Inter Press Service » Women’s Health http://www.ipsnews.net Turning the World Downside Up Mon, 22 Dec 2014 14:14:10 +0000 en-US hourly 1 http://wordpress.org/?v=3.9.3 Groups Push Obama to Clarify U.S. Abortion Funding for Wartime Rapehttp://www.ipsnews.net/2014/12/groups-push-obama-to-clarify-u-s-abortion-funding-for-wartime-rape/?utm_source=rss&utm_medium=rss&utm_campaign=groups-push-obama-to-clarify-u-s-abortion-funding-for-wartime-rape http://www.ipsnews.net/2014/12/groups-push-obama-to-clarify-u-s-abortion-funding-for-wartime-rape/#comments Wed, 10 Dec 2014 00:49:17 +0000 Carey L. Biron http://www.ipsnews.net/?p=138188 Survivors at a workshop in Pader, northern Uganda. Thousands of women were raped during Uganda’s civil war but there have been few government efforts to assist them. Credit: Rosebell Kagumire/IPS

Survivors at a workshop in Pader, northern Uganda. Thousands of women were raped during Uganda’s civil war but there have been few government efforts to assist them. Credit: Rosebell Kagumire/IPS

By Carey L. Biron
WASHINGTON, Dec 10 2014 (IPS)

Nearly two dozen health, advocacy and faith groups are calling on President Barack Obama to take executive action clarifying that U.S. assistance can be used to fund abortion services for women and girls raped in the context of war and conflict.

The groups gathered Tuesday outside of the White House to draw attention to what they say is an ongoing misreading by politicians as well as humanitarian groups of four-decade-old legislation. That law, known as the Helms Amendment, specifies women’s health services that can be supported by U.S. overseas funding."We want to prevent these acts but also, when that violence does occur, to make sure that organisations and government agencies are providing the necessary post-rape care, including legal and social services, as well as mental and physical health services. Abortion services need to be part of that package.” -- Serra Sippel

This mis-interpretation, advocates warn, results in ongoing mental suffering, social disgrace and even additional abuse for women who have been raped.

“For over 40 years, the Helms Amendment has been applied as a complete ban on abortion care in U.S.-funded global health programmes – with no exceptions,” Purnima Mane, the president of Pathfinder International, a group that works on global sexual health issues, said in comments sent to IPS.

“The result is that Pathfinder and other U.S. government-funded agencies are unable to provide critical abortion care services to those at risk even under circumstances upheld by U.S. law and clearly allowable under the Helms Amendment. With the stroke of a pen, President Obama can change the outcome for many of these women and start to reverse more than four decades of neglect of their basic human rights and harm to their health.”

Advocates say such an executive action would be in line with both the law and broader public opinion. Indeed, on the face of it, the Helms Amendment seems to be quite clear.

The amendment bans U.S. funding from being used to “pay for the performance of abortion as a method of family planning” or to “motivate or coerce any person to practice abortions.” While the law does not specifically bar U.S. assistance being used for abortion services in the case of rape, critics have long noted that this has been the impact since the start.

“No U.S. administration has ever implemented this correctly, in terms of making exemptions in certain instances,” Serra Sippel, the president of the Center for Health and Gender Equity (CHANGE) and a key organiser of Tuesday’s demonstration, told IPS.

“This comes down to politics and the political environment in Washington. But what we need is for the president to take leadership and direct USAID” – the federal government’s main foreign assistance agency – “and the State Department to say the U.S. government is taking a stand and supporting access to abortion in these cases.”

Misinterpretation, self-censorship

Abortion has been, and remains, one of the most divisive issues in U.S. politics. By many metrics, this polarisation has only worsened with time.

This came to the cultural and political forefront in 1973, when the U.S. Supreme Court ruled in a landmark decision that a state law banning abortion (except to save the mother’s life) was unconstitutional. The ruling resulted in a lasting moral outrage among broad sections of the U.S. public, though polls suggest that a majority of those in the United States support services following rape, incest or when a mother’s life is at risk.

The Helms Amendment was among the first legislative responses to the court’s ruling, passed just months later. Since then, the amendment has resulted in a discontinuation of U.S. assistance for all abortion services in other countries.

It is important to note that these procedures remain legal in the United States, as well as in many of the countries in which U.S.-funded entities, including government departments, are operating. Humanitarian groups often feel they cannot even make abortion-related information available to women, including those raped during conflict – even if the Helms Amendment doesn’t specifically proscribe doing so.

“These restrictions, collectively, have resulted in a perception that U.S. foreign policy on abortion is more onerous than the actual law … [leading to] a pervasive atmosphere of confusion, misunderstanding and inhibition around other abortion-related activities beyond direct services,” analysis published last year by the Guttmacher Institute, a sexual health-focused think tank here, reports.

“Wittingly or unwittingly, both NGOs and U.S. officials have been transgressors and victims alike in the misinterpretation and misapplication of U.S. anti-abortion law … whether through misinterpretation or self-censorship, NGOs are needlessly refraining from providing abortion counseling or referrals.”

Global statistics on conflict-time rapes and resulting pregnancies are hard to come by. Human Rights Watch points to 2004 research carried out in Liberia, where rape was used as a weapon of war, suggesting that around 15 percent of wartime rapes led to pregnancy.

“Human rights practitioners and public health officials from Bosnia, the Democratic Republic of Congo, Colombia, and other countries at war, have collected evidence from conflict rape survivors showing both that pregnancy happens and that it has devastating consequences for women and girls,” Liesl Gerntholtz, the executive director of a Human Rights Watch’s women’s rights division, wrote Tuesday.

“They are left to continue unwanted pregnancies and bear children they often cannot care for and who are daily reminders of the brutal attacks they suffered. This, in turn, makes these children more vulnerable to stigmatization, abuse, and abandonment.”

Global acknowledgment

On Tuesday, the groups participating in the White House demonstration also called on President Obama to clarify that the Helms Amendment does not apply to pregnancies resulting from incest or if the mother’s life is at risk. Yet the focus of the calls remains on rape in the context of war and conflict.

Advocates say public consciousness on this issue has risen significantly over the past year and a half. To a great extent, this has been driven by the conflict in Syria and the rise of the Islamic State, as well as the ongoing violence in the Democratic Republic of the Congo (DRC), and the centrality of sexual violence in each of these.

“We know that rape has been used as a weapon of war throughout history. What’s new is the attention from governments and advocates over the past 18 months,” CHANGE’s Sippel says.

“The prevention of violence cannot stand alone. We want to prevent these acts but also, when that violence does occur, to make sure that organisations and government agencies are providing the necessary post-rape care, including legal and social services, as well as mental and physical health services. Abortion services need to be part of that package.”

The United States has been a strong global advocate against sexual violence in recent years, including with regard to conflict situations. President Obama has created the first U.S. action plan on women’s role in peace-building, a White House strategy on gender-based violence, among other actions.

Advocates say that clarifying the Helms Amendment would be the next logical step. Although the White House was unable to comment for this story, organisers of Tuesday’s rally say President Obama’s aides did meet with advocates working on sexual violence in Colombia, the DRC and elsewhere.

Edited by Kitty Stapp

The writer can be reached at cbiron@ips.org

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OPINION: Stand in Solidarity with Courageous Women’s Human Rights Defendershttp://www.ipsnews.net/2014/12/opinion-stand-in-solidarity-with-courageous-womens-human-rights-defenders/?utm_source=rss&utm_medium=rss&utm_campaign=opinion-stand-in-solidarity-with-courageous-womens-human-rights-defenders http://www.ipsnews.net/2014/12/opinion-stand-in-solidarity-with-courageous-womens-human-rights-defenders/#comments Tue, 02 Dec 2014 22:35:29 +0000 Zeid Raad Al Hussein http://www.ipsnews.net/?p=138061

Zeid Ra’ad Al Hussein is the United Nations High Commissioner for Human Rights and has extensive experience in international diplomacy and the protection of human rights.

By Zeid Ra'ad Al Hussein
UNITED NATIONS, Dec 2 2014 (IPS)

Almost two decades ago, in Beijing, 189 countries made a commitment to achieve equality for women, in practice and in law, so that all women could at last fully enjoy their rights and freedoms as equal human beings.

They adopted a comprehensive and ambitious plan to guarantee women the same rights as men to be educated and develop their potential. The same rights as men to choose their profession. The same rights to lead communities and nations, and make choices about their own lives without fear of violence or reprisal.

Credit: OHCHR

Credit: OHCHR

No longer would hundreds of thousands of women die every year in childbirth because of health care policies and systems that neglected their care. No longer would women earn considerably less than men. No longer would discriminatory laws govern marriage, land, property and inheritance.

In the years that followed, the world has witnessed tremendous progress: the number of women in the work force has increased; there is almost gender parity in schooling at the primary level; the maternal mortality ratio declined by almost 50 percent; and more women are in leadership positions.

Importantly, governments talk about women’s rights as human rights and women’s rights and gender equality are acknowledged as legitimate and indispensable goals.

However, the world is still far from the vision articulated in Beijing. Approximately one in three women throughout the world will experience physical and/or sexual violence in their lifetime. Less than a quarter of parliamentarians in the world are women.Attacks against women who stand up to demand their human rights and individuals who advocate for gender equality are often designed to keep women in their “place.” In some areas of the world, women who participate in public demonstrations are told to go home to take care of their children.

In over 50 countries there is no legal protection for women against domestic violence. Almost 300,000 women and girls died in 2013 from causes related to pregnancy and childbirth. Approximately one in three married women aged 20 to 24 were child brides.

In many parts of the world, women and girls cannot make decisions on their most private matters – sexuality, marriage, children. Girls and women who pursue their own life choices are still murdered by their own families in the dishonourable practice of so-called honour killings.

All of our societies remain affected by stereotypes based on the inferiority of women which often denigrate, humiliate and sexualise them.

Today we have the responsibility to protect the progress made in the past 20 years and address the remaining challenges. In doing so, we must recognise the vital role of women who defend human rights, often at great risk to themselves and their families precisely because they are viewed as stepping outside socially prescriptive gender stereotypes.

We must recognise the role of all people, women and men, who publicly call for gender equality and often, as a result, find themselves the victim of archaic and patriarchal, but powerful, threats to their reputations, their work and even their lives.

These extraordinary individuals – women’s human rights defenders – operate in hostile environments, where arguments of cultural relativism are common and often against the background of the rise of extremist, misogynistic groups, which threaten to dismantle the gains of the past.

Attacks against women who stand up to demand their human rights and individuals who advocate for gender equality are often designed to keep women in their “place.” In some areas of the world, women who participate in public demonstrations are told to go home to take care of their children.

Consider the recent example of a newspaper publishing naked photos of a woman, claiming she was a well-known activist – an attack designed to shame this defender into silence. In other places, when women claim their right to affordable modern methods of contraception, they are labelled as prostitutes in smear campaigns seeking to undermine their credibility.

Online attacks against those who speak for women’s human rights and gender equality by so-called “trolls” – who threaten heinous crimes – are increasingly reported.

These attacks have a common thread – they rely on gender stereotypes and deeply entrenched discriminatory social norms in an attempt to silence those who challenge the age old system of gender inequality. However, these defenders will not be silenced, and we must stand in solidarity with them against these cowardly attacks.

This is why my office has decided to launch a campaign to pay tribute to women and men who defy stereotypes and fight for women’s human rights. The campaign runs from Human Rights Day, Dec. 10 this year, to International Women’s Day, Mar. 8, 2015. We encourage everyone to join the ranks of these strong and inspiring advocates, on social media (#reflect2protect) and on the ground.

As we approach the 20-year anniversary of Beijing, discrimination and violence against women, and the stereotypes that confine them into narrowly fixed roles must end. Women have the right to make their own decisions about their lives and their bodies.

Guaranteeing and implementing these rights are non-negotiable obligations of all states. Women human rights defenders were instrumental in securing the ambitious programme laid out in Beijing. Their work, their activism and their courage deserve our recognition, our support and our respect.

Edited by Kitty Stapp

 

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OPINION: All Family Planning Should Be Voluntary, Safe and Fully Informedhttp://www.ipsnews.net/2014/11/opinion-all-family-planning-should-be-voluntary-safe-and-fully-informed/?utm_source=rss&utm_medium=rss&utm_campaign=opinion-all-family-planning-should-be-voluntary-safe-and-fully-informed http://www.ipsnews.net/2014/11/opinion-all-family-planning-should-be-voluntary-safe-and-fully-informed/#comments Wed, 26 Nov 2014 23:10:52 +0000 Dr. Babatunde Osotimehin http://www.ipsnews.net/?p=137986

Dr. Babatunde Osotimehin is the Executive Director of UNFPA, the United Nations Population Fund.

By Dr. Babatunde Osotimehin
UNITED NATIONS, Nov 26 2014 (IPS)

The tragic deaths and injuries of women following sterilisation in the Indian state of Chhattisgarh have sparked global media coverage and public concern and outrage.

Now we must ensure that such a tragedy never occurs again.

Dr. Babatunde Osotimehin. Credit: UNFPA

Dr. Babatunde Osotimehin. Credit: UNFPA

The women underwent surgery went with the best intentions – hoping they were doing the right thing for themselves and their families.

Now their husbands, children and parents are left to live without them, reeling with deep sadness, shock and mourning.

The only way to respond to such a tragedy is with compassion and constructive action, with a focus on human rights and human dignity.

Every person has the right to health. And this includes sexual and reproductive health—for safe motherhood, for preventing and treating HIV and other sexually transmitted infections, and for family planning.

Taking a human rights-based approach to family planning means protecting the health and the ability of women and men to make their own free and fully informed choices.

All family planning services should be of quality, freely chosen with full information and consent, amongst a full range of modern contraceptive methods, without any form of coercion or incentives.

The world agreed on these principles 20 years ago in Cairo at the International Conference on Population and Development.

Governments also agreed on the goals to achieve universal education and reproductive health by 2015, to reduce child and maternal mortality, and to promote gender equality and the empowerment of women.As we mourn the loss of the women who died in India, we must make sure that no more women suffer such a fate.

The Cairo Conference shifted the focus away from human numbers to human beings and our rights and choices.

Family planning is a means for individuals to voluntarily control their own bodies, their fertility and their futures.

Research and experience show that when given information and access to family planning, women and men choose to have the number of children they want. Most of the time, they choose smaller families. And this has benefits that extend beyond the family to the community and nation.

Family planning is one of the best investments a country can make. And taking a holistic and rights-based approach is essential to sustainable development.

We know that it is important to tackle harmful norms that discriminate against women and girls. This means, first of all, providing quality public education, and making sure that girls stay in school.

Second, we must empower women to participate in decisions of their families, communities and nations.

Third, we must reduce child mortality so parents have confidence their children will survive to adulthood.

And fourth, we must ensure every woman’s and man’s ability to plan their family and enjoy reproductive health and rights.

As we mourn the loss of the women who died in India, we must make sure that no more women suffer such a fate.

The organisation that I lead, UNFPA, the United Nations Population Fund, supports a human rights-based approach to family planning, and efforts to ensure safe motherhood, promote gender equality and end violence against women and girls.

In all of these areas, India has taken positive steps forward. One such step is the development of appropriate clinical standards for delivering family planning and sterilisation services.

When performed according to appropriate clinical standards with full, free and informed consent, amongst a full range of contraceptive options, sterilisation is safe, effective and ethical. It is an important option for women and couples.

Yet much work remains to be done in every country in the world to ensure universal sexual and reproductive health and reproductive rights.

The recent events in India highlight the need for improved monitoring and service provision, with the participation of community members and civil society, to ensure that policies are implemented, and to guarantee that services meet national and international standards.

Already the prime minister has quickly initiated investigations, a medical team was sent to the site, and a judicial commission was appointed by the state government to investigate the deaths of the women. I commend them for this immediate response.

Several people, including the doctor who conducted the surgeries and the owner of the firm that produced the suspected medicines, have been arrested. There is every hope that those responsible will be held accountable.

There is also hope that the government will take further measures to restore public confidence in its family planning programs as it upholds the human rights, choices and dignity of women and men.

Any laws, procedures or protocols that might have allowed or contributed to the deaths and other human rights violations should be reformed or changed to prevent recurrences.

As the world’s largest democracy, India is home to more than 1.2 billion people and recognised as a global leader in medicine, science and technology.

Given its leadership and expertise, India can ensure that family planning programmes meet, or exceed, clinical and human rights standards throughout the country.

UNFPA and many partners stand ready to support such an effort.

Edited by Kitty Stapp

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Survivors of Sexual Violence Face Increased Riskshttp://www.ipsnews.net/2014/11/survivors-of-sexual-violence-face-increased-risks/?utm_source=rss&utm_medium=rss&utm_campaign=survivors-of-sexual-violence-face-increased-risks http://www.ipsnews.net/2014/11/survivors-of-sexual-violence-face-increased-risks/#comments Tue, 25 Nov 2014 19:10:55 +0000 Lyndal Rowlands http://www.ipsnews.net/?p=137954 Students at Columbia University carry mattresses on the Carry That Weight National Day of Action to show their support for survivors of sexual assault. Credit: Warren Heller

Students at Columbia University carry mattresses on the Carry That Weight National Day of Action to show their support for survivors of sexual assault. Credit: Warren Heller

By Lyndal Rowlands
UNITED NATIONS, Nov 25 2014 (IPS)

“A recurring nightmare for me is I’m trying to tell someone something and they are not listening. I’m yelling at the top of my lungs and it feels like there is a glass wall between us.”

Jasmin Enriquez is a two-time survivor of rape. Like two-thirds of rape survivors, Enriquez knew her rapists. The first was her boyfriend when she was a high school senior, the second a fellow student she had been seeing at college."What I hear from women is that they are told to shut up: they are told to shut up during it, they are told to shut up after it, and they are told by some institutions to continue keeping their mouths shut." -- Dr. Dana Sinopoli

“[The nightmare] shows how I’ve always felt that even as someone coming forward as a survivor, as soon as I start giving details to some people, they instantly start to shut it down. As in, you’re being crazy or hyperemotional, instead of taking it as one whole piece and looking at it holistically,” Enriquez told IPS.

Women who have experienced gender-based violence are at a significantly increased risk of developing a mental disorder, such as post-traumatic stress disorder, anxiety or depression, within one to three years after the assault.

Enriquez explains, “People don’t seem to understand that after being sexually assaulted, it’s something that you have to live with the rest of your life.

“Most of the time there is an incredible amount of anxiety or depression or other mental health issues that people just don’t understand,” she says. “It’s been five years since I was sexually assaulted and I still live through the trauma.”

A special Lancet series published Friday says that one in three women have experienced physical or sexual violence from their partner.

Researcher Dr. Susan Rees from the University of New South Wales told IPS that there is strong evidence that if you are exposed to gender-based violence, you are at a much higher risk for the onset of post-traumatic stress disorder (PTSD), anxiety and depression as well as attempted suicide.

Rees’ research into the connection between gender-based violence and mental disorders has shown that women who have been assaulted are significantly more likely to experience a mental disorder in their lifetime.

Women who have experienced one form of gender-based violence have a 57 percent chance of developing a mental disorder compared with only 28 percent of women who have not experienced gender-based violence. Significantly, 89 percent of women who have experienced gender-based violence three to four times will develop a mental disorder.

It is important for survivors of assault to get early support to help prevent the onset of an associated mental disorder, Rees said.

However, experiencing sexual assault can be confusing, especially for young women and girls, and this may prevent them from getting early intervention.

Enriquez explains that she didn’t initially realise the connection between her response to the trauma of sexual violence and the symptoms she was experiencing.

“I’ve recently been very jumpy, kind of always tense and I get startled easy, I didn’t understand why that was happening and it was very frustrating.”

Enriquez’ fiancé, who is not the person who assaulted her, used to jump out at her or play games to surprise her, and she found this really upsetting,

“I didn’t understand that it was related to me being sexually assaulted until probably my senior year of college. I feel like if I had been educated about what normal symptoms are of PTSD, I would have known that there was more to it and that it was a normal piece of it.”

Community attitudes affect prevalence

Community attitudes towards women, including strong patriarchal attitudes, power imbalance and gender inequality contribute to the prevalence of violence against women, said Rees.

“It makes sense that if you change attitudes then you can change prevalence, you can reduce the risk for women,” she said.

This is what Enriquez aims to do with her organisation Only With Consent. Together with her fiancé, Enriquez speaks with students to raise awareness and change young people’s attitudes towards sexual assault.

“I definitely think that there’s a gender piece that goes with both the mental health and the sexual assault and that it ties back to any time a woman expresses an emotion of being angry or upset we immediately call her out for being irrational or emotional.” Enriquez told IPS.

“If the majority of survivors who are speaking out are women, and they are expressing these feelings of being upset or being angry, or being really hurt, or any of those feelings, we discredit what they are saying, because we see them as irrational creatures,” Enriquez said.

Psychologist Dr. Dana Sinopoli told IPS that it is also important to consider how gender-based violence affects men, especially men who experience childhood sexual assault. She said that this should involve addressing gender stereotypes such as that men are aggressive or impulsive.

As Carry That Weight explains on its website:

“People of all gender identities can experience and be affected by sexual and domestic violence—women are not the only survivors just as men are not the only perpetrators. We strive to challenge narrow and inaccurate representations of what assault looks like and also acknowledge that these forms of violence disproportionately affect women, transgender, gender nonconforming, and disabled people.”

Sinopoli added however that changing community attitudes towards women was an important part of addressing gender-based violence.

“Consistently what I hear from women is that they are told to shut up, they are told to shut up during it, they are told to shut up after it, and they are told by some institutions to continue keeping their mouths shut.

“That is what we can link to the depression and the anxiety and a lot of the re-experiencing and retriggering that is so central to PTSD,” Sinopoli said.

Sinopoli added that “the way that society reacts, to someone who discloses or is struggling, is so important.

“The more that people speak up the more that we will actually see a decline in such significant psychological symptoms.”

Early intervention can help

When helping someone who has experienced violence, Rees said that it is important that friends and family reassure the victim that it “it is never acceptable to be hit, or to be treated violently or to be raped.”

Unfortunately, population studies show that women who have experienced gender-based violence are also at increased risk of experiencing it again in their lifetime.

“This might be the case because often men target women who are vulnerable, so if she has a mental disorder or trauma as a result of an early childhood adversity, she may be more likely to be targeted by men who in a sense benefit from powerlessness, inequality and fear.”

She said that warning bells that a relationship is unhealthy include controlling, jealous behaviour such as telling you who you should socialise with, or getting jealous because you are doing better than he is at university.

“Often women think that’s because he cares about me, he’s worried about me and that why he wants to know where I am all the time,”

But this type of behaviour should actually be seen as a warning of future emotional and perhaps physical abuse, Rees said.

Rees said that the reasons women don’t leave violent relationships are complex,

“She may be suffering depression. She may not have the economic resources to leave. She may worry about the children, and rightly so, because often people end up homeless, and she also may know that she’s at high risk of retaliation from the perpetrator if she leaves.”

Rees also explained that it is important for health practitioners to receive training so they can be confident to ask about domestic violence and respond appropriately.

She added that primary health care responses need to be integrated with community-based services to ensure that survivors have access to help that is sensitive to the complex impact of sexual violence.

Edited by Kitty Stapp

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Pakistan’s Paraplegics Learning to Stand on their Own Feethttp://www.ipsnews.net/2014/11/pakistans-paraplegics-learning-to-stand-on-their-own-feet/?utm_source=rss&utm_medium=rss&utm_campaign=pakistans-paraplegics-learning-to-stand-on-their-own-feet http://www.ipsnews.net/2014/11/pakistans-paraplegics-learning-to-stand-on-their-own-feet/#comments Mon, 24 Nov 2014 13:34:03 +0000 Ashfaq Yusufzai http://www.ipsnews.net/?p=137914 Over 2,000 paraplegic women have received treatment and training at the Paraplegic Centre of Peshawar, in northern Pakistan, enabling them to earn a living despite being confined to a wheelchair. Credit: Ashfaq Yusufzai/IPS

Over 2,000 paraplegic women have received treatment and training at the Paraplegic Centre of Peshawar, in northern Pakistan, enabling them to earn a living despite being confined to a wheelchair. Credit: Ashfaq Yusufzai/IPS

By Ashfaq Yusufzai
PESHAWAR, Pakistan , Nov 24 2014 (IPS)

When a stray bullet fired by Taliban militants became lodged in her spine last August, 22-year-old Shakira Bibi gave up all hopes of ever leading a normal life.

Though her family rushed her to the Hayatabad Medical Complex in Peshawar, capital city of Pakistan’s northern-most Khyber Pakhtunkhwa (KP) province, doctors told the young girl that she would be forever bed-ridden.

Bibi fell into a deep depression, convinced that her family would cast her aside due to her disability. Worse, she feared that she would not be able to care for her daughter, particularly since her husband had succumbed to tuberculosis in 2012, making her the sole breadwinner for her family.

“All credit goes to the Paraplegic Centre of Peshawar (PPC), which enabled me to become a working man. Otherwise, my family would have starved to death." -- 40-year-old Muhammad Shahid, a victim of spinal damage
In the end, however, all her worries were for naught.

Today Bibi, a resident of the war-torn North Waziristan Agency, part of Pakistan’s Federally Administered Tribal Areas (FATA), is a successful seamstress and embroiderer, and is skillfully managing the affairs of her small family.

She says it is all thanks to the Paraplegic Centre of Peshawar (PPC), the only one of its kind in Pakistan, where she is currently undergoing intensive physiotherapy. Already Bibi is showing signs of recovery, but this is not the only thing that is making her happy.

“Her real joy is her craft, which she learned here at the Centre,” Bibi’s mother, Zar Lakhta, tells IPS. “We are no longer concerned about her future.”

According to PPC’s chief executive officer, Syed Muhammad Ilyas, the majority of those who suffer injury to their spinal cords remain immobile for life, unable to work and fated to be a burden on loved ones.

“Breaking a bone or two is one thing,” Ilyas tells IPS. “Breaking one’s back or neck is another story altogether.

“Unlike any other bone in our body, the spine, or back bone, not only keeps our body straight and tall, it also protects the delicate nervous tissue called the spinal cord, which serves as a link between our body and the brain,” he asserts.

If this link is severed, a person can literally become a prisoner in their own body, losing bowel and bladder control, as well as the use of their legs. The physical aspect of such an injury alone is enough to plunge a patient into the deepest despair; but there is yet another tragic twist to the story.

“Believe it or not about 80 percent of our patients are the only bread winners of their respective families,” Ilyas explains, “while more then 90 percent live below the poverty line [of less than two dollars a day].”

As a result, finding employment for paraplegics is just as vital as offering physical therapy that might help them regain the use of their lower bodies.

“This is why we have employed experts who teach tailoring, computer sills, dress-making, glass painting and embroidery to our patients,” Ilyas says.

Most families travel between 100 and 400 km to reach the Centre, but their efforts are always rewarded. In addition to skills training, the PPC offers individual and group counseling sessions, all part of a holistic treatment programme aimed at helping patients find dignity and self-worth, to be able to function on their own after being discharged from the PPC.

This has certainly been the case for 40-year-old Muhammad Shahid, who suffered a backbone injury in the Swat district of the Khyber Pakhtunkhwa province back in 2008.

“I was sent to the PPC, after surgery in a government-run hospital, where I learnt embroidery,” he tells IPS. “Now I am working in my home and earn about 300 dollars a month, which I use to educate and feed my two sons and daughter.”

“All credit goes to the PPC, which enabled me to become a working man. Otherwise, my family would have starved to death,” he tells IPS over the phone from his hometown in the Swat Valley.

The PPC was established in 1979 by the International Committee of the Red Cross (ICRC) to provide free treatment to those wounded in the 1979-1989 Soviet War in Afghanistan. Later, the KP government took control of the facility, opening it up to locals in the tribal areas.

The Centre has been a godsend for the thousands who have sustained injuries in crossfire between militants and government forces, who since 2001 have been battling for control of Pakistan’s mountainous regions that border Afghanistan.

Director-general of health services for Khyber Pakhtunkhwa, Dr. Waheed Burki, says more than 40,000 people, including 5,000 security personnel and 3,500 civilians, have been killed since 2005 alone. A further 10,000 have been injured.

Burki says about 90 percent of those who frequent the PPC were injured in war-related incidents.

But Amirzeb Khan, a physiotherapist at the Centre, says that the patients are not all victims of violence. Some have sustained injuries from road traffic accidents and small firearms, while others suffered spinal cord damage as a result of falls from rooftops, trees and electricity poles.

“The majority of the patients are between 20 and 30 years old, which means they fall into the ‘most productive’ age-group,” Khan tells IPS.

Many of these young people come to the Centre fearing the worst; yet almost all leave as productive members of society, armed with the skills necessary to make a living despite being confined to a wheelchair.

Those with minor injuries have even learned how to walk again.

“About 3,000 of our patients are now prospering,” Khan adds. “Of these, roughly 2,000 are women.”

In a country where the average annual income is 1,250 dollars, according to government data, the cost of treating spinal injuries is far greater than most families can afford. In places like the United States and Europe, experts tell IPS, rehabilitating such a patient could run up a bill touching a million dollars.

By offering their services for free, and developing low-cost technologies and equipment, the PPC has closed a yawning health divide in a vastly unequal country, at least for paraplegics.

An administrator named Ziaur Rehman tells IPS that plans are afoot to turn the PPC into a ‘Centre of Excellence’ for patients with spinal cord injuries from all over the country and the region over the next five years.

The hope is to create a multiplier effect, whereby those who receive training here will take their newly acquired skills and pass them on to their respective communities.

A living example of this is 24-year-old Shaheen Begum, who now runs her own embroidery centre in the Hangu district of KP. Immobilised by a back injury in 2011, she underwent rigorous physical therapy at the Centre, while also learning computer skills and fabric painting.

“Now I am imparting these skills to women in my neighbourhood and my children are in good schools,” she tells IPS happily.

Edited by Kanya D’Almeida

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AIDS Is No. 1 Killer of African Teenagershttp://www.ipsnews.net/2014/11/africa-aids-is-no-1-killer-of-teenagers/?utm_source=rss&utm_medium=rss&utm_campaign=africa-aids-is-no-1-killer-of-teenagers http://www.ipsnews.net/2014/11/africa-aids-is-no-1-killer-of-teenagers/#comments Fri, 21 Nov 2014 12:02:19 +0000 Sam Olukoya http://www.ipsnews.net/?p=137909 As AIDS becomes the leading cause of death of adolescents in Africa, empowering youth – especially girls - to make safe life choices and avoid HIV is crucial. Credit: Mercedes Sayagues

As AIDS becomes the leading cause of death of adolescents in Africa, empowering youth – especially girls - to make safe life choices and avoid HIV is crucial. Credit: Mercedes Sayagues

By Sam Olukoya
LAGOS, Nigeria, Nov 21 2014 (IPS)

Two years ago, Shola* was kicked out of the family house in Abeokuta, in southwestern Nigeria, after testing HIV-positive at age 13. He was living with his father, his stepmother and their seven children.

“The stepmother insisted that Shola must go because he is likely to infect her children,” Tayo Akinpelu, programme director of Youth’s Future Savers Initiative, told IPS.

SNAPSHOT: ADOLESCENTS WITH HIV IN TANZANIA
In Tanzania, alarmingly, HIV prevalence has not decreased among adolescents aged 15-19 between 2007 and 2012.
An estimated 165,000 adolescents live with HIV, of whom 97,000 girls and 68,000 boys. Some were born with HIV and others contracted it as children or teens.
To better understand their needs, the Tanzania Commission for AIDS conducted a survey of HIV positive teenagers aged 15-19 in seven regions.
Among its findings:

• Four in ten were sexually active, mostly with a regular partner.
• Just a little more than half reported using condoms at last sex.
• A third reported they had experienced sexual violence. Few had discussed the abuse with friends or relatives or reported it to authorities.
• Just over one-third were aware of family planning and child protection services
The study urges delivering information about child protection and sexual and reproductive health services to teens living with HIV so they can make safe life choices and access care and support.
National HIV prevalence is five percent, according to UNAIDS.
Akinpelu turned to Shola’s mother, who had remarried. But she refused, arguing that his father should be responsible for their son.

“Shola felt as an outcast,” says Akinpelu. Eventually, Shola’s grandparents took him in.

HIV among teenagers is devastating families in Nigeria and elsewhere in Africa, where AIDS has become the leading cause of death among adolescents.

“This is absolutely unacceptable,” says Craig McClure, chief of HIV programmes with the United Nations Children’s Fund (UNICEF), in New York. “What’s more, AIDS-related deaths are decreasing for all age groups except adolescents.”

The global AIDS death toll fell by 30 percent between 2005 and 2012 but increased by 50 percent among adolescents, says a UNICEF report.

Fear of seeking help

One reason for this shocking teen death toll, says Dr. Arjan de Wagt, chief of HIV/AIDS with UNICEF in Abuja, is the low number of adolescents on antiretroviral treatment (ART).

Of the 3.1 million Nigerians living with HIV, half are under 24 years. But only two out of ten HIV positive youth over 15 and just one out of ten under 15 received the lifesaving drugs in 2013, de Wagt told IPS.

Rejection by family and society, as happened to Shola, or fear of rejection, prevents adolescents from seeking help.

“Many HIV positive adolescents are dying in silence because they are too ashamed to access treatment,”’ Blessing Uju, a Lagos-based youth counsellor, told IPS.

“The shame is even bigger for the girls. In Nigeria, if you are HIV positive, the impression is that you are a commercial sex worker,” she says.

Sally* did not tell her parents or siblings when she tested HIV positive four years ago, at age 19.

“At the family level, there is a lot of stigma,” she told IPS.

Although aware of the danger of not taking her medication regularly, Sally often skipped it to avoid being seen with pills at home.

“As a young person, you need a confidant. If you are not strong, you might end up taking your life,” she says.

Teenagers need family help to stay on ART, says Akinpelu.

Shola’s grandparents would normally cook the first meal for the day in the afternoon until Akinpelu explained to them that the pills can cause nausea on an empty stomach and Shola needed a hearty meal earlier.

Uju says that treatment fatigue hits adolescents hard. “Some say they prefer to die than to continue taking their drugs,” she says.

adolescents_graph_unaids

High death toll

Of the 2.1 million adolescents living with HIV worldwide in 2012, more than 80 per cent are in sub-Saharan Africa, according to the United Nations Joint Programme on HIV/AIDS (UNAIDS).

Malawi, with 93,000 HIV positive teenagers, has 6,900 annual AIDS-related adolescent deaths.

The death toll is linked to late diagnosis and starting ART too late, explains Judith Sherman, of UNICEF in Lilongwe.

Malawi’s policy is that all children seen in health facilities should be offered an HIV test. “Unfortunately, this does not happen routinely,” she says.

FAST FACTS

AIDS DEATHS AMONG ADOLESCENTS IN 2013


• South Africa 11,000
• Tanzania 10,000
• Ethiopia 7,900
• Kenya 7,800
• Zimbabwe 6,500
• Uganda 6,300
• Malawi 5,600
• Zambia 4,400
• Mozambique 3,900
• Rwanda 1,200
• Lesotho 1,200

Teenagers’ adherence to ART is lower than adults, says Sherman, “for a range of reasons like treatment fatigue, depression, fear of stigma, denial and unstable family relationships.”

Tanzania’s estimated 165,000 adolescents living with HIV face similar challenges as their peers in Nigeria and Malawi. (see sidebar)

Allison Jenkins, chief of HIV/AIDS with UNICEF in Tanzania, says that one effective way to help teenagers are clubs.

“Teen clubs improve adherence to treatment, especially among members who attend regularly,” she told IPS.

HIV among teen girls

Alarmingly, adolescent HIV prevalence is highly gendered, with teen girls showing infection rates that UNAIDS calls ”unacceptably high”.

Teen girls aged 15-19 in Mozambique have a prevalence of seven per cent, more than double the boys of the same age. Botswana presents a similar scenario.

Lucy Attah, of the Lagos-based Women and Children Living with HIV & AIDS, blames poverty.

“Girls have to trade sex for money to sustain themselves,” she says. “The pressure for money is higher in the cities where teenage girls compete to get the best mobile phones and clothes.”

Adolescents become sexually active, try drugs and alcohol, feel invulnerable, and experience the social and economic pressures of becoming an adult. HIV and the lack of youth-friendly health services compound the problem, says the UNICEF report.

 “We must do more and do it well, focusing on sub-Saharan Africa and on adolescent girls, where the heaviest burden lies,” says McClure.

*names changed to protect privacy

Edited by Mercedes Sayagues

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Depression Casts Cloak of Infertility Over Kashmir Valleyhttp://www.ipsnews.net/2014/11/depression-casts-cloak-of-infertility-over-kashmir-valley/?utm_source=rss&utm_medium=rss&utm_campaign=depression-casts-cloak-of-infertility-over-kashmir-valley http://www.ipsnews.net/2014/11/depression-casts-cloak-of-infertility-over-kashmir-valley/#comments Wed, 19 Nov 2014 12:02:32 +0000 Shazia Yousuf http://www.ipsnews.net/?p=137817 Of the 100 patients seen at Kashmir’s psychiatric facilities each day, roughly 75 are women. Credit: Shazia Yousuf/IPS

Of the 100 patients seen at Kashmir’s psychiatric facilities each day, roughly 75 are women. Credit: Shazia Yousuf/IPS

By Shazia Yousuf
SRINAGAR, India, Nov 19 2014 (IPS)

It was almost midnight when Mushtaq Margoob woke up to the incessant ringing of his phone. It was his patient, a young woman whom Margoob, a renowned Kashmiri psychiatrist and head of the department of psychiatry at the only psychiatric hospital in Kashmir, had been treating for depression for many years.

“See me now. I don’t have time till tomorrow,” the patient screamed down the phone. “I might have killed myself by then.”

The woman was educated, had a PhD in Bioscience and came from a rich family. After her marriage last year, the symptoms of her depression had begun to fade away, and she had started crawling back to a normal life.

“I have gifted lifelong sadness to my daughter.” -- Shahzada Akhtar, a Kashmiri woman living with PTSD
But the day she made the hasty phone call to the doctor, she had learned something that shattered her life into fragments all over again.

“I have been diagnosed with Premature Ovarian Failure [POF],” she said to Margoob at his home. “If I cannot have any children, what should I live my life for?”

Although Margoob was able to pacify her with timely counseling and medication, the diagnosis and the constant reminder of being infertile have taken his patient back into deep depression.

“The mental stress due to ongoing conflict has taken a toll on the physical health of young women, especially their maternal health,” explains Margoob.

Downward spiral of mental and maternal health

The conflict here, which dates back to the 1947 partition of India and Pakistan, has claimed some 60,000 lives as Indian armed forces, Pakistani troops and ordinary Kashmir citizens struggle to assert control over the bitterly contested region.

The “pro-freedom” uprising of 1989, launched by Kashmiris who resented the presence of Indian and Pakistani troops, morphed into a long-standing resistance movement that has left deep scars on Kashmiri society.

As a result, the area known as the Kashmir Valley, tucked in between towering mountain ranges in the northern Indian state of Jammu and Kashmir, is witnessing an alarming increase in childlessness and infertility among local women.

Infertility is becoming increasingly common among young Kashmiri women, who are suffering from stress and trauma due to the long-standing conflict in the region. Credit: Shazia Yousuf/IPS

Infertility is becoming increasingly common among young Kashmiri women, who are suffering from stress and trauma due to the long-standing conflict in the region. Credit: Shazia Yousuf/IPS

Physical and mental health experts cite conflict-related stress as the main cause of the health crisis among women, which has robbed thousands of their fertility.

The most recent Indian National Family Health Survey (NFHS) indicates that 61 percent of currently married Kashmiri women report one or more reproductive health problems.

This is significantly higher in comparison to the national average of 39 percent. The percentage of POF among infertile women below 40 years of age is also abnormally high – 20 to 50 percent – when compared to the nationwide rate of one to five percent.

“Stress causes structural changes in the brain and disturbs the secretion of various neurotransmitters. These changes lead to various physical ailments including thyroid malfunction, which in turn can cause infertility among women of childbearing age,” Margoob explains to IPS.

According to statistics available with the Government Psychiatric Diseases Hospital, 800,000 Kashmiris are suffering from Post Traumatic Stress Disorder (PTSD) and most of them are women. PTSD, like many other mental health disorders, directly affects women’s childbearing capacity.

Stress and stigma

In Kashmir, psychiatry OPDs are run at two hospitals – the Shri Maharaja Hari Singh (S.M.H.S) facility in Srinagar, and the Government Psychiatric Diseases hospital – six days a week. Of almost 100 patients seen at each OPD every day, 75 are females.

One of the many women who frequents these facilities is 20-year-old Mir Afreen, who grew up watching her mother battling mental illness. In 1996, when Afreen was only two, her mother, Shahzada Akhtar, received a message about the death of her cousin brother in cross-fire.

“I had met him only a day before. I couldn’t believe he had died. I tried to cry out his name but had lost my voice,” recalls Akhtar.

Akhtar never recovered from the sudden, devastating news, and soon developed PTSD.

In consequence, her daughter’s childhood quickly slipped into darkness. Afreen often saw her mother sedated, sleeping for days at a time, going without food, and crying for no apparent reason.

She was always taken along to psychiatric clinics, hospitals and faith healers where her mother searched for a cure for her condition. Happiness was far, far away from their home.

“I have gifted lifelong sadness to my daughter,” Akhtar tells IPS tearfully.

Her statement is not too far from the truth. For the last several years, Afreen has been complaining about chest pains and breathlessness. Akhtar first thought it was due to stress, or her daughter’s recent obesity.

But when Afreen developed facial hair and her monthly cycles became irregular, Akhtar took her to a gynecologist.

“The doctor uttered a long name which I couldn’t understand, so I asked her to explain the [condition] to me,” Akhtar says. “She told me if this is not treated, Afreen will never have children.”

Afreen was diagnosed with Polycystic Ovarian Syndrome (PCOS). Unknown and almost non-existent before the conflict, the syndrome now affects 10 percent of Kashmiri females including teenagers.

A major endocrine disorder in women of reproductive age and one of the leading causes of infertility across the world, PCOS has emerged as another major cause of infertility among Kashmiri women in recent years.

Medical experts have identified stress as one of the main reasons for the emergence of PCOS in Kashmir. A study conducted by Sher-i-Kashmir Institute of Medical Sciences (SKIMS), the major tertiary healthcare facility in Kashmir, on 112 women with PCOS, found that 65 to 70 percent of them had psychiatric illnesses including PTSD, depression and Obsessive Compulsive Disorder (OCD).

Akhtar feels helpless. Unlike other ailments, Afreen’s particular health issue is not up for discussion, not even with her own siblings. If the word spreads, she thinks, it will ruin her daughter’s marriage prospects and thus destroy her life.

“Even when I take her to the doctor, I make sure that no one sees us,” reveals Akhtar. “I first check the place and then let my daughter in.”

Afreen does the same. She has not revealed anything about her condition to her friends. When the girls talk about their grooms and life after marriage, she keeps mum. When it is the time for her medication, she secretly swallows the pills without water.

Current trends predict a bleak future

Nazir Ahmad Pala, an endocrinologist at SKIMS, says that more and more young females visit the endocrinology department for various disorders. A good number of disorders, he says, are born from depression.

Anxiety over the possibly loss of male breadwinners is prompting many women to choose education and employment over marriage. Credit: Shazia Yousuf/IPS

Anxiety over the possibly loss of male breadwinners is prompting many women to choose education and employment over marriage. Credit: Shazia Yousuf/IPS

“In the past, the department received mostly older patients but now around 20 percent of our patients are school and college going girls with endocrine abnormalities. This trend is disturbing,” Pala tells IPS.

The young girls mostly complain of obesity and ovulatory disturbances that bring a temporary halt in their menstrual cycles.

The condition is called Central Hypogonadism and is common in depressed women, explains the doctor. Another equally frequent ailment is galactorrhea, a spontaneous secretion of milk from the mammary glands due to an abnormal increase of prolactin levels in the body caused by antidepressant intake.

“Unfortunately most of the [conditions], in one way or the other, lead to infertility. And the root cause of all these [conditions] is the stressful life that women have been living in the post-conflict era,” Pala asserts.

Experts here are sounding warnings about the catastrophic shape that women’s health in the Valley is taking. A study conducted at SKIMS on maternal health indicates that 15.7 percent of Kashmiri women of childbearing age will never have an offspring without clinical intervention.

Another conflict-related cause of infertility among Kashmiri women is late marriages. Over the war years, the marital age has risen from an average of 18-21 to 27-35 years. Because of economic insecurity and anxiety over the prospect of losing male breadwinners, women are choosing education and employment over marriage.

“Economic instability and insecurity is eating our society like termites,” says Margoob.

The doctor reveals that cut-throat competition in schools and colleges to earn a secure future has hugely disturbed the mental health of young girls as well.

Dissociative Disorders (DD), marked by disruptions or breakdowns in identity, memory or perception, are rapidly increasing in young school- and college-going girls, along with conditions like Panic Disorder, all of which interrupt the “smooth journey to motherhood”, Margoob says.

*Patients’ names have been changed on request.

Edited by Kanya D’Almeida

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The Young, Female Face of HIV in East and Southern Africahttp://www.ipsnews.net/2014/11/the-young-female-face-of-hiv-in-east-and-southern-africa/?utm_source=rss&utm_medium=rss&utm_campaign=the-young-female-face-of-hiv-in-east-and-southern-africa http://www.ipsnews.net/2014/11/the-young-female-face-of-hiv-in-east-and-southern-africa/#comments Fri, 07 Nov 2014 07:24:48 +0000 Miriam Gathigah http://www.ipsnews.net/?p=137644 Gender inequalities explain why prevention is failing to contain HIV infection among young women in East and Southern Africa. UNAIDS calls for a major effort to reduce their risk of infection. Credit: Mercedes Sayagues/IPS

Gender inequalities explain why prevention is failing to contain HIV infection among young women in East and Southern Africa. UNAIDS calls for a major effort to reduce their risk of infection. Credit: Mercedes Sayagues/IPS

By Miriam Gathigah
NAIROBI, Nov 7 2014 (IPS)

Experts are raising alarm that years of HIV interventions throughout Africa have failed to stop infection among young women 15 to 24 years old.

“Prevention is failing for young women,” says Lillian Mworeko, HIV expert with International Community of Women Living with HIV in Eastern Africa, based in Uganda.

Among women in East and Southern Africa, four out of ten new HIV infections among women aged 15 years and over happen among  those aged 15 to 24, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Worryingly, HIV infection rates among young women are double or triple those of their male peers. In South Africa, the HIV prevalence of 18 percent among women aged 20-24 is three times higher than in men of the same age. 

The failure of prevention: young women and HIV in East and Southern Africa

In Lesotho, HIV prevalence of four percent among adolescent girls rises four-fold by the time they are 24.

In Botswana, the number of women newly infected with HIV (6,200 in 2012) has only declined by 14 percent since 2009.

The age of consent for marriage is 15 years in Malawi and Tanzania.

Nearly half of all girls in Malawi are married by age 19.

In South Africa, within the 25- 29 year age group, HIV prevalence among women is 28% and 17% among men (UNFPA)

In Tanzania, young women are almost three times more likely to be HIV positive than young men

In Malawi, the number of women acquiring HIV has not decreased since 2009, at 29,000 per year.

In Tanzania, HIV prevalence jumps from one percent among girls under 17 years old to 17 percent by age 24.

In Sub-Saharan Africa, adolescent and young women account for one in four new infections.

Source: UNAIDS

Equally alarming are surveys showing that fewer than two in ten young women know their HIV status.

Experts attribute this high HIV prevalence to gender inequalities, violence against women, limited access to health care, education and jobs, and health systems that do not address the needs of youth.

Biology does not help. Teenage girls’ immature genital tract is more prone to abrasions during sex, opening entry points for the virus, Dr Milly Muchai told IPS.

Muchai, a reproductive health expert in Kenya, says it is not just sex that drives HIV infections among young women but the age of the male sexual partner.

“The risk increases steadily with male partners aged 20 years and over,” she explains.

Older men are more likely to have HIV than teenage boys. The Kenya AIDS Indicator Survey 2012 shows that male HIV prevalence remains low and stable until the age of 24, when it shoots up significantly.

Due to intergenerational sex, women in this region are acquiring HIV five to seven years earlier than men, says Muchai, because these relationships are characterised by multiple sexual partners and low condom use. In transactional sex, the young woman receiving gifts or money loses power to negotiate safe sex.

But Kenya is not a unique scenario.

Shocking figures

In Swaziland, Lesotho and Botswana, more than one in 10 females aged 15 to 24 are living with HIV, according to UNAIDS.

Dr Gang Sun, UNAIDS country director in Botswana, says that, in spite of the country’s remarkable progress in reduction of new infections and treatment, HIV is still a girls’ and women’s epidemic due to gender inequality and unequal power dynamics.

Among Batswana youth aged 20 to 24 years, HIV infection among women triples that of men, nearly 15 percent compared to 5 percent, he says.

Mary Pat Kieffer, senior director at Elizabeth Glaser Paediatric AIDS Foundation in Malawi, told IPS that as teenage girls become older, the risk of infection rises.

In Swaziland, HIV prevalence is six percent for girls aged 15 to 17 but rises to a whopping 43 percent by age 24.

Source: UNICEF

Source: UNICEF

A package of interventions

Kieffer says that many of the issues – poverty, lack of secondary education, few jobs, rape and intimate partner violence – that underpin the unacceptably high HIV prevalence among young women are bigger than what HIV programs alone can address.

Mworeko observes major gaps in reproductive and sexual health services for young people, when they are neither children nor adults, in the region.

“Whether it is prevention, treatment, care and support services, young people do not have a youth friendly corner,” she says.

Paska Kinuthia, youth officer with UNAIDS in South Africa, told IPS that sexuality education needs to be strengthened in schools across the region.

“The regional average of comprehensive knowledge of HIV and AIDS stands at 41 percent for young men and 33 percent for young women,” he says.

Experts agree there is no one single solution to protect young women and a combination of interventions is needed.

Addressing restrictive laws on the age of consent for HIV testing and for access to sexual and reproductive health services would be a good place to start, experts say.

Promoting gender equality and providing jobs for young people are part of the solution, says Sun.

In Tanzania, HIV infection among girls more than triples between 15-19 and 20-24 years.

This fact, says Allison Jenkins, chief of HIV/AIDS with the United Nations Children’s Fund in Dar es Salaam, underlines “the importance of orienting HIV prevention and economic livelihoods interventions during her transition to adulthood.”

For all these reasons, UNAIDS is calling for “a major movement to protect adolescent girls and young women from HIV infection.”

Edited by: Mercedes Sayagues

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Mozambique Tackles its Twin Burden of Cervical Cancer and HIVhttp://www.ipsnews.net/2014/10/mozambique-tackles-its-twin-burden-of-cervical-cancer-and-hiv/?utm_source=rss&utm_medium=rss&utm_campaign=mozambique-tackles-its-twin-burden-of-cervical-cancer-and-hiv http://www.ipsnews.net/2014/10/mozambique-tackles-its-twin-burden-of-cervical-cancer-and-hiv/#comments Fri, 31 Oct 2014 05:27:07 +0000 Mercedes Sayagues http://www.ipsnews.net/?p=137498 http://www.ipsnews.net/2014/10/mozambique-tackles-its-twin-burden-of-cervical-cancer-and-hiv/feed/ 0 OPINION: The Survivorshttp://www.ipsnews.net/2014/10/opinion-the-survivors/?utm_source=rss&utm_medium=rss&utm_campaign=opinion-the-survivors http://www.ipsnews.net/2014/10/opinion-the-survivors/#comments Fri, 17 Oct 2014 15:19:03 +0000 Yury Fedotov http://www.ipsnews.net/?p=137243

Yury Fedotov is Executive Director of the UN Office on Drugs and Crime

By Yury Fedotov
VIENNA, Oct 17 2014 (IPS)

Oct. 18 is the EU’s Anti-Trafficking Day, as well as the United Kingdom’s Anti-Slavery Day. These events offer a good opportunity to talk about human trafficking within Europe’s borders, but we should not forget that there are victims and survivors all over the world.

People like Grace, not her real name, who grew up in a large family in Western Nigeria. On leaving high school her uncle lured Grace to Lagos with false promises that her education would continue. But instead of libraries and lessons, this young Nigerian girl was forced to wear suggestive clothing and work long hours in her uncle’s beer parlour. She was pressured into sleeping with any customer willing to pay. Her aunt kept the money.

Courtesy of UNODC

Courtesy of UNODC

Those who are trafficked, like Grace, are often destitute, alone and afraid. In the face of exploitation and constant abuse it is difficult to summon the courage to flee. Fortunately, she had access to a radio and overheard a show on human trafficking.

One of the interviewees, a staff member for the African Centre for Advocacy and Human Development, encouraged anyone needing help to contact the centre. Grace realised there might be a way out.

Grace approached the centre after running away from her aunt and uncle. She was given a medical examination, as well as a place to sleep and counselling. The centre later sponsored her training as a seamstress, and later, with support, she was able to open a shop to sell her clothes. Grace had successfully taken the long journey from victim to human trafficking survivor.

Although Grace’s cruel experiences are individual to her, they are sadly not unique. In its publication, Hear Their Story, the UN Office on Drugs and Crime (UNODC) highlights numerous stories of children and young people forced to sell themselves, and their labour.

UNODC’s human trafficking report found that 136 different nationalities detected in 118 countries between 2007 and 2010, making this a truly global crime.

Around 27 per cent of those trafficked are children forced into numerous sordid occupations, including petty crime, begging and the sex trade. 55-60 per cent of individuals trafficked globally are women. If the figure for women is added to those for young girls, it becomes 75 per cent.

The majority of these women are coerced into the sex trade; many others find themselves working as domestic servants or forced labour. There is also a commonly held myth that men are not trafficked. This is untrue. Men are also exploited for forced labour and can suffer extreme forms of abuse.

To counter this crime that shreds both dignity and human rights, there is a need to work constantly at the grassroots level. We have to be present where the traffickers are committing their gross crimes, and where victims can be helped to make the transition to a new life.

Countries also need to ratify and adopt the Convention Against Transnational Organized Crime and its protocol on human trafficking. The Convention creates a legal framework for mutual legal assistance and other means of tackling organised crime. But what is really needed is comprehensive data, meaning better reporting from countries, and proper funding.

In 2011, the UN Voluntary Trust Fund for human trafficking managed by UNODC, and which has a special emphasis on children, provided grants to 11 organisations working at the ground level. Thanks to their work, children and young adults, such as Grace, have been supported. But more funds are needed to provide legal support and advice, treatment for physical abuse, safe houses, additional life skills, as well as schooling and training.

Grace’s life changed when she heard a radio story that helped her become a survivor. On the EU’s Anti-Trafficking Day and the UK’s Anti-Slavery Day, we have to ensure that other victims find their voices, and when they escape or are freed, we are waiting to offer much needed protection.

Edited by Kitty Stapp

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Displacement Spells Danger for Pregnant Women in Pakistanhttp://www.ipsnews.net/2014/10/displacement-spells-danger-for-pregnant-women-in-pakistan/?utm_source=rss&utm_medium=rss&utm_campaign=displacement-spells-danger-for-pregnant-women-in-pakistan http://www.ipsnews.net/2014/10/displacement-spells-danger-for-pregnant-women-in-pakistan/#comments Wed, 08 Oct 2014 12:41:56 +0000 Ashfaq Yusufzai http://www.ipsnews.net/?p=137065 A doctor examines a woman in an IDP camp in Bannu, a city in Pakistan’s northern Khyber Pakhtunkhwa (KP) province, where over 40,000 pregnant women are at risk due to a lack of maternal health services. Credit: Ashfaq Yusufzai/IPS

A doctor examines a woman in an IDP camp in Bannu, a city in Pakistan’s northern Khyber Pakhtunkhwa (KP) province, where over 40,000 pregnant women are at risk due to a lack of maternal health services. Credit: Ashfaq Yusufzai/IPS

By Ashfaq Yusufzai
PESHAWAR, Pakistan, Oct 8 2014 (IPS)

Imagine traveling for almost an entire day in the blistering sun, carrying all your possessions with you. Imagine fleeing in the middle of the night as airstrikes reduce your village to rubble. Imagine arriving in a makeshift refugee camp where there is no running water, no bathrooms and hardly any food. Now imagine making that journey as a pregnant woman.

In northern Pakistan, a military campaign aimed at ridding the Federally Administered Tribal Areas (FATA) of Taliban militants has led to a humanitarian crisis for hundreds of thousands of civilians.

When the army began conducting air raids on the 11,585-square-km North Waziristan Agency on Jun. 15, residents were forced to flee – most of them on foot – to the neighbouring Khyber Pakhtunkhwa (KP) province, where they have now taken refuge in sprawling IDP camps.

“In Pakistan, 350 women die per 100,000 live births from pregnancy-related complications. In FATA, the situation is extremely bad, with 500 women dying for every 100,000 live births. The situation warrants urgent attention.” -- Fayyaz Ali, a public health expert in Pakistan's Khyber Pakhtunkhwa province
Officials estimate the number of displaced at just over 580,000, of which half are women.

In the ancient city of Bannu, which now houses the largest number of refugees, some 40,000 pregnant women are facing up to their ultimate fear: a lack of hospitals, doctors and basic medical supplies.

For 30-year-old Tajdara Bibi, a mother of three, these fears became a reality in June, when she had to flee her home in North Waziristan and trudge the 55 km to KP along with her fellow villagers.

The journey wore her down, and by the time she was admitted to the maternity hospital in Bannu, the doctors were too late: she delivered a stillborn baby a few hours later.

Muhammad Sarwar, who attended to Bibi, told IPS that an extreme shortage of female doctors has put pregnant women on a knife’s edge.

“At least four women died of pregnancy-related complications on the way to Bannu, while 20 others had miscarriages at the hospital,” he said.

“We have only four female doctors in the whole district, who are required to provide treatment to all the women,” he added.

With thousands of women now clamouring for care, the province’s limited healthcare services are falling short, sometimes with disastrous consequences.

Gul Rehman, a 44-year-old shopkeeper, is still reeling from a recent tragedy. He told IPS his wife went into labour prematurely during the arduous journey to Bannu.

“We could not find transport so we had to walk. When we finally reached the hospital, we were kept waiting… there were no doctors readily available.

“After 10 hours, they finally operated on my wife – but the baby was already dead,” he explained. Aside from the trauma of losing their child, the couple is also struggling to cope with the wife’s health condition, which has deteriorated rapidly after the stillbirth.

According to Fawad Khan, Health Cluster and Emergency Coordinator for the World Health Organisation (WHO) in Pakistan, existing health facilities are not equipped to deal with the wave of arrivals from North Waziristan.

The WHO is currently assisting the KP health department to “prevent unnecessary deaths”, the official told IPS, adding that 73 percent of displaced women and children in Bannu are in “desperate need of care.”

Some 30 percent of pregnant women among IDPs are at risk of delivery-related complications, a situation that could easily be addressed by upgrading existing facilities. There is also an urgent need for gynaecologists to provide antenatal and postnatal care, he stated.

Twelve health centres have already been established to tackle malnutrition among women and children in the camps. Without proper nourishment, officials fear pregnant women will face additional complications during birth, and low birth-weight among newborns could create additional challenges for health workers.

“Four percent of the total displaced women are pregnant and need immediate attention,” Abdul Waheed, KP’s director-general of health, told IPS, adding that some 20 basic health units have already been strengthened to take on those most in need.

Still, the crisis has reached proportions that even seasoned officials are scarcely able to comprehend. Waheed explained that Bannu has never before had to host such a large population of homeless people, and is struggling to cope.

Prior to the recent wave of refugees from North Waziristan, the KP province had already welcomed over 1.5 million people from FATA. This latest influx brings the number of displaced since 2001 to over 2.5 million.

“We are sending doctors from teaching hospitals in Peshawar [capital of KP] on a rotational basis to meet the situation,” he asserted.

The United Nations Children’s Fund (UNICEF) and the U.N. Population Fund (UNFPA) have joined the WHO in supporting the Pakistan government’s push for improved health services. Some 65 doctors from the Pakistan Institute of Medical Sciences (PIMS) in Islamabad have joined NGO workers in Bannu to provide urgent care.

Part of the problem, according to Ali Ahmed, KP’s focal person for IDPs, is that few medical professionals are keen to take up posts in the militancy-infested region. For years the Taliban have operated with impunity in these federal areas, hiding out along the mountainous border with Afghanistan that stretches for some 2,400 km.

The military’s counter-insurgency programme was launched in a bid to finally wipe out extremist elements that fled Afghanistan during the U.S. invasion in 2001 and took root along the porous border.

But until the region regains a sense of normalcy, it will be hard to lure professionals here, officials say. Despite being offered lucrative packages, doctors have refused to take up posts, even temporarily, in Bannu.

The government is looking to fill this gap by appointing 10 doctors, including five female doctors, to the newly renovated Women and Children Hospital, which remains understaffed and ill equipped.

The city’s other two category ‘B’ hospitals, the Khalifa Gul Nawaz Teaching Hospital (KGTH) and the District Headquarters Teaching Hospital, suffer similar setbacks, while the arrival of the IDPs has more than tripled the number of patients demanding services, Ahmed said.

Three rural health centres in close proximity to the refugee camps, as well as 34 basic health units, have received an injection of funds and resources, and 20 assistant nutritional officers have been deployed to cater to the needs of 41 percent of affected children, he told IPS.

But far greater efforts will be needed to tackle the crisis, which is compounding an already bleak picture of maternal health in Pakistan.

Fayyaz Ali, a public health expert here in KP, told IPS, “In Pakistan, 350 women die per 100,000 live births from pregnancy-related complications. In FATA, the situation is extremely bad, with 500 dying for every 100,000 live births. The situation warrants urgent attention.”

Edited by Kanya D’Almeida

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Floods Wash Away India’s MDG Progresshttp://www.ipsnews.net/2014/10/floods-wash-away-indias-mdg-progress/?utm_source=rss&utm_medium=rss&utm_campaign=floods-wash-away-indias-mdg-progress http://www.ipsnews.net/2014/10/floods-wash-away-indias-mdg-progress/#comments Tue, 07 Oct 2014 17:52:07 +0000 Priyanka Borpujari http://www.ipsnews.net/?p=137040 When isolated by floodwaters, families have no choice but to use boats for transportation; even children must learn the survival skill of rowing. Here in India’s Morigaon district, one week of rains in August affected 27,000 hectares of land. Credit: Priyanka Borpujari/IPS

When isolated by floodwaters, families have no choice but to use boats for transportation; even children must learn the survival skill of rowing. Here in India’s Morigaon district, one week of rains in August affected 27,000 hectares of land. Credit: Priyanka Borpujari/IPS

By Priyanka Borpujari
MORIGAON, India, Oct 7 2014 (IPS)

The northeastern Indian state of Assam is no stranger to devastating floods. Located just south of the eastern Himalayas, the lush, 30,000-square-km region comprises the Brahmaputra and Barak river valleys, and is accustomed to annual bouts of rain that swell the mighty rivers and spill over into villages and towns, inundating agricultural lands and washing homes, possessions and livestock away.

Now, the long-term impacts of such natural disasters are proving to be a thorn in the side of a government that is racing against time to meet its commitments under the Millennium Development Goals (MDGs), a set of poverty reduction targets that will expire at the year’s end.

A woman dries blankets after her home went underwater for five days in one of the villages of the Morigaon district. The woven bamboo sheet beyond the clothesline used to be the walls of her family’s toilet. August rains inundated 141 villages in the district. Credit: Priyanka Borpujari/IPS

A woman dries blankets after her home went underwater for five days in one of the villages of the Morigaon district. The woven bamboo sheet beyond the clothesline used to be the walls of her family’s toilet. August rains inundated 141 villages in the district. Credit: Priyanka Borpujari/IPS

Target 7C of the MDGs stipulated that U.N. member states would aim to halve the proportion of people living without sustainable access to safe drinking water and basic sanitation by 2015.

While tremendous gains have been made towards this ambitious goal, India continues to lag behind, with 60 percent of its 1.2 billion people living without access to basic sanitation.

Diving into the river is an easy solution to a lack of bathrooms for children and men, even though the water has been stagnant for about a month. Skin rashes are the most common ailment caused by contact with unclean water, according to village doctors. Credit: Priyanka Borpujari/IPS

Diving into the river is an easy solution to a lack of bathrooms for children and men, even though the water has been stagnant for about a month. Skin rashes are the most common ailment caused by contact with unclean water, according to village doctors. Credit: Priyanka Borpujari/IPS

Now, recurring floods and other disasters are putting further strain on the government, as scores of people are annually displaced, and left without safe access to water and sanitation. In 2012 alone, floods displaced 6.9 million people across India.

Currently, Assam is one of the worst hit regions.

Floods in Morigaon have submerged about 45 roads in the district. Most people wade through the water, believing this is quicker than waiting for a rickety boat to transport them across. Credit: Priyanka Borpujari/IPS

Floods in Morigaon have submerged about 45 roads in the district. Most people wade through the water, believing this is quicker than waiting for a rickety boat to transport them across. Credit: Priyanka Borpujari/IPS

Since May this year, several waves of floods have affected more than 700,000 people across 23 of the state’s 27 districts, claiming the lives of 68 people.

In places where roads have collapsed, the government has erected bamboo bridges. When the government is absent, locals do this work themselves. This man and child travel from one village to another on a boat, and travel by foot over the bridges. Credit: Priyanka Borpujari/IPS

In places where roads have collapsed, the government has erected bamboo bridges. When the government is absent, locals do this work themselves. This man and child travel from one village to another on a boat, and travel by foot over the bridges. Credit: Priyanka Borpujari/IPS

Heavy rainfall during one week of August devastated the Morigaon and Dhemaji districts, and the river island of Majuli. A sudden downpour that lasted two days in early September in parts of Assam and the neighbouring state of Meghalaya claimed 44 and 55 lives respectively.

Men transporting milk from Dhemaji to Dibrugarh district across the Brahmaputra River wash their utensils in the river. The lack of hygiene and proper sanitation facilities is a severe concern in flood-affected areas. Credit: Priyanka Borpujari/IPS

Men transporting milk from Dhemaji to Dibrugarh district across the Brahmaputra River wash their utensils in the river. The lack of hygiene and proper sanitation facilities is a severe concern in flood-affected areas. Credit: Priyanka Borpujari/IPS

The Indian federal government last week announced its intention to distribute some 112 million dollars in aid to the affected population.

In Dhemaji district, closer to the northeastern Indian state of Arunachal Pradesh, people use a rope boat in the absence of a road. Credit: Priyanka Borpujari/IPS

In Dhemaji district, closer to the northeastern Indian state of Arunachal Pradesh, people use a rope boat in the absence of a road. Credit: Priyanka Borpujari/IPS

One of the primary concerns for officials has been the sanitation situation in the aftermath of the floods, with families forced to rig up makeshift sanitary facilities, and women and children in particular made vulnerable by a lack of water and proper toilets.

Women from the Mishing community in Dhemaji district are shocked by the siltation caused by the floods. Their homes on stilts – known as chaang ghor – are built on a raised platform. But the sands have submerged the homes in this village by two feet. Credit: Priyanka Borpujari/IPS

Women from the Mishing community in Dhemaji district are shocked by the siltation caused by the floods. Their homes on stilts – known as chaang ghor – are built on a raised platform. But the sands have submerged the homes in this village by two feet. Credit: Priyanka Borpujari/IPS

Directly following the floods, the ministry of drinking water and sanitation advised the public health and engineering department of the Assam government to “urgently” make provision for such disasters, particularly ensuring safe water for residents in remote rural areas.

Women from Rekhasapori village in Dhemaji district walk on the hot sand towards a health camp set up by Save The Children. Most people complain of rashes, and acidity from acute hunger. Credit: Priyanka Borpujari/IPS

Women from Rekhasapori village in Dhemaji district walk on the hot sand towards a health camp set up by Save The Children. Most people complain of rashes, and acidity from acute hunger. Credit: Priyanka Borpujari/IPS

Among other suggestions, the ministry recommended the “hiring of water tankers for emergency water supply to affected sites […], procuring of sodium hypochlorite, halogen tablets and bleaching powder for proper disinfection [and] hiring of sufficient vehicles fitted with water treatment plants to provide onsite safe drinking water.”

Mohini Pait delivered her daughter on the day after floods in the Rekhasapori village of Assam state washed her house away. She and her baby are currently living in one of many relief camps that dot the roads in flood-affected areas throughout Assam. Credit: Priyanka Borpujari/IPS

Mohini Pait delivered her daughter on the day after floods in the Rekhasapori village of Assam state washed her house away. She and her baby are currently living in one of many relief camps that dot the roads in flood-affected areas throughout Assam. Credit: Priyanka Borpujari/IPS

In Morigaon and Dhemaji, families are slowly trying to pick up the pieces of their lives, but experts say unless proper disaster management measures are put in place, the poorest will suffer and floods will continue to erode India’s progress towards the MDGs.

Edited by Kanya D’Almeida

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Q&A: “The Battle Continues”http://www.ipsnews.net/2014/10/qa-the-battle-continues/?utm_source=rss&utm_medium=rss&utm_campaign=qa-the-battle-continues http://www.ipsnews.net/2014/10/qa-the-battle-continues/#comments Sat, 04 Oct 2014 05:17:35 +0000 Joan Erakit http://www.ipsnews.net/?p=137000 Shahida Amin, a young Pakistani woman, brings her 10-month-old son to school every day. Credit: Farooq Ahmed/IPS

Shahida Amin, a young Pakistani woman, brings her 10-month-old son to school every day. Credit: Farooq Ahmed/IPS

By Joan Erakit
UNITED NATIONS, Oct 4 2014 (IPS)

The Programme of Action adopted at the landmark 1994 International Conference on Population and Development (ICPD) included chapters that defined concrete actions covering some 44 dimensions of population and development, including the need to provide for women and girls during times of conflict, the urgency of investments in young people’s capabilities, and the importance of women’s political participation and representation.

The diversity of issues addressed by the Programme of Action (PoA) provided the opportunity for states to develop and implement a “comprehensive and integrated agenda”.

In reality, governments and development agencies have been selective in their actions, and many have taken a sectoral approach to implementation, which has resulted in fragmented successes rather than holistic gains.

Few are better placed to reflect on progress made over the last two decades than the executive director of the United Nations Population Fund (UNFPA), Dr. Babatunde Osotimehin.

Excerpts from the interview follow.

Q: In 1994 you were advocating for reproductive health and rights at the first ICPD in Cairo. Twenty years later, you are leading UNFPA as its executive director. What has that journey looked like for you?

A: The last four years have opened me up to the challenges that the organisation and the mandate itself have faced. Twenty years ago, we were able to secure commitments from governments on various aspects of poverty reduction, but more importantly the empowerment of women and girls and young people, including their reproductive rights – but the battle is not over.

Today, we are on the cusp of a new development agenda and we, as custodians of this agenda, need to locate it within the conversation of sustainable development – a people-centred agenda based on human rights is the only feasible way of achieving sustainable development.

Q: What were some of the biggest challenges that the ICPD Programme of Action faced in its early years?

Babatunde Osotimehin, executive director of UNFPA, the United Nations Population Fund. Credit: UNFPA

Babatunde Osotimehin, executive director of UNFPA, the United Nations Population Fund. Credit: UNFPA

A: I think that Cairo was very cognizant of the status of women in society. It was also cognizant of the status of girls – particularly of young adults, and of the issues of sexuality and the power struggle between men and women over who decides on the sexuality of women.

The battle is not strictly about a woman’s ability to control her fertility, but it goes beyond the issue of fertility and decision-making. Women still earn less than men for doing the same job. There is no proportional representation in politics of women, and in the most severe cases, little girls don’t go to school as much as boys.

That is a continuous struggle, and our job is to ensure that gender equality in the very strict sense is accomplished, so we achieve what I always refer to as a “gender neutral” society.

Q: The Demographic Dividend is going to be an important focus in the post-2015 development agenda. How will UNFPA work to assess and meet the needs of young people?

A: We are already doing it!

Of course, we are going to strengthen and scale up our work. We don’t pretend that UNFPA can provide all the inputs needed to reap the dividend. But raising the bar and promoting youth visibility and participation at the political level is something that we will be doing with member states and partners.

For example, how do we ensure that we can partner with UNESCO, to continue to do the good work they are doing in terms of education – particularly with girls’ education? And how can we partner with ILO [the International Labour Organisation] to ensure that we have job creation, skills and all of the things that enable young people to come into the job market to get the opportunities they are looking for?

How do we ensure that within member states themselves, we’re creating spaces that enable young people to feel that they are part of the system?

It is impossible to get the kind of rapid development we’re looking at if member states do not accept the principles of comprehensive sexuality education, and do not accept that young people should also be exposed to information and services about contraception.

Q: How will you respond to women and girls in conflict areas, especially pregnant women or those who have faced violence and abuse?

A: That’s something we do superbly. We are also conscious of the fact that the world may see more crises. Today, we are looking at Gaza, we are looking at Syria, we are looking at Iraq, we are looking at the Central African Republic, we are looking at South Sudan, we are looking at old conflict areas in the world, which are still there. We cannot forget the IDPs [Internally Displaced Persons] who have existed for so long in northern Kenya, in the Zaatari Camp in Jordan, these are areas where we work actively.

We offer three types of response: services for girls and women to prevent GBV [gender-based violence]; services for the survivors of GBV, so that they can receive care for the physical assault; and services for their emotional and psychological support so that they are reintegrated back into the society.

We provide education, antenatal care, delivery services and postnatal care for women in camps and mothers around the world.

Our flagship programme, before we expanded to all of this, was recognising that women in conflict areas have dignity needs. Very few people think of women and their regular needs in war and conflict, so we provide them dignity kits, to enable them to preserve their health and dignity.

Something UNFPA has been trying to do more is increase attention to and prevent GBV and talk about it in such a way that we can show that it’s actually more prevalent than it is assumed, not only in conflict, but in domestic circumstances as well.

This story originally appeared in a special edition TerraViva, ‘ICPD@20: Tracking Progress, Exploring Potential for Post-2015’, published with the support of UNFPA, the United Nations Population Fund. The contents are the independent work of reporters and authors.

Edited by Kanya D’Almeida

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OPINION: On Reproductive Rights, Progress with Concernshttp://www.ipsnews.net/2014/10/opinion-on-reproductive-rights-progress-with-concerns/?utm_source=rss&utm_medium=rss&utm_campaign=opinion-on-reproductive-rights-progress-with-concerns http://www.ipsnews.net/2014/10/opinion-on-reproductive-rights-progress-with-concerns/#comments Wed, 01 Oct 2014 16:29:45 +0000 Joseph Chamie http://www.ipsnews.net/?p=136954 Contraceptives on sale at a store in Sanaa, Yemen. Credit: Rebecca Murray/IPS

Contraceptives on sale at a store in Sanaa, Yemen. Credit: Rebecca Murray/IPS

By Joseph Chamie
NEW YORK, Oct 1 2014 (IPS)

For most of human history, reproductive rights essentially meant men and women accepting the number, timing and spacing of their children, as well as possible childlessness. All this changed radically in the second half of the 20th century with the introduction of new medical technologies aimed at both preventing and assisting human reproduction.

Those technologies ushered in historic changes in reproductive rights and behaviour that continue to reverberate around the world, giving rise to increasingly complex theological, ethical and legal concerns that need to be addressed.New reproductive technologies have given rise to serious theological, ethical and legal concerns that have not been satisfactorily addressed.

Up until around the middle of the past century, reproductive rights were limited. The available birth control methods were rhythm, coitus interruptus (withdrawal), condoms and for some, the diaphragm.

Those methods in too many instances were unreliable and not considered user friendly. Also, while induced abortion has been practiced for ages, it was a drastic, dangerous and largely unlawful medical procedure.

In 1960, the oral contraceptive pill was introduced, dramatically transforming women’s reproductive rights and behaviour. In addition to the pill, modern methods of family planning, including the intra uterine device (IUD), injectables, implants, emergency contraceptive pills and sterilisation, have given women and men effective control over procreation.

Modern contraceptives have contributed to major changes in sexual behaviour and marriage. Women empowered with modern contraception can choose without the fear of pregnancy whether to have sexual relationships, enabling them to postpone childbearing or avoid it altogether.

And instead of marriage, cohabitation has become increasingly prevalent among many young couples, especially in industrialised countries.

The use of modern contraceptives also facilitated a rapid decline in family size worldwide. Between 1950 and the close of the 20th century, the world’s total fertility rate fell from five children per woman to nearly half that level.

Every major region of the world experienced fertility declines during that half century, with the greatest occurring in Asia and Latin America and the smallest in Africa.

With improved medical techniques, changing social norms and grassroots movements, induced abortion also became increasingly legalised globally. Although some remain strongly opposed to induced abortion, nearly all industrialised countries have passed laws ensuring a woman’s right to abortion.

Also at the 1994 International Conference on Population and Development (ICPD), 179 governments indicated their commitment to prevent unsafe abortion and in circumstances where abortion is not against the law, such abortion should be made safe.

Reproductive rights to terminate a pregnancy, however, have also led to excess female fetus abortions. Particularly widespread in China and India, their sex ratios at birth of 117 and 111 boys per 100 girls are blatantly higher than the typical sex ratio at birth of around 106.

Consequently, the numbers of young “surplus males” unable to find brides are more than 35 million in China and 25 million in India.

The introduction in 1970 of in vitro fertilisation (IVF) – fertilisation in a laboratory by mixing sperm with eggs surgically removed from an ovary followed by uterine implantation – radically altered the basic evolutionary process of human reproduction.

IVF provides childless couples the right and means to have biological children. It is estimated that more than five million IVF babies have followed since the birth of the first “test-tube baby” in 1978.

However, IVF has also raised ethical concerns. In addition to creating a pregnancy through “artificial” means, IVF has become a massive commercial industry prone to serious abuses and exploitation of vulnerable couples in the desire to make profits from childbearing.

IVF also permits gestational surrogacy, which extends reproductive rights to same-sex couples. In contrast to traditional surrogacy, where the surrogate is the actual mother, gestational surrogacy allows the surrogate to be unrelated to the baby with the egg coming from the intended mother or donor.

While those who are childless have a right to have biological children, gestational surrogacy raises challenging ethical questions, such as the exploitation of poor women, as well as complex legal issues, especially when transactions cross international borders.

In 1997, the cloning – or propagation by self-replication rather than through sexual reproduction – of the first mammal, Dolly the sheep, was achieved. The birth of Dolly was a major reproductive development.

Following the cloning of Dolly, scores of other animals, including fish, mice, cows, horses, dogs and monkeys, have been successfully cloned. These developments suggest that in the near future some humans may wish to assert their reproductive rights to be cloned, again raising serious theological, ethical and legal questions.

Among the transhumanist reproductive technologies imagined in the more distant future, one that stands out is ectogenesis, or the development of a fetus outside the human womb in an artificial uterus.

While ectogenesis may expand the extent of fetal viability, free women from childbearing and expand reproductive rights, it poses serious, unexplored medical, ethical and legal issues.

During the past half-century remarkable technological progress has been made in human reproduction. As a result of this medical progress, women and men have acquired wide-ranging reproductive rights and technologies to determine the number, timing and spacing of their children and to overcome childlessness with biological offspring.

The new reproductive technologies, however, have also given rise to serious theological, ethical and legal concerns that have not been satisfactorily addressed. Anticipated future medical breakthroughs in human reproduction make it even more imperative for the international community of nations to address the growing challenges and concerns regarding reproductive technologies and rights.

Edited by Kitty Stapp

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Zimbabwe’s Family Planning Dilemmahttp://www.ipsnews.net/2014/10/zimbabwes-family-planning-dilemma/?utm_source=rss&utm_medium=rss&utm_campaign=zimbabwes-family-planning-dilemma http://www.ipsnews.net/2014/10/zimbabwes-family-planning-dilemma/#comments Wed, 01 Oct 2014 01:58:02 +0000 Ignatius Banda http://www.ipsnews.net/?p=136924 There has been an increase in pregnancies among Zimbabwean adolescents aged 15-19 years, from 21 percent between 2005 and 2006 to 24 percent between 2010 and 2011. Credit: Credit: Jeffrey Moyo/IPS

There has been an increase in pregnancies among Zimbabwean adolescents aged 15-19 years, from 21 percent between 2005 and 2006 to 24 percent between 2010 and 2011. Credit: Credit: Jeffrey Moyo/IPS

By Ignatius Banda
BULAWAYO, Zimbabwe, Oct 1 2014 (IPS)

Pregnant at 15, Samantha Yakubu* is in a fix. The 16-year-old boy she claims was responsible for her pregnancy has refused to accept her version of events, insisting that he was “not the only one who slept with her”.

Now Yakubu has dropped out of school and, like many sexually active youth in Zimbabwe, faces an uncertain future.

The issue of contraceptive use remains controversial and divisive in this country of 13.72 million people.

Parents and educators are agreed on one thing: that levels of sexual activity among high-school students are on the rise. What they do not agree on, however, is how to deal with the corresponding inrcrease in teenage pregnancies.

“Lack of adequate, medically accurate information on puberty leaves young people dependent on uninformed peer sources and unguided Internet searches for information." -- Stewart Muchapera, communications analyst with the UNFPA in Zimbabwe.
While Zimbabwe has made huge gains in some areas of reproductive health, including stemming new HIV infections, according to the Health Ministry, various United Nations agencies have raised concerns about the growing number of adolescent pregnancies, which experts say point to a low use of prophylactics and a dearth of other family planning methods.

According to the U.N. Population Fund (UNFPA), contraceptive use in Zimbabwe stands at 59 percent, one of the highest in sub-Saharan Africa. Still, this is lower than the 68 percent mark that the government pledged to achieve by 2020 at the 2012 London Summit on Family Planning.

A proposal last year by a senior government official to introduce contraceptives into schools, allowing condoms to be distributed free of charge, was met with disbelief and anger among parents, who insisted this was tantamount to promoting promiscuity among learners.

There is still no agreement between parents and educators about the stage at which students can be introduced to sex education.

“Lack of adequate, medically accurate information on puberty leaves young people dependent on uninformed peer sources and unguided Internet searches for information,” says Stewart Muchapera, a communications analyst with the UNFPA in Zimbabwe.

“The fertility rate among teenage girls aged 15-19 in 2010/11 was 115 per 1,000 girls, a significant increase from 99 per 1,000 girls in 2005/6,” Muchapera tells IPS, adding that geographic location also determines the likelihood of early pregnancy, with girls living in rural areas twice as likely to be affected than their urban counterparts.

In fact, the rate of adolescent pregnancies is just 70 per 1,000 girls in urban areas, compared to 144 per 1,000 girls in rural areas, he adds.

The Zimbabwe Demographic and Health Survey (ZDHS) reports that nine out of 10 sexually active girls aged 15 to 19 are in some form of a marriage, and that for two out of three girls who first had sex before age the of 15, sex was forced against their will.

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

Currently, Zimbabwe has a maternal mortality ratio of 790 deaths per 100,000 live births and an under-five mortality rate of 93 deaths per 1,000 live births.

Janet Siziba, a peer educator with the Matabeleland Aids Council, says there is a stigma attached to early pregnancy, with many forced to drop out of school or endure financial hardships after the birth of a child, particularly after the disappearance of an adolescent father.

“You can escape both pregnancy and HIV by increased condom use and, perhaps more importantly, by using other female contraceptives [such as the female condom and oral contraceptives],” Siziba tells IPS.

But with young people getting mixed messages on contraceptives, the trend is unlikely to change anytime soon. In fact, the country’s registrar-general Tobaiwa Mudede has actually warned women against using contraceptives, on the grounds that they cause cancer and are a ploy by developed countries to stem population growth in Africa.

Family planning advocates including the Zimbabwe National Family Planning Council (ZNFPC) called his comments retrogressive especially at a time when the country’s health system is struggling to stem maternal mortality and also provide adequate antenatal care.

Through its National Adolescent Sexual and Reproductive Health Strategy (ASRH), the Ministry of Health now allows adolescents to access contraceptives at public institutions such as clinics and hospitals, but peer educators are concerned that youth are not too eager to collect contraceptives in full view of the public.

The result is an increase in pregnancies among adolescents in the 15-19 age group from 21 percent between 2005 and 2006 to 24 percent between 2010 and 2011.

Experts say that conservative attitudes towards contraceptive use could slow down global efforts under the multi-sector Family Planning 2020 (FP2020) initiative, which seeks to increase access to contraception for women and girls between 15 and 49 years of age in developing countries.

According to the Bill and Melinda Gates Foundation–supported FP2020 project, 260 million people from developing countries had access to contraceptives in 2012, and the initiative aims to add 120 million more by the year 2020.

*Names have been changed

This story originally appeared in a special edition TerraViva, ‘ICPD@20: Tracking Progress, Exploring Potential for Post-2015’, published with the support of UNFPA, the United Nations Population Fund. The contents are the independent work of reporters and authors.

Edited by Kanya D’Almeida

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Lack of Accountability Fuels Gender-Based Violence in Indiahttp://www.ipsnews.net/2014/09/lack-of-accountability-fuels-gender-based-violence-in-india/?utm_source=rss&utm_medium=rss&utm_campaign=lack-of-accountability-fuels-gender-based-violence-in-india http://www.ipsnews.net/2014/09/lack-of-accountability-fuels-gender-based-violence-in-india/#comments Tue, 30 Sep 2014 00:32:31 +0000 Stella Paul http://www.ipsnews.net/?p=136927 Women in the north Indian village of Katra Shadatganj in the state of Uttar Pradesh, where two young girls were recently raped and hanged. Credit: Stella Paul/IPS

Women in the north Indian village of Katra Shadatganj in the state of Uttar Pradesh, where two young girls were recently raped and hanged. Credit: Stella Paul/IPS

By Stella Paul
CHIRANG, India, Sep 30 2014 (IPS)

On a bright March morning, a 17-year old tribal girl woke as usual, and went to catch fish in the village river in the Chirang district of India’s northeastern Assam state.

Later that evening, villagers found her lifeless body on the riverbank. According to Taburam Pegu, the police officer investigating the case, her assailants had raped her before slitting her throat.

The girl was a member of the Bodo tribe, which has been at loggerheads with Muslims and Santhals – another indigenous group in the region. The tragic story reveals a terrible reality across India, where thousands of girls and women are sexually abused, tortured and murdered in a tide of gender-based violence (GBV) that shows no sign of slowing.

“We have a culture of impunity. Our legal system itself negates the possibility [...] of punishment in cases of violence against women.” -- Anjuman Ara Begum, former programme officer at the Asian Human Rights Commission
Conflict and a lack of accountability, particularly across India’s northern, eastern and central states where armed insurgencies and tribal clashes are a part of daily life for over 40 million women, fuel the fire of sexual violence.

According to a report released earlier this year by the United Nations Secretary-General assessing progress on the programme of action adopted at the 1994 International Conference on Population and Development (ICPD) in Cairo, violence against women is universal, with one in every three women (35 percent) experiencing physical or sexual abuse in her lifetime.

Of all the issues related to the ICPD action plan, ending gender-based violence was addressed as a key concern by 88 percent of all governments surveyed. In total, 97 percent of countries worldwide have programmes, policies or strategies to address gender equality, human rights, and the empowerment of women.

Still, multiple forms of violence against women continue to be an hourly occurrence all around the world.

A recent multi-country study on men and violence in the Asia-Pacific region, conducted by the United Nations, reported that nearly 50 percent of 10,000 men surveyed admitted to sexually or physically abusing a female partner.

In India, a country that has established a legal framework to address and end sexual violence, 92 women are raped every day, according to the latest records published by the government’s National Crime Records Bureau (NCRB).

This is higher than the average daily number of rapes reported in the Democratic Republic of the Congo, which currently stands at 36.

Sexual violence is particularly on the rise in conflict areas, experts say, largely due to a lack of accountability – the very thing the United Nations describes as “key to preventing and responding to gender-based violence.”

According to Suhas Chakma, director of the Asian Centre for Human Rights in New Delhi, “There are human rights abuses committed by security forces and human rights violations by the militants. And then there is also violence against women committed by civilians. No matter who is committing the crime […] there has to be accountability – a component completely missing” from the current legal framework.

An example of this is Perry*, a 35-year-old woman from the South Garo Hills district of India’s northeastern Meghalaya state – home to 14 million women and three armed groups – who was killed by militants in June this year.

Members of the Garo National Liberation Army (GNLA), an insurgent group, allegedly tried to rape Perry and, when she resisted, they shot her in the head, blowing it open. The GNLA refused to be held accountable, claiming that the woman was an informant and so “deserved to die”.

Another reason for the high levels of GBV in India is the dismal conviction rate – a mere 26 percent – in cases involving sexual assault and violence.

In 3,860 of the 5,337 rape cases reported in the past 10 years, the culprits were either acquitted or discharged by the courts for lack of ‘proper’ evidence, according to the NCRB.

“We have a culture of impunity,” Anjuman Ara Begum, a Guwahati-based lawyer and former programme officer at the Asian Human Rights Commission, told IPS, adding, “Our legal system itself negates the possibility or certainty of punishment in cases of violence against women.”

With a declining conviction rate, armed groups have been playing the role of the judiciary to deliver instant justice. In October 2011, a kangaroo court of the armed Maoists in the Palamu district of India’s eastern Jharkhand state cut off the hands of a man accused of rape.

In August 2013, the Kangleipak Communist Party (KCP) – an insurgent group operating in the northeastern state of Manipur – launched an “anti-rape task force”.

Sanakhomba Meitei, the secretary of KCP, told IPS over the phone that his group would deliver fast-track justice for rape victims. “Our intervention [will] instill fear in the [minds of the] rapists,” said Meitei, adding, “We will deliver stringent punishment.”

This is a worrying trend, but inevitable, given the failure of the legal system to deliver justice in these troubled areas, according to A L Sharada, director of Population First – a partner of the United Nations Population Fund (UNFPA) in India.

“What we need is a robust legal system, and mob justice hurts that possibility. In fact, such non-judicial justice systems are also very patriarchal in nature and ultimately against women. What we really need are quick convictions [in] every case of gender violence that has been filed,” Sharada stated.

According to the NCRB over 50,000 women were abducted across the country in 2013 alone, while over 8,000 were killed in dowry-related crimes. More than 100,000 women faced cruelty at the hands of their husbands or other male relatives, but only 16 percent of those accused were convicted.

*Not her real name

This story originally appeared in a special edition TerraViva, ‘ICPD@20: Tracking Progress, Exploring Potential for Post-2015’, published with the support of UNFPA, the United Nations Population Fund. The contents are the independent work of reporters and authors.

Edited by Kanya D’Almeida

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Conflict Keeps Mothers From Healthcare Serviceshttp://www.ipsnews.net/2014/09/conflict-keeps-mothers-from-healthcare-services/?utm_source=rss&utm_medium=rss&utm_campaign=conflict-keeps-mothers-from-healthcare-services http://www.ipsnews.net/2014/09/conflict-keeps-mothers-from-healthcare-services/#comments Fri, 26 Sep 2014 03:52:47 +0000 Stella Paul http://www.ipsnews.net/?p=136884 Increasing levels of violence across India due to ethnic tensions and armed insurgencies are taking their toll on women and cutting off access to crucial reproductive health services. Credit: Stella Paul/IPS

Increasing levels of violence across India due to ethnic tensions and armed insurgencies are taking their toll on women and cutting off access to crucial reproductive health services. Credit: Stella Paul/IPS

By Stella Paul
BASTAR, India, Sep 26 2014 (IPS)

Twenty-five-year-old Khemwanti Pradhan is a ‘Mitanin’ – a trained and accredited community health worker – based in the Nagarbeda village of the Bastar region in the central Indian state of Chhattisgarh.

Since 2007, Pradhan has been informing local women about government health schemes and urging them to deliver their babies at a hospital instead of in their own homes.

Ironically, when Pradhan gave birth to her first child in 2012, she herself was unable to visit a hospital because government security forces chose that very day to conduct a raid on her village, which is believed to be a hub of armed communist insurgents.

“I have seen women trying to use home remedies like poultices to cure sepsis just because they don’t want to run into either an army man or a rebel." -- Daniel Mate, a youth activist from the town of Tengnoupal, on the India-Myanmar border
In the panic and chaos that ensued, the village all but shut down, leaving Pradhan to manage on her own.

“Security men were carrying out a door-to-door search for Maoist rebels. They arrested many young men from our village. My husband and my brother-in-law were scared and both fled to the nearby forest.

“When my labour pains began, there was nobody around. I boiled some water and delivered my own baby,” she said.

Thanks to her training as a Mitanin, which simply means ‘friend’ in the local language, Pradhan had a smooth and safe delivery.

But not everyone is so lucky. Increasing levels of violence across India due to ethnic tensions and armed insurgencies are taking their toll on women and cutting off access to crucial reproductive health services.

This past June, for instance, 22-year-old Anita Reang, a Bru tribal refugee woman in the conflict-ridden Mamit district of the northeastern state of Mizoram, began haemorrhaging while giving birth at home.

The young girl eventually bled to death, Anita’s mother Malati told IPS, adding that they couldn’t leave the house because they were surrounded by Mizo neighbours, who were hostile to the Bru family.

According to Doctors Without Borders (MSF), a global charity that provides healthcare in conflict situations and disaster zones across the world, gender-based violence, sexually transmitted infections including HIV, and maternal and neonatal mortality and morbidity all increase during times of conflict.

This could have huge repercussions in India, home to over 31 million women in the reproductive age group according to the United Nations Population Fund (UNFPA).

The country is a long way from achieving the Millennium Development Goal (MDG) target of 103 deaths per 100,000 live births by 2015, and is still nursing a maternal mortality rate of 230 deaths per 100,000 births.

There is a dearth of comprehensive nationwide data on the impact of conflict on maternal health but experts are agreed that it exacerbates the issue of access to clinics and facilities.

MSF’s country medical coordinator, Simon Jones, told IPS that in India the “most common causes of neonatal death are […] prematurity and low birth weight, neonatal infections and birth asphyxia and trauma.”

The government runs nationwide maternal and child health schemes such as Janani Suraksha Yojana and Janani Shishu Suraksha Karykram that provide free medicine, free healthcare, nutritional supplements and also monetary incentives to women who give birth at government facilities.

But according to Waliullah Ahmed Laskar, an advocate in the Guwahati High Court in the northeastern state of Assam, who also leads a rights protection group called the Barak Human Rights Protection Committee, women wishing to access government programmes must travel to an official health centre – an arduous task for those who reside in conflict-prone regions.

In central and eastern India alone, this amounts to some 22 million women.

There is also a trust deficit between women in a conflict area and the health workers, Laskar told IPS. “Women are [often] scared of health workers, who they think hold a bias against them and might ill-treat them.”

For Jomila Bibi, a 31-year-old Muslim refugee woman from Assam’s Kokrajhar district, such fears were not unfounded; the young woman’s newborn daughter died last October after doctors belonging to a rival ethnic group allegedly declined to attend to her.

Bibi was on the run following ethnic clashes between Bengali Muslims and members of the Bodo tribal community in Assam that have left nearly half a million people displaced across the region.

Daniel Mate, a youth activist in the town of Tengnoupal, which lies on India’s conflicted border with Myanmar, recounted several cases of women refusing to seek professional help, despite having severe post-delivery complications, due to compromised security around them.

“When there is more than one armed group [as in the case of the armed insurgency in Tengnoupal and surrounding areas in northeast India’s Manipur state], it is difficult to know who is a friend and who is an enemy,” he told IPS.

“I have seen women trying to use home remedies like poultices to cure sepsis just because they don’t want to run into either an army man or a rebel,” added Mate, who campaigns for crowd-funded medical supplies for the remotest villages in the region, which are plagued by the presence of over a dozen militant groups.

The solution, according to MSF’s Jones, is an overall improvement in comprehensive maternal care including services like Caesarean sections and blood transfusions.

Equally important is the sensitisation of health workers and security personnel, who could persuade more women to seek healthcare, even in troubled times.

Other experts suggest regular mobile healthcare services and on-the-spot midwifery training to women in remote and sensitive regions.

According to Kaushalendra Kukku, a doctor in the Kanker government hospital in Bastar, “When violence erupts, all systems collapse. The best way to minimise the risk of maternal death in such a situation is to take the services to a woman, instead of expecting her to come to [the services].”

Pradhan, who has now resumed her duties as a community health worker, agrees. “I was able to deliver safely because I was trained. If other women receive the same training, they can also help themselves.”

Edited by Kanya D’Almeida

This story originally appeared in a special edition TerraViva, ‘ICPD@20: Tracking Progress, Exploring Potential for Post-2015’, published with the support of UNFPA, the United Nations Population Fund. The contents are the independent work of reporters and authors.

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Comprehensive Sex Education: A Pending Task in Latin Americahttp://www.ipsnews.net/2014/09/comprehensive-sex-education-a-pending-task-in-latin-america/?utm_source=rss&utm_medium=rss&utm_campaign=comprehensive-sex-education-a-pending-task-in-latin-america http://www.ipsnews.net/2014/09/comprehensive-sex-education-a-pending-task-in-latin-america/#comments Thu, 25 Sep 2014 21:52:35 +0000 Fabiana Frayssinet http://www.ipsnews.net/?p=136879 By Fabiana Frayssinet
BUENOS AIRES, Sep 25 2014 (IPS)

In most Latin American countries schools now provide sex education, but with a focus that is generally restricted to the prevention of sexually transmitted diseases – an approach that has not brought about significant modifications in the behaviour of adolescents, especially among the poor.

The international community made the commitment to offer comprehensive sexuality education (CSE) during the 1994 International Conference on Population and Development in Cairo.

“Although some advances have been made in the inclusion of sexual and reproductive education in school curriculums in Latin America and the Caribbean, we have found that not all countries or their different jurisdictions have managed to fully incorporate these concepts in classroom activities,” Elba Núñez, the coordinator of the Latin American and Caribbean Committee for the Defence of Women’s Rights (CLADEM), told IPS.

Teenage mom Maura Escobar with her baby María. Credit: Daniela Estrada/IPS

Teenage mom Maura Escobar with her baby María. Credit: Daniela Estrada/IPS

The 2010 CLADEM study ‘Systematisation of sexuality education in Latin America’ reports that Argentina, Brazil, Colombia, Mexico and Uruguay are the countries that have come the closest to the concept of comprehensive sex education, and they are also the countries that have passed legislation in that respect.

Others, like Chile, Costa Rica, El Salvador, Guatemala and Peru, continue to focus on abstinence and birth control methods, while emphasising spiritual aspects of sexuality, the importance of the family, and the need to delay the start of sexual activity.

But programmes in the region still generally have problems “with respect to the enjoyment and exercise of this right,” especially among ethnic minorities and rural populations, said Núñez from Paraguay.

Countries such as Argentina, Brazil and Mexico have also run into difficulties in implementing sex education programmes outside the main cities.

These shortcomings are part of the reason that Latin America is the region with the second highest teen pregnancy rate – 38 percent of girls and women get pregnant before the age of 20 – after sub-Saharan Africa, as well as a steep school dropout rate.

In Argentina, a law on comprehensive sex education, which created a National Programme of Comprehensive Sex Education, was approved in 2006.

Ana Lía Kornblit, a researcher at the Gino Germani Research Institute, described the programme as “an important achievement because it makes it possible to exercise a right that didn’t previously exist.”

But in some provinces the teaching material, “which is high quality, is not used on the argument that [schools] do not agree with some of the content and they plan to design material in line with local cultural and religious values,” she said.

“Children can see everything on TV or the Internet, but in school it isn’t talked about for fear of encouraging them to have sex,” Mabel Bianco, president of the Foundation for the Education and Study of Women (FEIM), told IPS.

“But in the media everything is eroticised, which incites them to engage in sexual behaviour. And the worst thing is they don’t have the tools to resist the pressure from their peers and from society to become sexually active,” she said. “CSE would enable them to say no to sexual relations that they don’t want to have.”“Children can see everything on TV or the Internet, but in school it isn’t talked about for fear of encouraging them to have sex.” -- Mabel Bianco

Lourdes Ramírez, 18, just finished her secondary studies at a public school in Mendiolaza in the central Argentine province of Córdoba. She told IPS that in her school, many parents of students in the first years of high school “kick up a fuss” when sex education classes are given “because they say their kids are young and those classes will make them start having sex sooner.”

“It’s absurd that you see everything on TV, programmes with girls in tiny thongs, but then in school they can’t teach how to use a condom or that people should only have sex when they really want to,” Ramírez said.

In her school, the Education Ministry textbooks and materials arrived, but they were not distributed to the students “and were only kept in the library, for people to come and look at.”

Carmen Dueñas, a high school biology teacher in Berazategui, 23 km southeast of Buenos Aires, said it was surprising that even when available birth control methods are explained to the students, “many girls want to get pregnant anyway.”

“They think that when they get pregnant they will have someone to love, that they’ll have a role to play in life if they have a family of their own,” said the teacher, who forms part of a municipal-national CSE project.

“There are conflicts and violence in a significant proportion of families, and teenagers don’t feel they have support; families are torn apart, and there is domestic abuse, violence, alcohol and drug use,” said Marité Gowland, a specialist in preschool education in Florencio Varela, 38 km from the Argentine capital.

“All of this leads to adolescents falling into the same cycle, and it is difficult for them to put into practice what they learn in school,” she said. “Many schools provide the possibility for kids to talk about their problems, but the school alone can’t solve them.”

A project in Berazategui is aimed at breaking the mould. Students are shown a film where a girl gets pregnant when she is sexually abused by her stepfather, but manages to stay in school after talking to her teacher.
“We chose this scenario because sometimes we have clues that there are cases like this in our schools,” Dueñas said.

Through games, the project teaches students how to use condoms. In addition, students can place anonymous questions in a box. “There are girls who comment that although they haven’t even gotten their first period, they have sex, because they have older boyfriends. Then the group discusses the case,” Dueñas said, to illustrate how the project works.

Another member of CLADEM, Zobeyda Cepeda from the Dominican Republic, said that what prevails in most of the region is a “biological approach, or a religious focus, looking at sexuality only as part of marriage.”

Until the focus shifts to a rights-based approach, experts say, Latin America will not meet its international obligations to ensure that “every pregnancy is wanted [...] and every young person’s potential is fulfilled.”

This story originally appeared in a special edition TerraViva, ‘ICPD@20: Tracking Progress, Exploring Potential for Post-2015’, published with the support of UNFPA, the United Nations Population Fund. The contents are the independent work of reporters and authors.

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes

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‘Therapeutic Abortion’ Could Soon Be Legal in Chilehttp://www.ipsnews.net/2014/09/therapeutic-abortion-could-soon-be-legal-in-chile/?utm_source=rss&utm_medium=rss&utm_campaign=therapeutic-abortion-could-soon-be-legal-in-chile http://www.ipsnews.net/2014/09/therapeutic-abortion-could-soon-be-legal-in-chile/#comments Wed, 24 Sep 2014 13:26:44 +0000 Marianela Jarroud http://www.ipsnews.net/?p=136835 Alicia is one of the millions of Chilean women who have had an illegal, unsafe abortion because in their country terminating a pregnancy is punishable with up to five years in prison, regardless of the circumstances. Now the country is moving towards legalising therapeutic abortion. Credit: Marianela Jarroud/IPS

Alicia is one of the millions of Chilean women who have had an illegal, unsafe abortion because in their country terminating a pregnancy is punishable with up to five years in prison, regardless of the circumstances. Now the country is moving towards legalising therapeutic abortion. Credit: Marianela Jarroud/IPS

By Marianela Jarroud
SANTIAGO, Sep 24 2014 (IPS)

Chile, one of the most conservative countries in Latin America, is getting ready for an unprecedented debate on the legalisation of therapeutic abortion, which is expected to be approved this year.

In Chile, more than 300,000 illegal abortions are practiced annually – a scourge that is both cause and effect of many other social problems.

“Abortion in Chile is like the drug trade – surrounded by illegality and precariousness,” 27-year-old Alicia, who had an abortion five years ago, told IPS.

Latin America – stronghold of illegal abortion

In Chile, the Dominican Republic, El Salvador, Honduras and Nicaragua abortion is punishable by prison under any circumstance, although in Honduras the medical code of ethics allows it if the mother’s life is at risk.

One illustration that stiff penalties do not reduce abortions but only make them unsafe is the Dominican Republic, where the constitution has guaranteed the right to life from conception since 2010. But 90,000 abortions are year are practiced in that country, which means one out of every four pregnancies is interrupted.

In the rest of the countries in the region – with the exception of Cuba, Uruguay and Mexico City – only therapeutic abortion is allowed. Nevertheless, there are 31 abortions for every 1,000 women of child-bearing age, higher than the global average.

In Costa Rica, Guatemala, Paraguay, Peru and Venezuela abortion is only legal if the mother’s life is at risk. In Ecuador and Panama it is also legal in case of rape.

Guatemala exemplifies the effects of clandestine abortions. Of the 65,000 women who undergo an abortion in that country every year, 21,500 are hospitalised as a result. In Argentina and Bolivia the decision is made by a judge. In Argentina abortion is only legal in case of rape or risk to a mother’s life, and in Bolivia in cases of incest as well.

It is estimated that there is one abortion for every two pregnancies that end in birth in Argentina.

In Colombia abortion is legal for the abovementioned reasons as well as severe birth defects, as it is in Brazil – but only in cases where the fetus shows abnormal brain development.

Abortion on demand is only legal in Cuba and Uruguay – in the latter as of 2012, and since then the number of abortions has gone down.

In addition, abortion on demand has been legal in the Mexican capital since 2007. But that triggered a counter-reform in the country, and 17 of the 31 states have now banned abortion under any circumstances.

“A friend told me about a gynecologist, I went to see him and he told me the date, time and place to meet him,” Alicia said. “My mom came with me. A van picked me up on a random street corner in the city and I had no idea where we were going. I still remember my mother’s face, the anxiety of not knowing if I would come back, and in what condition.

“In a house a doctor and a woman, I don’t know if she was a midwife or a nurse, were waiting for me. They doped me up. When I woke up it was done. They put me in the van and took me back to my mother. We never talked about it again,” she said sadly.

The legalisation of abortion is one of the Chilean state’s big debts to women, Carolina Carrera, the president of Corporación Humanas, told IPS.

“Chile’s highly punitive legislation is a violation of the human rights of women because this level of penalisation means that women who abort do so in unsafe conditions, with physical and psychological risks,” she added.

In addition, smuggling has increased of Misoprostol, also known as RU486 or medication abortion. The medicine is sold at exorbitantly high prices, without clear medical indications, she added.

Claudia, 24, had to go to a house on one of the hills in the port city of Valparaíso, 140 km northwest of Santiago, to buy the drug to interrupt an unwanted pregnancy.

“It was a dangerous place,” she said. “I had to pay more than 600 dollars. I looked around and thought: and if something happens to me, who do I call? An ambulance, the police? No, I’d be put in prison!”

In Latin America, where the Catholic Church still has an enormous influence, abortion is illegal everywhere except Cuba, Uruguay and Mexico City. However, most countries allow therapeutic abortion in circumstances suggested by the United Nations: rape, risk to the mother’s life, or severe birth defects.

Chile is one of only seven countries in the world that ban abortion under any circumstance. Four others are in Latin America – the Dominican Republic, El Salvador, Honduras and Nicaragua – and two are in Europe – Malta and the Vatican.

Therapeutic abortion was legal in Chile from 1931 to 1989, when it was banned by the government of late dictator General Augusto Pinochet (1973-1990). None of the democratic administrations that have governed the country since then have touched the issue until now.

Since then, women who undergo an abortion have faced a possible prison sentence of up to five years.

“The frequency of abortion has remained steady in the last 10 years in Chile,” Dr. Ramiro Molina with the Centre on Reproductive Medicine and Integral Development of the Adolescent at the University of Chile told IPS. “The number of cases has not gone down, nor have there been major changes in the ages: the highest rates of abortion are still found among women between the ages of 25 and 34.”

He said there are only records of some 33,500 women a year who are treated for abortion-related complications – a figure he described as “very misleading” because it only takes into account those who go to a public health centre for emergency treatment.

Molina explained that the real total is estimated by multiplying that number by 10, which would indicate that 335,000 women a year undergo illegal abortions in Chile.

In the Latin American countries with the strictest legislation, abortions are practiced in conditions that pose a high risk to women, making it a public health problem as well as a reflection of inequality.

“Abortion is a socioeconomic indicator of poverty,” Molina said.

According to the World Health Organisation, an estimated 21.6 million unsafe abortions took place worldwide in 2008. The estimated annual total in Latin America is 4.4 million, 95 percent of which are clandestine. And 12 percent of maternal deaths in the region are the result of unsafe abortion.

Molina, one of the region’s leading experts in his field, said that while progress has been made in the last two decades, it has been very slow because “a religious-based philosophical vision” continues to prevail and stands in the way of further advances.

In Chile, the government of socialist President Michelle Bachelet, in office since March, is preparing to launch a debate on the legalisation of therapeutic abortion in case of rape, risk to the mother’s life, or severe birth defects.

She has stated on several occasions that abortion will be decriminalised this year in Chile.

During her first term (2006-2010), Bachelet authorised the free distribution of Levonorgestrel, better known as the morning after pill, by government health centres to all girls and women over the age of 14 who requested it. But its actual distribution still depends on the ideology of mayors, who are responsible for public health centres in their jurisdictions.

The morning after pill came too late for Francisco and Daniela. When she enrolled in the university, “we got pregnant,” she told IPS. The couple thought about it long and hard, but they lived with her parents and Francisco only worked part-time.

“I felt like it was cutting her life short, her dreams, her prospects,” said Francisco, who somehow managed to scrape together the 600 dollars for the abortion.

Now, at the age of 35, they have a little girl. But they remember it as a traumatic incident, “because it was clandestine, unsafe and unjust.”

Although the legalisation of therapeutic abortion was one of Bachelet’s campaign pledges, abortion remains a taboo subject in Chile. Many are afraid of the political consequences in this country of 17.8 million people, where more than 65 percent of the population is Catholic.

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes

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Mission Midwife: The Case for Trained Birth Attendants in Senegalhttp://www.ipsnews.net/2014/09/mission-midwife-the-case-for-trained-birth-attendants-in-senegal/?utm_source=rss&utm_medium=rss&utm_campaign=mission-midwife-the-case-for-trained-birth-attendants-in-senegal http://www.ipsnews.net/2014/09/mission-midwife-the-case-for-trained-birth-attendants-in-senegal/#comments Wed, 24 Sep 2014 04:48:54 +0000 Doreen Akiyo Yomoah http://www.ipsnews.net/?p=136842 Only 65 percent of Senegalese women give birth in the presence of a skilled attendant. Credit: Travis Lupick/IPS

Only 65 percent of Senegalese women give birth in the presence of a skilled attendant. Credit: Travis Lupick/IPS

By Doreen Akiyo Yomoah
DAKAR, Sep 24 2014 (IPS)

Diouma Tine is a 50-year-old vegetable seller and a mother of six boys. In her native Senegal, she tells IPS, motherhood isn’t a choice. “If you’re married, then you must have children. If you don’t, then you don’t get to stay in your husband’s house, and no one will respect you.”

Despite this prevailing cultural outlook, becoming a mother here is neither easy, nor safe, with only 65 percent of Senegalese women giving birth in the presence of a skilled attendant.

According to available data, 54 percent of Senegal’s 13.7 million people live in rural areas. Of these, some 3.3 million are women of reproductive age, an estimated 85 percent of who live about 45 minutes from a health facility.

The country has a worryingly high maternal mortality rate (MMR). The last government survey taken in 2005 found that 41 women died per 1,000 live births, giving the country a ranking of 144 out of 181.

“In some regions, like the Kolda and Tamba Regions, you can find up to 1,000 deaths per 100,000 live births [since] some women are denied the ability to make decisions about when to go to hospital, [and] sometimes when roads are bad it’s difficult for them to get to a health centre.” -- Gacko Ndèye Ndiaye, coordinator of the gender cell at the Ministère de la Santé et Action Sociale (Ministry of Health and Social Action)
Between 2005 and 2010, the MMR in Senegal fell from 401 to 392 deaths per 100,000 live births, representing some progress but hinting at the scale of unmet need around the country.

One of the Millennium Development Goals (MDGs) is to achieve universal access to reproductive healthcare by 2015, but it is increasingly clear to health workers and policy makers that Senegal will not reach this target.

This year’s State of the World’s Midwifery Report produced by the United Nations Population Fund (UNFPA) projected that Senegal’s population was set to increase by 59 percent to 21.9 million by 2030.

“To achieve universal access to sexual, reproductive, maternal and newborn care, midwifery services must respond to one million pregnancies per annum by 2030, 53 percent of these in rural settings,” the report stated, adding that the health system must be configured to cover some 66 million antenatal visits, 11.7 million births, and 46.7 million post-partum and postnatal visit from 2012 to 2030.

This past May, on the International Day of the Midwife, former Prime Minister Aminata Touré called attention to a gap of 1,336 midwives in the country, setting in motion a government-sponsored recruitment drive to rapidly increase the number of trained birth attendants.

The midwife shortage is felt most severely in rural areas: the Matam region in eastern Senegal, for instance, has only 14 midwives for a population of nearly 590,000, while Tambacounda, to the south of Matam, has only 38 for a population of about 670,000.

Senegal has both ‘sage-femmes’ (fully trained midwives), and ‘matrones’, direct-entry midwives who deliver the vast majority of babies in Senegal but lack proper education, and often learn their trade on site, sometimes spending less than six months in a clinical training setting before being taking up posts in rural areas.

“There is kind of a crisis in education,” Kaya Skye, executive director of the African Birth Collective, tells IPS.

“Matrones learn how to take blood pressure, but they don’t understand what that means. [With matrones] there is an urgency to get the baby out as soon as possible [and] an overuse of drugs, which is […] another cause of mortality,” she explained.

In fact, Touré stated during a speech on May 12 that 60 percent of maternal deaths in the country could have been avoided with “sufficient personnel, a suitable medical platform, [and] democratic access to women’s health services, notably the disadvantaged in remote areas.”

Gacko Ndèye Ndiaye, coordinator of the gender cell at the Ministère de la Santé et Action Sociale (Ministry of Health and Social Action), and a midwife by trade, tells IPS that numbers alone don’t tell the whole story.

“There are disparities between different areas,” she asserted. “In some regions, like the Kolda and Tamba Regions, you can find up to 1,000 deaths per 100,000 live births [since] some women are denied the ability to make decisions about when to go to hospital, [and] sometimes when roads are bad it’s difficult for them to get to a health centre.”

The National Agency of Statistics and Demography’s 2011 health indicators report found that over 90 percent of urban births are assisted by a trained assistant, but that number falls to just half for rural births.

Skye’s African Birth Collective works to fill these gaps, and recently built the Kassoumai Birth Centre in the Kabar village of the southern Casamance region to meet the needs of mothers and midwives.

According to Skye, “Traditional midwives said they wanted their own place to practice; that they didn’t feel welcome in government clinics. There was nothing in Kabar for women – they were giving birth in the showers behind their houses.”

Although the government does provide training for midwives, building this centre was “about creating infrastructure that is outside of government protocols and facilitating that dialogue where the traditional midwives can say ‘We do it this way’,” Skye says.

A long colonial history and post-colonial education in Senegal has meant that the Western obstetric model has been dominant.

Grassroots efforts, including the work of ENDA Santé, the health division of an international NGO called Environmental Development Action in the Third World, are helping to foster a better balance between Westernised birthing techniques and traditional methods.

The African Birth Collective and ENDA Santé have translated the educational manual ‘A Book for Midwives’ into French, giving birth attendants in Francophone West Africa access to crucial information, such as the case for non-supine positions, and inverted resuscitation methods.

For women like Tine, the pride that comes from being a mother will always outweigh the dangers and complications of pregnancy and childbirth.

But if the government of Senegal scales up its efforts to improve health services, it can remove the fear factor altogether, and make a strong contribution towards global efforts to ensure the health and safety of every mother.

This story originally appeared in a special edition TerraViva, ‘ICPD@20: Tracking Progress, Exploring Potential for Post-2015’, published with the support of UNFPA, the United Nations Population Fund. The contents are the independent work of reporters and authors.

Edited by Kanya D’Almeida

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