for free.

Now in its eighth year, and assisted by the Pakistan National Forum on Women’s Health (PNFWH), it has trained 38 doctors to carry out the surgery. These numbers, experts say, pale in comparison to the scale of Pakistan’s maternal health crisis.

‘100 percent preventable’

According to the country’s latest Demographic and Health Survey, 276 women out of every 100,000 die during childbirth.

“All these deaths are 100 percent preventable if we can provide quality of care and stop child marriages,” Dr. Sajjad Ahmed, head of the Fistula Project in Pakistan, told IPS.

He believes that delaying the age at which a woman experiences her first pregnancy would be a huge step forward in preventing conditions like fistula.

According to the UNFPA, “For both physiological and social reasons, mothers aged 15-19 are twice as likely to die of childbirth than those in their 20s. Obstructed labour is especially common among young, physically immature women giving birth for the first time.”

But changing the mindset that sees nothing wrong with the idea of a child bride will not be easily accomplished, especially in rural Pakistan.

Dr. Suboohi Mehdi (Surgeon at Koohi Goth Hospital, Karachi) on Fistula Cases from IPS News on Vimeo.

Thirteen-year-old Shahbano, hailing from the village of Sanghar in Pakistan’s Sindh province, occupies the bed next to Bibi. She tells IPS she was married at 11 and developed fistula three weeks ago, during prolonged labour involving her first child.

Luckily, both Shahbano and her baby son survived the ordeal, but she must now hope that her surgery goes well, so she is not afflicted by incontinence for the rest of her life.

“In our culture, when a girl first begins to menstruate, her parents are obliged to marry her off,” Shahbano’s husband, Abid Hussain, told IPS.

Neither he nor his teenage wife had any idea that the Sindh provincial assembly passed the Child Marriage Restraint Act last month, prohibiting the marriage of children under 18 years of age. Violation of the bill could earn offenders a three-year prison term or a 450-dollar fine.

In 1929, the official marriage age stood at 14 years, and in 1965 the law changed, making it illegal to marry anyone under the age of 16. Today, Sindh is the only province to have recognised 18 as the bare minimum age for marriage – a decision that has elicited vehement opposition from religious groups.

Maulana Muhammad Khan Sherani, chairman of the Council of Islamic Ideology, which acts as an unofficial parliamentary advisor, said in reference to the amendment: “Some people want to please the international community [by going] against Islamic teachings and practices.”

“Such proclamations act as a spanner in our fight against early marriage and early pregnancy,” Ahmed asserted.

He says if he could give girls like Shahbano one piece of advice it would be to educate their children, especially their daughters.

“It will take a generation to put things right, but education will automatically bring about a cultural change, which could delay marriages. I see that as the only way to eradicate this condition,” he stressed.

Currently, the country only has the capacity to handle 2,000 cases of fistula, but doctors end up treating just 500 to 600 women a year.

Ahmed says this is largely due to the fact that people do not know the condition is preventable or treatable, and so avoid seeking out medical assistance. Many women live in rural areas without access to televisions, radios or cell phones, making it hard to spread awareness.

To circumvent the problem, hospitals have mobilised ‘lady health workers’ – women who go door-to-door in remote areas delivering information on sexual reproductive health and rights.

“We have a huge brigade of almost 100,000 lady health workers,” Ahmed said. Although they cover just 60 percent of the country, they act as a bridge between rural populations and urban-based care providers.

Perhaps these sustained efforts will enable Pakistan to see the day when conditions like fistula are nothing but a distant memory.


]]> 0
U.N. Releases Guidelines on Reparations for Victims of Sexual Violence Thu, 12 Jun 2014 21:54:12 +0000 Thalif Deen The village of rape survivor Angeline Mwarusena continues to be threatened by militia. Credit: Einberger/argum/EED/IPS

The village of rape survivor Angeline Mwarusena continues to be threatened by militia. Credit: Einberger/argum/EED/IPS

By Thalif Deen

When sexual violence – whether against men, women or children – takes place in United Nations peacekeeping missions worldwide, the world body has been quick to single out the perpetrators and expel them back to their home countries.

But the U.N. has little or no authority to prosecute offenders, mete out justice or ensure adequate compensation to victims.

The 193 member states, which provide thousands of troops for peacekeeping missions largely in Asia, Africa, and Latin America and the Caribbean, are beyond the reach of the long arm of the law.

But at a summit meeting in London this week, U.N. Secretary-General Ban Ki-moon released a set of guidelines titled ‘Reparations for Conflict-Related Sexual Violence.’

These reparations include restitution, compensation, rehabilitation and guarantees of non-repetition.

"People should have the right to silence if they so choose, but they also have the right to social justice [...]." -- Sanam Naraghi Anderlini, co-founder of the International Civil Society Action Network (ICAN)
“A key element of reparation is that it should be proportional to the gravity of the violations and the harm suffered,” says the 20-page document.

Sanam Naraghi Anderlini, co-founder of the International Civil Society Action Network (ICAN), told IPS it would be useful to know how the United Nations plans to disseminate the guidelines so that its own staffers are trained in these issues.

“And what means do they have to ensure compliance?” she asked.

In other words, is this guidance just for optional use, or is this setting a baseline standard by which the United Nations must operate?

“What are the penalties for non-compliance? And how will they monitor this?” asked Anderlini, who is also a senior fellow at the Massachusetts Institute of Technology (MIT)’s Centre for International Studies.

In its report, the United Nations also points out some of the flaws in the existing system.

In South Africa, for example, reparations to victims of sexual violence took the form of a one-off payment of approximately 4,000 dollars.

However, the policy failed to take into consideration both power differentials within families, as well as the historic lack of access to bank accounts among women.

“Local victims groups reported the money was often deposited into the accounts of male family member and women were given limited or no control over the resources,” the guidelines stated.

In some cases, tensions over how money should be spent in households lent itself to family violence, according to the United Nations.

Shelby Quast, policy director at the New York-based Equality Now, told IPS it is vital that reparations occur alongside development of a human rights-based legal framework that protects the rights of women and girls in the post-conflict and development periods.

“Because so much sexual violence is targeted toward adolescent girls, it is also important the variety of reparations – medical, psychological, financial, etc – pay special attention to the unique needs of girls at this particularly formative time in their lives,” she added.

Addressing the London summit on ‘Ending Sexual Violence in Conflict’, Zainab Hawa Bangura, U.N. special representative on sexual violence in conflict, said: “Reparations are routinely left out of peace negotiations or sidelined in funding priorities, even though they are of utmost importance to survivors.”

Under-Secretary-General for Humanitarian Affairs Valerie Amos cited a study by the International Criminal Tribunal for the former Yugoslavia (ICTY), which found that in one concentration camp near Sarajevo, 4,000 of the 5,000 male prisoners said they had been raped.

She said research in the east of the Democratic Republic of Congo (DRC) found that one in six of the men surveyed said they had experienced conflict-related sexual violence.

And a study in post-conflict Liberia found that among former combatants, 42 percent of women and 33 percent of men had experienced sexual violence.

“There are huge gaps in research, but we know that all sexual crimes are under-reported and those against men and boys in conflict are particularly difficult to quantify,” said Amos.

Under-Secretary-General Phumzile Mlambo-Ngcuka, who is also the executive director of U.N. Women, said stronger action is the need of the hour, and “sexual violence in conflict is a frontline concern for us.”

Anderlini, who has done extensive research on the subject and is armed with field experience, told IPS victims of sexual violence should have the right and ability to move beyond ‘victimhood’ and reclaim their lives.

To this end, they require physical and psycho-social care, access to justice, and educational and professional opportunities to rebuild their lives. They also need a socio-cultural context that accepts and respects them, she pointed out.

Anderlini also said justice for victims should not be limited to legal justice or stand-alone reparation programmes that depend on people coming forward.

“People should have the right to silence if they so choose, but they also have the right to social justice – meaning that the framing has to go beyond just reparation programmes to ensure that health, education, economic programming in conflict/ post conflict integrate and address the needs of people affected by sexual violence.”

For example, she said, health clinics and workers must be trained to deal with sexual violence issues in all these settings.

Educational and professional training and opportunities should be made available to sexual violence victims that also integrate a psycho-social dimension and group therapy support, said Anderlini, author of ‘Women Building Peace: What They do, Why it Matters.’


]]> 2
Op-Ed: First Decolonisation, Now ‘Depatriarchilisation’ Mon, 09 Jun 2014 22:42:21 +0000 Lakshmi Puri Young Bangladeshi women raise their fists at a protest in Shahbagh. Credit: Kajal Hazra/IPS

Young Bangladeshi women raise their fists at a protest in Shahbagh. Credit: Kajal Hazra/IPS

By Lakshmi Puri

At the end of this week leaders of the Group of 77 and China will meet in Bolivia to commemorate the 50th anniversary of the group.

From the original 77, this group now brings together 133 countries, making it the largest coalition of governments on the international stage. Promoting an agenda of equity among nations and among people, sustainable and inclusive development and global solidarity have been at the heart of the G77’s priorities since its inception. But none of it will be achieved without fully embracing the agenda of gender equality and women’s empowerment.

Two weeks ago, I travelled to Bolivia to attend a historic international meeting in preparation for the G77 Summit, exclusively dedicated to women and gender equality. More than 1,500 women, many of them indigenous, packed the room, full of energy. Evo Morales, the president of Bolivia, was also present – a testimony to his commitment and leadership to this critical agenda.

At this meeting, a message emerged, loud and clear. If we want the 21st century to see the end of discrimination, inequality and injustice, we must focus on women and girls – half the world’s population, which continues to experience discrimination every day and everywhere. The 20th century saw the end of colonisation. Now the 21st century must see the end of discrimination against women.  From decolonisation, we must move to depatriarchilisation.

Lakshmi Puri, deputy executive director of UN Women, speaks at a press conference on the International Day to End Violence Against Women. Credit: UN Photo/Mark Garten

Lakshmi Puri, deputy executive director of UN Women, speaks at a press conference on the International Day to End Violence Against Women. Credit: UN Photo/Mark Garten

This meeting took place at a critical time and in a significant place. Latin America has lived through its own struggles against discrimination and oppression. In a continent that used to be marked by striking inequalities and violent dictatorships, a vibrant movement has emerged to put the region on the path of social justice, democracy, and equality. In Bolivia there is a constitutional law against violence against women and a law against political violence, making it a pioneer in the region and beyond.

This hope for a brighter and more just future must now spread to the world as a whole, and the G77 can play a defining role. The elaboration of the Post-2015 development agenda and Sustainable Development Goals (SDGs) is coming to a critical point. The Open Working Group on Sustainable Development Goals is about to complete its work and member states will finalise the new development agenda in the course of next year.

This coincides with the 20-year review and appraisal of the Beijing Declaration and Platform for Action, the landmark international framework to achieve gender equality and women’s rights. Beijing+20 provides us with an opportunity to drive accelerated and effective implementation of the gender equality and women’s rights agenda and to ensure that it is central to the new development framework.

We need to take full advantage of these processes and their interconnections to ensure that gender equality, women’s rights and women’s empowerment feature prominently in the new development agenda and to accelerate implementation.

We have a historic opportunity and a collective responsibility to make the rights and well-being of women and girls a political priority; both globally and within every country. To this end, the new framework must adopt a comprehensive, rights-based and transformative approach that addresses structural inequality and gender-based discrimination.

This comprehensive approach must include targets to eliminate discrimination against women in laws and policies; end violence against women; ensure the realisation of sexual and reproductive health and rights of women and adolescent girls throughout their life cycles; and the recognition, reduction and redistribution of unpaid care work.

Now is the time to put the full political weight behind passage of long-pending legislation to eliminate discrimination against women and promote gender equality.

Now is the time to allocate the resources to fund services for victims and survivors of violence against women.

Now is the time to strengthen national data collection and undertake a time use survey to better understand unpaid care work or a survey on violence against women.

Now is the time to make public spaces safe for women and girls.

Now is the time to improve rural infrastructure to strengthen women’s access to markets and help tackle rural feminised poverty.

Now is the time to showcase champions of gender equality, to recognise role models that have overcome stereotypes and helped level the playing field for girls and women in all areas, in politics and business, in academia and in public service, in the home and the community.

Mahatma Gandhi rightly said that true freedom from colonialism will not be achieved unless each and every citizen is free, equal and is able to realise his or her potential. The 21st century must see the end of the centuries’ old practice of patriarchy and gender discrimination, and unshackle women and girls so they can fully enjoy their human rights.

When the G77 meets later this week at its 50th anniversary commemorative Summit, I have high hopes that they will make this defining agenda of gender equality and women’s empowerment a centerpiece of their global development and freedom project for the next 50 years.


*Lakshmi Puri is the deputy executive director of U.N. Women, based in New York.

]]> 0
Marriage a Barrier to ARV treatment for Swazi Women Thu, 05 Jun 2014 09:11:38 +0000 Mantoe Phakathi A Swazi mother with her baby. In July Swaziland will roll out Option B+, the latest treatment recommended by the World Health Organisation for HIV positive mothers. Credit: Mantoe Phakathi/IPS

A Swazi mother with her baby. In July Swaziland will roll out Option B+, the latest treatment recommended by the World Health Organisation for HIV positive mothers. Credit: Mantoe Phakathi/IPS

By Mantoe Phakathi
MBABANE, Jun 5 2014 (IPS)

For months, Nonkululeko Msibi could not find her voice each time she wanted to share the news to her husband. She had learned that she was infected with HIV at the age of 16 when delivering her firstborn baby at Swaziland’s Mbabane Government Hospital.

“Although I was shocked by the news, I accepted it,” Msibi told IPS. “But the most difficult part was breaking the news to my husband.”

Her biggest fear was to be thrown out of their marital home should he believe that she had brought HIV into the family.

Despite being put on antiretroviral treatment (ART) at the baby’s birth and living two kms away from the clinic, where she could easily refill her prescriptions, her daughter contracted HIV, possibly through breast milk.


26 percent national HIV prevalence among people 15-49

110,000 HIV positive women aged 15 and over

67 percent of maternal deaths are due to HIV

5,600 newly infected women in 2012

Two thirds of every 100 infections are women aged 25 and older

7 out of 10 nursing mothers did not receive ARVs during breastfeeding

Source: Unaids 2012 and 2013

“Because I did not disclose my status, I failed to convince my mother-in-law that I had to breastfeed exclusively,” said Msibi.

Her second baby is also HIV positive because, she says, the clinic failed to give her nevirapine, although the nurses knew her status.  “I don’t know why this happened,” she said.

Born and bred at rural Motshane, about 15 kilometres from the capital city of Mbabane, Msibi dropped out of school in Grade 3 and got married at the age of 15 when five months pregnant. A product of a broken family, with both her parents deceased, marriage is the most important thing in her life.

“There must be someone to look after you and your children, especially if you’re unemployed like me,” said Msibi.

So, when she received the HIV diagnosis, she imagined her world falling apart, did not tell anyone and did not follow ART properly.

But she is not the only woman in this kind of dilemma.

“We realised that some women do not return to health centres within the stipulated timelines,” said researcher Thandeka Dlamini. She and other researchers set out to find why married women start ART late or drop out.

Their study, conducted by MarxART, a project by the Swaziland National AIDS Programme (SNAP), found “distinct socio-cultural challenges faced by women before initiating ART that result in specific gendered decision making patterns.”

This matters because in July Swaziland will roll out Option B+, the latest treatment recommended by the World Health Organisation for HIV positive mothers. Option B+ consists of lifelong provision of ART to pregnant women, regardless of their CD4 count. CD4s, or helper cells, fight infections in the body.

Since last year, Option B+ has been provided to 600 women to test feasibility, acceptance and clinic readiness. Soon it will be offered to the four out of ten pregnant women who are HIV positive. Among these, women aged 30-34 showed the highest prevalence – more than half were HIV positive in 2010.

Gendered decisions

Although Swazi women have better health-seeking behaviour than men, they find it hard to deal with HIV because of socio-cultural barriers, says the study. Many HIV positive married women live in a dilemma between obeying their husbands or following the advice of the health workers

According to Dlamini, in this conservative country, where women were considered minors until not long ago, wives must obey their husbands, even if they oppose ART or prefer traditional medicine.

Dlamini said an HIV diagnosis threatens married women’s sense of security because they fear being cast out by their spouses or in-laws.

“Submission might result in death, revolt can result in life, but threatens the loss of dignity and the refuge found in a marriage, and can bring shame when a marriage fails,” said a 25-year-old married woman quoted in the study.

National HIV prevalence is 26 percent among people aged 15-49, and 5,600 women were newly infected with HIV in 2012, according to the United Nations. Two thirds of infections are among women aged 25 and over – in their married, childbearing years.

Although the 2007 Swaziland Demographic and Health Survey reports that both married and single women have a high HIV prevalence, they are faced with different choices when it comes to ART. Single women can take a decision on their own; married women can’t.

Dr Velephi Okello, senior medical officer at SNAP, said the findings will help strengthen its HIV communications strategy.

“This study has helped us understand why women are either dropping out or initiating ART late,” said Okello.

The 2013 Global Report of the Joint United Nations Programme on HIV/AIDS (UNAIDS) shows that nine out of ten Swazis remain on ART after a year. But Okello said one dropout is one too many.

“We need to understand the barriers they encounter at social level so that we help them stay on treatment,” said Okello.

Dlamini recommends empowering married women with skills to negotiate access to ART, and researching how some women successfully navigate this tricky situation.

One such woman is Msibi, now 24, who is on treatment together with her husband.

“When my firstborn fell seriously ill, I realised I had to disclose,” she said.

Counselling from health workers helped her find the voice to break her silence. Msibi approached her mother-in-law, who already suspected that the child was HIV positive. An HIV test confirmed her fears.

“But that made it easy for me to disclose to my husband, who found it difficult to accept at first, but eventually he did,” she said. Later he trained as an HIV/AIDS counsellor at the local clinic, and the couple now helps each other follow ART carefully.

]]> 2
Working Cambodian Women ‘Too Poor’ to Have Children Sat, 31 May 2014 08:10:50 +0000 Michelle Tolson Women in Cambodia’s garments sector work 10-12 hours a day. Credit: Michelle Tolson/IPS

Women in Cambodia’s garments sector work 10-12 hours a day. Credit: Michelle Tolson/IPS

By Michelle Tolson
PHNOM PENH, May 31 2014 (IPS)

The movement for reproductive justice sees women’s decision to have – or not have – children as a fundamental right. Should they choose to bear a child, women should have the right to care and provide for them; if they opt not to give birth, family planning services should be made available to enable women to space or prevent pregnancies.

In Cambodia, where women make up 60 percent of the population of 14 million people, this fundamental right is being trampled by insecure labour contracts, toxic working conditions and a near-total absence of maternity benefits for working mothers.

Take Cambodia’s garments industry, a massive sector that accounts for 80 percent of the country’s exports. A full 90 percent of the workforce is female, but labour rights have not accompanied employment opportunities.

"[The] lack of labour rights for women [is] a worrying trend that is completely changing the culture of Cambodia.” -- Tola Moeun, head of the labour programme at the Community Legal Education Centre
Ever since the country entered into a liberalising agreement with the World Trade Organisation (WTO) in 2005, long-term contracts have been edged out in favour of short term or fixed duration contracts (FDCs), the latter being far more popular among East Asian factory owners and western clothing brands like Gap, Walmart and H&M.

These informal arrangements “abuse garment workers’ reproductive rights,” Sophea Chrek, a former garment worker and technical assistant to the Workers Information Center (WIC) – which recently staged a fashion show to highlight the issue – told IPS.

“Women employed under FDCs for three to six months, or sometimes even one month, will not risk their job by having a baby. Usually, they choose to have an abortion…before the contract ends to ensure that the line leaders or supervisors are not aware of their pregnancy,” Chrek added.

According to Cambodian labour law, factories are supposed to provide maternity leave, but most get around this requirement with short contracts, which leave the estimated 600,000 workers vulnerable to employers’ whims.

Melissa Cockroft, a technical advisor on sexual and reproductive health, tells IPS that women without access to family planning services resort to unsafe and unregulated measures, such as using over-the-counter Chinese products to induce abortions.

These methods can be fatal, but women seem hesitant to avail themselves of NGO-provided free or discounted service at on-site infirmaries, which are less confidential.

Sometimes their grueling schedules, which include 10 to 12-hour workdays with only a short lunch break in between, keep them from making appointments. Many of these women, Cockroft says, are just too busy to even think of starting families.

Garment workers’ reticence to use reproductive services can be cultural too, as talking about sexual health is considered ‘shameful’ in traditional Cambodian society.

Cambodian law also stipulates that factories provide working mothers with childcare, but Cockroft says she has only seen one operational childcare facility during all her years as an advocate in the field.

For some women, the decision to leave their children at home emerges from a desire to spare them the grueling commute – many factory workers travel shoulder-to-shoulder in trucks or on compact wagons pulled by tuk tuks, ubiquitous motorcycle taxis, down Cambodia’s notoriously unsafe roads.

Very often, babies remain at home with their grandmothers in the countryside while their mothers go off to work in the city, where they earn roughly 100 dollars per month. Union leaders are trying to raise this minimum wage to 160 dollars.

In general, though, both Cockroft and Chrek say garment workers consider themselves “too poor” to have children.

Entertainers and street workers

Meanwhile, in Cambodia’s popular entertainment sector, women face a unique set of challenges, their access to reproductive health services hindered by the informal and unpredictable nature of their work.

Independent researcher Dr. Ian Lubek tells IPS that entertainment workers are likely to experience a much higher risk of foetal alcoholic syndrome due to the number of beverages they are forced to consume every night in order to get tips from their customers. Research from the International Labour Organisation (ILO) suggests that a female beer seller or hostess consumes up to 11 drinks a night.

Years of advocacy efforts have at least enabled entertainers working for international beer companies to secure better wages, with women employed by the Cambrew brewery now drawing a salary of close to 160 dollars a month.

Higher wages, according to Phal Sophea, former beer seller and representative for the Siem Reap division of the Cambodia Food and Service Workers Federation (CFSWF), amounts to less economic pressure to have transactional sex.

“I think better pay will reduce sex work because the [women] generally go out with customers when the pay is too low,” she told IPS.

Of all the groups of working women struggling to raise children, street-based sex workers are among the most marginalised and are often subject to police violence, arrests and forced detention in anti-trafficking ‘reeducation centres’.

While unions for entertainment workers can negotiate contracts, sex workers are left completely vulnerable to the laws of the streets.

Civil Society Steps Up

In 2006 the sex worker-led collective Women’s Network for Unity (WNU) set up informal schools in drop-in centres where sex workers lived, for children between the ages of five and 16 to learn Khmer, English, mathematics and the arts.

Operating in collaboration with the Asia Pacific Network of Sex Workers, the initiative has successfully reinstated 184 children into the public school system.

WNU Board Member Socheata Sim says the collective does not limit its services to children of sex workers, but extends support to people living with HIV/AIDS, and residents of slum communities who are not only living in abject poverty but are constantly threatened with eviction from their humble dwellings.
Pen Sothary, a former sex worker and secretary of the sex-worker led collective Women’s Network for Unity (WNU), told IPS that many women are so poor they take whatever work they can get.

Labour research indicates that Cambodians living in urban areas require, at the very least, 150 dollars a month in order to survive; most salaries are set below 100 a month, making it very difficult for the average working Cambodian to make ends meet, and feed their families. As it is, 40 percent of Cambodian children are chronically malnourished.

WNU Board Member Socheata Sim explained that sex work might be the only option for the many women without a formal education; according to a report on education levels among women in Cambodia, only one-third of school-aged girls are enrolled at the lower secondary school level, and one in ten at the upper secondary school level.

Many sex workers want a better life for their children, but few can afford the high fees, bribes and related costs of formal schooling.

Furthermore, sex workers living in slum dwellings face a constant threat of eviction. Tola Moeun, head of the labour programme at the Community Legal Education Centre, told IPS that high rates of evictions are now forcing many women to migrate abroad in search of employment.

“Yet once abroad, if undocumented, migrant workers find they do not have the rights citizens have,” he lamented.

In Thailand, for instance, where tens of thousands of Cambodian women now live and work, undocumented workers are fired from their jobs if they become pregnant, are denied maternity leave and earn half the 300-baht (nine-dollar) daily minimum wage.

Tola sees the “lack of labour rights for women as a worrying trend that is completely changing the culture of Cambodia.”


]]> 0