Inter Press Service » Women’s Health http://www.ipsnews.net Turning the World Downside Up Sat, 20 Sep 2014 12:43:36 +0000 en-US hourly 1 http://wordpress.org/?v=3.9.2 U.N. Urged to Reaffirm Reproductive Rights in Post-2015 Agendahttp://www.ipsnews.net/2014/09/u-n-urged-to-reaffirm-reproductive-rights-in-post-2015-agenda/?utm_source=rss&utm_medium=rss&utm_campaign=u-n-urged-to-reaffirm-reproductive-rights-in-post-2015-agenda http://www.ipsnews.net/2014/09/u-n-urged-to-reaffirm-reproductive-rights-in-post-2015-agenda/#comments Fri, 19 Sep 2014 21:32:25 +0000 Thalif Deen http://www.ipsnews.net/?p=136747 Millions of women in Pakistan do not have access to family planning services. Credit: Zofeen Ebrahim/IPS

Millions of women in Pakistan do not have access to family planning services. Credit: Zofeen Ebrahim/IPS

By Thalif Deen
UNITED NATIONS, Sep 19 2014 (IPS)

The U.N.’s post-2015 development agenda has been described as the most far-reaching and comprehensive development-related endeavour ever undertaken by the world body.

But where does population, family planning and sexual and reproductive health rights (SRHR) fit into the proposed 17 Sustainable Development Goals (SDGs), which are an integral part of that development agenda?"We must continue to fight until every individual, everywhere on this planet, is given the opportunity to live a healthy and sexual reproductive life." -- Purnima Mane, head of Pathfinder International

Of the 17, Goal 3 is aimed at “ensuring healthy lives and promoting well-being for all at all ages,” while Goal 5 calls for gender equality and the “empowerment of all women and girls.”

But when the General Assembly adopts the final list of SDGs in September 2015, how many of the proposed goals will survive and how many will fall by the wayside?

Meanwhile, SRHR will also be a key item on the agenda of a special session of the General Assembly next week commemorating the 20-year-old Programme of Action (PoA) adopted at the landmark International Conference on Population and Development (ICPD) in Cairo in 1994.

In an interview with IPS, Dr. Babatunde Osotimehin, executive director of the U.N. Population Fund (UNFPA) said, “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 girs and young people, including their reproductive rights.

“But the battle is not over,” he said.

“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,” he declared.

Purnima Mane, president and chief executive officer of Pathfinder International, told IPS, “We are delighted the final set of [proposed] SDGs contains four critical targets on SRHR: three under the health goal and one under the gender goal.”

The inclusion of a commitment to universal access to sexual and reproductive health care services, including family planning, information and education, and the integration of reproductive health into national strategies and programmes, is necessary and long overdue, she said.

“But we have not reached the finish line yet,” cautioned Mane, who oversees an annual budget of over 100 million dollars for sexual and reproductive health programmes in more than 20 developing countries.

The SDGs still need to be adopted by the General Assembly, “and we must all continue to raise our voices to ensure these SRHR targets are intact when the final version is approved,” she added.

Mane said civil society is disappointed these targets are not as ambitious or rights-based as they should be.

“And translating the written commitment into actionable steps remains a major challenge and is frequently met with resistance. We must retain our focus on these issues,” she said.

Sivananthi Thanenthiran, executive director of the Malaysia-based Asian-Pacific Resource & Research Centre for Women (ARROW) working across 17 countries in the region, told IPS it is ideal to have SRHR captured both under the gender goal as well as the health goal.

The advantages of being part of the gender goal is that the rights aspects can be more strategically addressed – because this is the area where universal commitment has been lagging – the issues of early marriage, gender-based violence, harmful practices – all of which have an impact on the sexual and reproductive health of women, she pointed out.

“The advantages of being part of the health goal is that interventions to reduce maternal mortality, increase access to contraception, reduce sexually transmitted diseases, including HIV/AIDS, are part and parcel of sound national health policies,” Thanenthiran said.

It would be useful for governments to learn from the Millennium Development Goals (MDGs) process and ensure that the new goals are not implemented in silos, she added. “Public health concerns should be addressed with a clear gender and rights framework.”

Maria Jose Alcala, director of the secretariat of the High-Level Task Force for ICPD, told IPS what so many governments and stakeholders around the world called for throughout the negotiations was simply to affirm all human rights for all individuals – and that includes SRHR.

The international community has an historic opportunity– and obligation — to move the global agenda forward, and go beyond just reaffirming agreements of 20 years ago as if the world hasn’t changed,and as if knowledge and society hasn’t evolved, she noted.

“We know, based on ample research and evidence, based on the experiences of countries around the world, as well as just plain common sense, that we will never achieve poverty eradication, equality, social justice, and sustainable development if these fundamental human rights and freedoms are sidelined or traded-off in U.N. negotiations,” Jose Alcala said.

Sexual and reproductive health and rights are a must and prerequisite for the post-2015 agenda “if we are to really leave nobody behind this time around,” she declared.

Mane told IPS, “As the head of Pathfinder, I will actively, passionately, and strongly advocate for SRHR and family planning to be recognised and aggressively pursued in the post-2015 development agenda.”

She said access to SRHR is a fundamental human right. “We must continue to fight until every individual, everywhere on this planet, is given the opportunity to live a healthy and sexual reproductive life. ”

Asked about the successes and failures of ICPD, Thanenthiran told IPS there is a need to recognise the progress so far: maternal mortality ratios and infant mortality rates have decreased, access to contraception has improved and life expectancy increased.

However, much remains to be accomplished, she added. “It is apparent from all recent reports and data that SRHR issues worldwide are issues of socio-economic inequality.”

In every country in the world, she noted, women who are poorer, less educated, or belong to marginalised groups (indigenous, disabled, ethnic minorities) suffer from undesirable sexual and reproductive health outcomes.

Compared to their better educated and wealthier sister citizens, these women and girls are more likely to have less access to contraception, have pregnancies at younger ages, have more frequent pregnancies, have more unintended pregnancies, be less able to protect themselves from HIV and other sexual transmitted diseases, suffer from poor maternal health, die in childbirth and suffer from fistula and uterine prolapse.

Hence the sexual and reproductive health and rights agenda is also the equality agenda of this century, she added.

“Governments must commit to reducing these inequalities and carry these learnings from ICPD at 20 into the post-2015 development agenda,” Thanenthiran said.

Edited by Kitty Stapp

The writer can be contacted at thalifdeen@aol.com

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Geographical Divide in Maternal Health for Syrian Refugeeshttp://www.ipsnews.net/2014/09/geographical-divide-in-maternal-health-for-syrian-refugees/?utm_source=rss&utm_medium=rss&utm_campaign=geographical-divide-in-maternal-health-for-syrian-refugees http://www.ipsnews.net/2014/09/geographical-divide-in-maternal-health-for-syrian-refugees/#comments Fri, 19 Sep 2014 15:17:22 +0000 Shelly Kittleson http://www.ipsnews.net/?p=136741 A young mother approaches a healthcare facility inside the Domiz refugee camp in Iraqi Kurdistan, mid-September 2014. Credit: Shelly Kittleson/IPS

A young mother approaches a healthcare facility inside the Domiz refugee camp in Iraqi Kurdistan, mid-September 2014. Credit: Shelly Kittleson/IPS

By Shelly Kittleson
DOHUK, Iraq, Sep 19 2014 (IPS)

At the largest refugee camp in Iraqi Kurdistan, young Syrian mothers and pregnant women are considered relatively lucky.

The number of registered Syrian refugees surpassed 3 million in late August, with the highest concentrations in Lebanon (over 1.1 million), Turkey (over 800,000), and Jordan (over 600,000). In all of the above, serious concerns have been expressed about the availability of healthcare services for expectant mothers.

In Lebanon, for example – which hosts the largest number of Syrian refugees, 76 percent of whom are women and children – the U.N. refugee agency (UNHCR) last year had to reduce its coverage of delivery costs for mothers to 75 percent instead of 100 percent, due to funding shortfalls.Though some in the Domiz camp live in tents on the edges of the camp with little access to basic sanitation facilities, others reside in small container-like facilities interspersed with wedding apparel shops and small groceries, and enjoy the right to public healthcare

The Domiz camp in the northern Dohuk province houses over 100,000 mostly Syrian Kurds, but is in a geographical area with a 189 percent coverage rate of humanitarian aid funding requests in 2014. The Syria Humanitarian Response Plan (SHARP) has received only 33 percent of the same.

Though some in the Domiz camp live in tents on the edges of the camp with little access to basic sanitation facilities, others reside in small container-like facilities interspersed with wedding apparel shops and small groceries, and enjoy the right to public healthcare.

This does not necessarily equate with quality healthcare, however. Halat Yousef, a young mother that IPS spoke to in Domiz, said that she had been told after a previous birth in Syria that she would need a caesarean section for any subsequent births.

On her arrival at the Dohuk public hospital, she was instead refused a bed, told to come back in a week and that she would have to give birth normally. They also told her she had hepatitis.

Fortunately, she said, her husband realised the seriousness of the situation and took her to the capital, where they immediately performed a C-section and found that she was instead negative for hepatitis. IPS met her as she was leaving healthcare facilities set up in the camp, holding her healthy 10-day-old infant.

Until recently, many mothers would also simply give birth in their tents. On August 4, Médicins San Frontiéres (MSF) opened a maternity unit in the camp that offers ante-natal check-ups, birthing services headed by MSF-trained midwives and post-natal vaccinations provided by staff who are also refugees.

Information on breastfeeding and family planning advice is also provided, according to MSF’s medical team leader in the camp, Dr Adrian Guadarrama.

MSF estimates that 2,100 infants are born in the camp every year, and others to refugees living outside of it.

The United Nations Population Fund (UNFPA) has long been providing safe delivery kits to healthcare providers. It also works to prevent unwanted pregnancies and provides contraceptives to those requesting them, thereby ensuring that pregnancies are planned, wanted and safer.

The clean delivery kits contain a bar of soap, a clear plastic sheet for the woman to lie on, a razor blade for cutting the umbilical cord, a sterilised umbilical cord tie, a cloth (to keep the mother and baby warm) and latex gloves.

UNFPA humanitarian coordinator Wael Hatahet told IPS that so far the programmes in Iraqi Kurdistan for Syrian refugees had received enough funding to cover the necessary services, and this was why ‘’the situation is no longer an emergency one for Syrians here’’.

Hatahet said that he gives a good deal of credit to the Kurdistan Regional Government (KRG), which – despite having seen a major cut in public funds from the central government as part of a prolonged tug-of-war between the two – continues to support Syrian refugees coming primarily from the fellow Kurdish regions across the border.

Many residents expressed dissatisfaction to IPS about what they considered ‘’privileged treatment’’ given to Syrian refugees while the massive influx of internally displaced persons (IDPs) that have arrived in the region over the past few months – after the Islamic State (IS) extremist group took over vast swathes of Iraqi territory in June – are seen to be suffering a great deal more.

Even Hatahet, who is of Syrian origins himself, noted that he had seen ‘’Iraqi IDPs wearing the same set of clothes for the past 15 days’’.

‘’We obviously try to support with garments and dignity kits,’’ he said, ‘’but it’s really, really sad.’’

However, he also noted that ‘’almost all the IDP operations are supported by the Saudi Fund [for Development]’’ totalling some 500 million dollars and announced in summer, ‘’which was strictly for IDPs and not refugees.’’

Hatahet expressed concerns that a broader shift in focus to Iraqi IDPs might result in a loss of the gains made in this geographical area of the Syrian refugee crisis, urging the international community to remember that ‘’we have 100,000 refugees scattered within the host community’’ and not just in the camps.

The Turkish office of UNFPA told IPS that, in its area of operations, ‘’it is estimated that about 1.3 million Syrian refugees have entered Turkey, of which only one-fifth of them are staying in camps due to limited space. 75 percent of the refugees are women and children under 18 years old.’’

It pointed out that ‘’women and girls of reproductive age under conditions of war and displacement are especially vulnerable to gender-based violence, including sexual violence, early and forced marriage, high-risk pregnancies, unsafe abortions, risky deliveries, lack of family planning services and commodities and sexually transmitted diseases.’’

(Edited by Phil Harris)

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Against All the Odds: Maternity and Mortality in Afghanistanhttp://www.ipsnews.net/2014/09/against-all-the-odds-maternity-and-mortality-in-afghanistan/?utm_source=rss&utm_medium=rss&utm_campaign=against-all-the-odds-maternity-and-mortality-in-afghanistan http://www.ipsnews.net/2014/09/against-all-the-odds-maternity-and-mortality-in-afghanistan/#comments Tue, 16 Sep 2014 19:09:10 +0000 Karlos Zurutuza http://www.ipsnews.net/?p=136646 Doctors Without Borders (MSF) says Afghanistan is “one of the riskiest places to be a pregnant woman or a young child”. Credit: DVIDSHUB/CC-BY-2.0

Doctors Without Borders (MSF) says Afghanistan is “one of the riskiest places to be a pregnant woman or a young child”. Credit: DVIDSHUB/CC-BY-2.0

By Karlos Zurutuza
KABUL, Sep 16 2014 (IPS)

Nasrin Mohamadi, a mother of four, has promised herself never to set foot in an Afghan public hospital again. After her first experience in a maternity ward, she has lost all faith in the state’s healthcare system.

“The doctors said that I had not fully dilated yet so they told me to wait in the corridor. I had to sit on the floor with some others as there wasn’t a single chair,” Mohamadi tells IPS, recalling her experience at Mazar-e Sharif hospital, 425 km northwest of Kabul.

“They finally took me into the room where three other women were waiting with their legs wide open while people came in and out. They kept me like that for an hour until I delivered without [an] anaesthetic, and not even a single towel to clean my baby or myself,” adds the 32-year-old.

“Immediately afterwards the doctors told me to leave as there were more women queuing in the corridor.”

“Many rural health clinics are dysfunctional, as qualified health staff have left the insecure areas, and the supply of reliable drugs and medical materials is irregular or non-existent." -- Doctors Without Borders (MSF)
Even after she left the hospital, Mohamadi’s ordeal was far from over. The doctors told her not to wash herself for ten days after the delivery, and as a result her stitches got infected.

“I paid between 600 and 800 dollars to give birth to my other three children after that; it was money well invested,” she says.

This is a steep price to pay in a country where the average daily income is under three dollars, and 75 percent of the population live in rural areas without easy access to health facilities.

Many women have no other option than to rely on public services, and the result speaks volumes about Afghanistan’s commitment to maternal health: some 460 deaths per 100,000 live births give the country one of the four worst maternal mortality ratios (MMR) in the world outside of sub-Saharan Africa.

While this represents a significant decline from a peak of 1,600 deaths per 100,000 births in 2002, far too many women are still dying during pregnancy and childbirth, according to the United Nations.

In 2013 alone, 4,200 Afghan women lost their lives while giving birth.

The lack of specialised medical attention during pregnancy or delivery for a great bulk of Afghan women is partly responsible. Few have access to health centres because these are only reachable in urban areas. The lack of both security and proper roads forces many women to deliver at home.

This does not bode well for the 6.5 million women of reproductive age around the country, particularly since Afghanistan only has 3,500 midwives, according to the U.N. Population Fund (UNFPA)’s latest State of the World’s Midwifery report.

This means that the existing workforce of midwives meets only 23 percent of women’s needs. The situation is poised to worsen: UNFPA estimates that midwifery services in the country “will need to respond to 1.6 million pregnancies per annum by 2030, 73 percent of these in rural settings.”

Even women with access to top-level urban facilities, such as the Kabul-based Malalai Maternity Hospital, are not guaranteed safety and comfort.

For instance, Sultani*, a mother of four, tells IPS she is far from satisfied with her experience.

“I gave birth through caesarean section to my four children in this hospital but the doctors who attended to me were unskilled,” she remarks bluntly. “A majority of them had only completed three years of medical [school].

“On a scale of one to 10, I can only give Malalai a four,” she concludes.

Sultani’s opinion may be specific to her own experience, but it finds echo in various reports and studies of the country’s health system. A 2013 activity report by Doctors Without Borders (MSF) labeled Afghanistan “one of the riskiest places to be a pregnant woman or a young child” due to a lack of skilled female medical staff.

“Private clinics are unaffordable for most Afghans and many public hospitals are understaffed and overburdened,” reports the organisation, which runs four hospitals across the country.

“Many rural health clinics are dysfunctional, as qualified health staff have left the insecure areas, and the supply of reliable drugs and medical materials is irregular or non-existent,” continues the report.

This is a sobering analysis of a country that will need to configure its health system to cover “at least 117.8 million antenatal visits, 20.3 million births and 81.3 million post-partum/postnatal visits between 2012 and 2030”, according to UNFPA.

Given that contraceptive use is still scarce, reaching only 22 percent of reproductive-age women, large families continue to be the norm. Afghan women give birth to an average of six children, a practice fuelled by a cultural obsession with bearing at least one son, who will in turn care for his parents in their old age.

A lack of information about birth spacing means mothers seldom have time to fully recover between deliveries, causing a range of health issues for the mother and a lack of milk for the newborn child.

Findings from a 2013 survey conducted by the Afghan Ministry of Public Health indicate that only 58 percent of children below six months were exclusively breastfed.

Still, this is an improvement from a decade ago and represents small but hopeful changes in the arena of women and children’s health. The same government survey found, for instance, that “stunting among children has decreased by nearly 20 percent from 60.5 percent in 2004 to 40.9 percent in 2013.”

Dr. Nilofar Sultani, who practices at the Malalai Maternity Hospital, tells IPS that medical assistance in Afghanistan has improved “significantly” over the last ten years.

“There are more health centres, and [they are] far better equipped. The number of skilled doctors has also grown,” explains Sultani, a gynaecologist.

But the most important change, she says, has been in women’s attitude towards medical care. “Before, very few women would come to the hospitals but today, the majority of women come forward on their own. They’re slowly losing their fear [of] doctors,” notes Sultani, adding that health centres are among the very few places where Afghan women can feel at ease without the presence of a man.

Edited by Kanya D’Almeida

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OPINION: Investing in Adolescent Girls for Africa’s Developmenthttp://www.ipsnews.net/2014/09/opinion-investing-in-adolescent-girls-for-africas-development/?utm_source=rss&utm_medium=rss&utm_campaign=opinion-investing-in-adolescent-girls-for-africas-development http://www.ipsnews.net/2014/09/opinion-investing-in-adolescent-girls-for-africas-development/#comments Mon, 15 Sep 2014 07:50:24 +0000 Hinda Deby and Dr. Julitta Onabanjo http://www.ipsnews.net/?p=136611 Elina Makore, 19, of Renco Mine just after delivering a healthy baby at Rutandare Clinic a remote Zimbabwean outpost supported by the United Nations Population Fund (UNFPA). Courtesy: UNFPA/Stewart Muchapera

Elina Makore, 19, of Renco Mine just after delivering a healthy baby at Rutandare Clinic a remote Zimbabwean outpost supported by the United Nations Population Fund (UNFPA). Courtesy: UNFPA/Stewart Muchapera

By Hinda Deby Itno and Julitta Onabanjo
JOHANNESBURG, Sep 15 2014 (IPS)

Adolescence is a time of transition from childhood to adulthood. It is also a time of change and challenge. 

Today’s adolescents, connected to each other like never before, can be a significant source of social progress and cultural change.

But they are also facing multiple challenges that seriously impact their future. And nowhere in the world do adolescents confront as formidable barriers to their full development as in Africa.

Today, adolescents and young people make up over one third of Africa’s population. They form a sizeable part of the population yet they lack critical investments, especially where it matters most – in sexual and reproductive health services, comprehensive sexuality education and skills building.

This calls for the serious and committed attention of all.

  Challenges facing adolescent girls

It is estimated that Africa has the world’s highest rates of adolescent pregnancy and maternal mortality. In Chad, Guinea, Mali, and Niger, where child marriage is common, half of all teenage girls give birth before the age of 18.

This was the case for Zuera, a girl from Kano in northern Nigeria, who became a wife and a mother at just 14 years. She suffered the agony of two stillbirths and was treated for obstetric fistula, which is damage caused by childbirth that leaves a woman incontinent, that arose from her first pregnancy.

Zeura was robbed of her childhood. She also missed out on the transition phase of adolescence and finally, she missed life.

All over Africa, stories like Zeura’s are commonplace. Millions of girls become brides before the age of 15. Close to 30 percent of girls on the continent give birth by age 18, when they are still adolescents. These adolescents face a higher risk of complications and death due to pregnancy than older women.

Nearly two thirds of them lack the basic knowledge they need to access crucial sexuality education and health information to protect themselves from early pregnancy and sexually transmitted diseases.

Research has found that at least 60 percent of young people aged 10 to 24 years are unable to prevent HIV, due to a lack of sexuality education. We cannot allow this to continue.

A resilient and informed generation

Young people will carry the African continent into the future. They need a safe and successful passage to adulthood.

And this is not a privilege but a right. Yet this right can only be fulfilled if families, society, and government institutions make focused investments and provide opportunities to ensure that adolescents and youth progressively develop the knowledge, skills and resilience they need for a healthy, productive and fulfilling life.

Comprehensive sexuality education, sexual and reproductive health services, education and skills building for adolescents and young people need to be placed at the heart of the Sustainable Development Goals (SDGs), with specific indicators and targets.

By building a strong foundation and investing in programmes that focus on delivering and achieving specific results for adolescents, Africa can achieve its transformation agenda.

Our desire is for every young person in Africa to be resilient and informed. We want every young African to be able to make their own decisions, to foster healthy relationships, access proper health care, actively participate in their education and ultimately, contribute to the development of their community and their future.

This means that programmes that are achieving results for adolescents in various parts of Africa must be scaled up. These include the husbands’ schools that have been developed in Niger, the girls’ empowerment initiative in Ethiopia, and the child marriage-free zones in Tanzania.

International institutions need to increase their commitments to adolescents, and address the nagging problems that confront adolescent girls and women across the African continent.

Adolescents have the potential to shape their world and indeed, the world in its entirety. It is in our interest to connect with them and enable them to change our world. Yes indeed!

Edited by: Nalisha Adams

 

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How Niger’s Traditional Leaders are Promoting Maternal Healthhttp://www.ipsnews.net/2014/09/will-you-be-chief-how-nigers-traditional-leaders-are-promoting-maternal-health/?utm_source=rss&utm_medium=rss&utm_campaign=will-you-be-chief-how-nigers-traditional-leaders-are-promoting-maternal-health http://www.ipsnews.net/2014/09/will-you-be-chief-how-nigers-traditional-leaders-are-promoting-maternal-health/#comments Thu, 11 Sep 2014 08:47:05 +0000 Joan Erakit http://www.ipsnews.net/?p=136577 Chief Yahya Louche of Bande, a village in Niger, addresses his constituents about maternal health and the importance of involving men. Credit: Joan Erakit/IPS

Chief Yahya Louche of Bande, a village in Niger, addresses his constituents about maternal health and the importance of involving men. Credit: Joan Erakit/IPS

By Joan Erakit
BANDE, Niger, Sep 11 2014 (IPS)

It is a long, 14-hour drive from Niger’s capital city Niamey to the village of Bande. And the ride is a dreary one as the roadside is bare. The occasional, lone goat herder is spotted every few kilometres and the sightings become a cause of both confusion and excitement since there aren’t any trees, or watering holes in sight.

Dry, hot and often plagued with sandstorms, Niger has a population of over 17.2 million, 80 percent of which live in rural areas. Insecurity, drought and trans-border issues contribute to this West African nation’s fragility where 50 percent of its citizens have access to health services.

IPS has travelled here with the United Nations Population Fund (UNFPA) to visit a school that — on a continent where male involvement in maternal health is not the norm and, in fact, men are oftentimes not present during the duration of the pregnancy or the birthing process due to cultural reasons — is pretty unique. It’s the School of Husbands.

Formed with support from UNFPA in 2011, the school has over 137 locations in Niger’s southern region of Zinder. Members are married men between the ages of 25 and 50, but young boys are now being recruited to come and sit in on meetings — to learn from their elders.

As IPS arrives at the village early one morning, a group of musicians approach the vehicle playing ceremonial music; they precede a traditional chief who is being escorted by his most trusted counsel and a throng of personal security who frantically chase away curious children with sticks.

Yahya Louche is the chief of Bande and he stops to talk to IPS about maternal health and the importance of involving men.

“I am a member of the School of Husbands,” Louche says of the informal institution that brings together married men to discuss the gains of reproductive health, family planning and empowerment.

“The School of Husbands is where there is no teacher and there is not student,” Louche continues, adding, “They are not getting paid, they are working for the well being of the population.”

The School of Husbands is a prime example of what can happen when men stand shoulder to shoulder with women, promoting safe births.

The Perils of No Care 

While visiting the health centre near the chief’s homestead, IPS spots a young woman making her way across the compound to the maternity room. She is weak and can barely make eye contact while two friends hold her up by each arm.

IPS is told that she delivered a baby at home and has walked kilometres to get help because she began bleeding profusely – it is an obstetrical emergency known as postpartum haemorrhage (PPH).

According to the World Health Organisation (WHO), PPH is responsible for about 25 percent of maternal mortality. Without prenatal or antenatal visits during pregnancy, complications are more likely to arise — some often leading to death.

“Before the School of Husbands, women didn’t want to go for delivery at health centres, they would stay at home and have their babies,” Louche explains.

According to the World Bank, Niger has a Maternal Mortality Ration (MMR) of 630 to 100,000 live births.

Women in Niger suffer.

It is a very well-known custom in the country that women are not to show their pain or discomfort. When they give birth, it is often in silence.  The woman on the delivery table makes no sound though pain is very visible on her face.

Madame Doudou Aissatoo, a midwife in Konni, a town in Niger, tells IPS that it is important to have reproductive health and family planning services readily available because many women walk for miles to come to the health centres. If commodities and services, or even midwives are unavailable, the women will leave and not return for a very long time.

“The very critical thing is to integrate it in the package; when a woman comes to the health centre for whatever reason, she has to get the family planning right away, whether it is a routine health check-up or something serious. Even on Saturday or Sunday, if a woman comes to the health centre, she’ll get it,” Aissatoo says.

Returning Home to Promote Health

The ancient story is quite fascinating; when a young boy leaves his homestead to find greener pastures, a time will mostly likely come when the folks back home call upon the man to become chief.

Often leaving the diaspora to fulfil his duties, a request to become chief is one that cannot be refused for turning it down is the equivalent to shaming ones ancestors.

It is such that the chiefs in Niger today come from different professional backgrounds and many have been doctors, diplomats and professors.

Traditional chiefs in Niger are the most important leaders — even heads of state and presidents seek their council before making big decisions. Without their blessing, one can assume that the road ahead will be difficult.

The UNFPA country office has understood the role that traditional chiefs play and has built a partnership in favour of promoting the health and rights of women.

In 2012, the traditional chiefs of Niger signed an agreement with UNFPA furthering a commitment to improve the health conditions of women.

“When we gathered in 2012, we made a commitment as an organisation to work with UNFPA in order to reduce the demographic growth, be part of sensitisation activities and gear towards improving reproductive health,” Louche explains.

When asked if she feels good about her husband participating in the institution, Fassouma Manzo, a local woman replies ecstatically: “Very much!”

A round of applause follows Manzo’s declaration as she continues, “before the School of Husbands, men didn’t have discussions with their women; but now, there is an issue for which they are very interested. As a woman, you can now find a space where you can talk and share with your man.  It’s a great side effect!”

Louche, a charismatic chief who spends much time talking to his constituents truly believes that empowering men puts the focus put on women.

The School of Husbands doesn’t just highlight the importance of seeking professional medical care when pregnant, but it also works to promote understanding between men and women — a gain that will only foster harmony for both sexes.

Edited by: Nalisha Adams

The writer can be contacted through Twitter on: @Erakit

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No Easy Choices for Syrians with Small Childrenhttp://www.ipsnews.net/2014/09/no-easy-choices-for-syrians-with-small-children/?utm_source=rss&utm_medium=rss&utm_campaign=no-easy-choices-for-syrians-with-small-children http://www.ipsnews.net/2014/09/no-easy-choices-for-syrians-with-small-children/#comments Thu, 04 Sep 2014 12:24:01 +0000 Shelly Kittleson http://www.ipsnews.net/?p=136492 What remains of a street in Aleppo, August 2014. Credit: Shelly Kittleson/IPS

What remains of a street in Aleppo, August 2014. Credit: Shelly Kittleson/IPS

By Shelly Kittleson
GAZIANTEP, Turkey, Sep 4 2014 (IPS)

The woman who walked into the Islamic Front (IF) media office near the Turkish border was on the verge of fainting under the hot Syrian sun, but all she cared about was her infant son.

With over half of the country’s population displaced, she was just one of the parents among the more than three million UN-registered Syrian refugees grappling with how to keep their children safe and healthy while dealing with the innumerable dangers inherent in war zones, refugee camps and statelessness.

When IPS met the young woman in early August, she was living in the nearby Bab Al-Salama camp in northern Syria after having been displaced from an area of heavy fighting.Over 200,000 Syrians are living outside the camps in Gaziantep and rent prices have roughly tripled since the massive influx of refugees starting. Protests broke out in mid-August against their presence, and they are increasingly being targeted by violence.

The infant was only a few weeks old and needed to be breastfed, but there was nowhere out of the sight of men. And so, wearing a stifling niqab, she asked to use the room that now serves to ‘register’ foreign journalists crossing the border.

The room afforded some shade and privacy in which to breastfeed and, once the twenty-two-year-old former fighter in charge of the office had stepped out, she started feeding her child.

As she blew gently his sweaty forehead, the woman told IPS that she had kidney problems and could not sit – she could only lie down or stand up. She said that she was also having problems accessing medical care, for both herself and her feverish son. And even if the black abaya covering her body and the niqab over her face were hot, ‘’it’s better to use them,’’ she said, ‘’it’s war”.

The area around the Bab Al-Salama camp just across the border from the Turkish town of Kilis has been bombed several times, including a car bomb in May that killed dozens.

On the other side of the border, the camps that the Turkish government has set up for the over 800,000 Syrian refugees registered with the United Nations are said to be able to accommodate fewer than 300,000 of them.

In formal and informal refugee camps throughout the world, women are notoriously at risk of sexual crimes. Alongside economic issues, many parents on both sides of the border cite this as a reason to marry off their daughters earlier, in the attempt to ‘’protect their honour’’ and find someone to provide for them.

The children resulting from these unions are almost always unable to be registered and are thus stateless, joining the ranks of the many Syrian Kurds and others denied citizenship under Syrian president Bashar Al-Assad’s regime.

Mohamed was an officer in the Syrian regime’s army. From a fairly large tribe in Idlib, his family was targeted by the regime once the conflict began and he has fought with different Free Syrian Army brigades over the past few years.

Soon after a number of women were reportedly raped by ’shabiha’ in his area, he moved his young wife, mother and sisters across the border. He now crosses illegally into Turkey to see them when not fighting.

Street scene in rebel-held Aleppo, August 2014. Credit: Shelly Kittleson/IPS

Street scene in rebel-held Aleppo, August 2014. Credit: Shelly Kittleson/IPS

Mohamed is seeking ways to reach Europe. When IPS first met him in autumn of 2013, he had no intention of leaving. However, since then, his first son has been born, stateless.  The Syrian regime did not issue passports to officers in order to prevent them from defecting even prior to the 2011 uprising, and none of his family possesses one.

As a professional soldier without a salary and with no moderate rebel groups providing adequate wages to support a family, as well as no desire to join extremist groups – many of which would pay better – he feels does not know how else he can provide for his family.

‘’There’ s no future here,’’ he said.

On the Turkish side of the border, Ahmad – originally from Aleppo, Syria’s industrial capital – says he does not want to leave the region.

“I once asked my wife what country in the world she would go to if she could, and she answered ‘Syria’,’’ he told IPS proudly.

However, he added that he had stopped going backwards and forwards as a fixer and media activist as the day approached for his wife to give birth and the situation in Aleppo worsened.

When children approached a table as IPS was having tea with him in a Turkish border town, he somewhat gruffly told a little girl begging that she should ‘’work, even if that means selling packets of tissues on the streets.’’

‘’They have to learn to work and not just ask for money. Turks are starting to get angry that we are here,’’ he said.

Over 200,000 Syrians are living outside the camps in Gaziantep and rent prices have roughly tripled since the massive influx of refugees starting. Protests broke out in mid-August against their presence, and they are increasingly being targeted by violence.

Meanwhile, some attempts are being made to raise money for schools inside Syria that would be virtual ‘bunkers’, as Assad’s regime continues to target both schools and medical facilities.

In rebel-held Aleppo, IPS stayed with a Syrian family for a number of days in August as the regime barrel bombing campaign continued and as the danger of an impending siege by government forces or a takeover by the extremist Islamic State (IS) became more likely.

The eldest of the family’s four girls – only eight-years-old – had recently been hit by a sniper’s bullet while crossing the road to one of the few schools still functioning. Although it was healing, the exit wound will leave a very ugly scar on her arm.

Whenever the bombs fell during the night, the occupants of the room would move about restlessly, while the eight-year-old was always already awake, staring into the dark, utterly motionless.

Her father was adamant, however, that – come what may – the family would not leave.

In the late afternoon, little boys could be seen playing outside in the street with scant protection from snipers, only the nylon tarp of a former UNHCR tent hung across the street in an attempt to shield them. Large gaping holes marked the buildings, or what was left of them, in the street around them.

(Edited by Phil Harris)

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OPINION: Iraq On the Precipicehttp://www.ipsnews.net/2014/09/opinion-iraq-on-the-precipice/?utm_source=rss&utm_medium=rss&utm_campaign=opinion-iraq-on-the-precipice http://www.ipsnews.net/2014/09/opinion-iraq-on-the-precipice/#comments Thu, 04 Sep 2014 04:23:16 +0000 Bill Miller http://www.ipsnews.net/?p=136478 Since Aug. 3, there has been a massive dislocation of some 200,000 people from Iraq, resulting in more than 1.2 million displaced. Credit: Mustafa Khayat/CC-BY-ND-2.0

Since Aug. 3, there has been a massive dislocation of some 200,000 people from Iraq, resulting in more than 1.2 million displaced. Credit: Mustafa Khayat/CC-BY-ND-2.0

By Bill Miller
NEW YORK, Sep 4 2014 (IPS)

The catastrophic events in Iraq that are unfolding daily are more significant than at any point in recent memory.

The Islamic State of Iraq and Syria (ISIS), which is now calling itself the Islamic State (IS), steamrolled out of Syria into Iraq and appeared to be unstoppable in its march to Baghdad. The Iraqi military, which was far larger and better armed, was either unable or unwilling to confront this ragtag, but determined, force of about 1,000 fighters.

Simultaneously, the world was riveted on the minority Yazidi community that had to escape to Mount Sinjar to avoid certain annihilation.

What made the situation even more dangerous was that Mount Sinjar is a rocky, barren hilltop about 67 miles long and six miles wide, protruding like a camel’s back with a daytime high temperature of 110 degrees, as Kieran Dwyer, communications chief for the U.N. Office for the Coordination of Humanitarian Affairs, recently reported from Erbil.

Dwyer also shared other staggering statistics:

– Since Aug. 3, there has been a massive dislocation of 200,000 people, as armed groups have ramped up their violence, and there are more than 1.2 million displaced people.

– The U.N. High Commission for Refugees is providing protection and assisting local authorities with shelter, including mattresses and blankets.

– The U.N. World Food Programme set up four communal kitchens in that Governorate and has provided two million meals in the past two weeks.

– The U.N. Children’s Fund (UNICEF) has provided drinking water and rehydration salts to help prevent or treat diarrhea, as well as provisions of high-energy biscuits for 34,000 children under the age of five in the past week.

– The U.N. Population Fund (UNFPA) is supporting over 1,300 pregnant women with hygiene supplies and helping local authorities with medical supplies to support 150,000 people.

While returning from South Korea, Pope Francis sanctioned intervening in Iraq to stop Islamist militants from persecuting not only Christian, but also all religious minority groups.

This is a dramatic turnaround, given that the Vatican normally eschews the use of force. His caveat was that the international community must discuss a strategy, possibly at the U.N., so that this would not be perceived as ‘a true war of conquest.’

Shortly thereafter, French President Francois Hollande called for an international conference to discuss ways of confronting the Islamic State insurgents who have seized control of territory in Iraq and Syria.

Both suggestions tie directly into U.S. President Barack Obama’s intention to preside over a meeting of the United Nations Security Council during his attendance at the world body’s annual General Assembly meeting in mid-September.

Specifically, Obama’s agenda will focus upon counterterrorism and the threat of foreign fighters traveling to conflict zones and joining terrorist organisations.

Additionally, all major players in the region, even ones that have had a traditional animosity to one another such as Iran vs. Saudi Arabia and the U.S., must be at the table.

It is critical to remember that a major reason for the disasters occurring in many areas of the Middle East can be traced directly back to the misguided and widely-viewed illegal invasion of Iraq by former President George W. Bush in March of 2003.

Allegedly, the U.S. went to Iraq to disarm Saddam Hussein of weapons of mass destruction (WMD), which did not exist.

When the bogus WMD argument collapsed, the rationale quickly moved to regime change and then to establishing democracy in the Arab world.

The real reasons were to control the oil fields and re-do that area so it could be manipulated by Western interests.

In reality, the legacy of the biggest U.S. foreign blunder in history left Iran as the powerhouse in the region, converted Iraq into a powder keg for conflict among the Sunnis and Shias, got 200,000 Iraqis and over 4,000 U.S. military personnel killed, and gave the American taxpayer a bill for two trillion dollars, which is a figure that will continue to rise because of the thousands of troops that will need medical and psychological assistance, as well as Iraq requesting financial, military and technical assistance in the future.

Tragically, some media outlets, such as Fox News and many right-wing talk radio stations, are putting the same purveyors of misinformation and disinformation – such as former Vice-President Dick Cheney, former Deputy Secretary of Defense Paul Wolfowitz, U.S. Administrator in Iraq Paul Bremer, Senator John McCain and Bill Kristol – back on the air to re-write history on how the Iraq War was really a glowing success.

In a democracy it is critical to have a cross-section of ideas and stimulating debate on Iraq and other issues, but it is questionable and foolish to heed the advice of such a devious and counterproductive group that adheres to the nonsensical tenets that if only the U.S. had stayed longer, left more troops or invested more blood and treasure in that region, there would have been a positive outcome.

They refuse to recognise that neither the Iraqis nor the Iranians wanted the U.S. to stay, and the American public was turning against a failed war.

Couple that with the fact that former Iraqi Prime Minister Nouri al-Maliki tried to isolate the Sunnis from any power-sharing or involvement in the political, financial and cultural facets of Iraq.

From the despicable beheadings of freelance photographer James Foley and freelance journalist Steven Sotloff, to the imposition of draconian Sharia Law that violates human and civil rights, the challenges in Iraq are multiplying daily.

Probably no one in the world knows this better than U.N. Secretary General Ban Ki-moon who said recently, “… I can bring world leaders to the river, but I cannot force them to drink.”

When the leaders of the world meet later this month at the U.N., it will be time for them to ‘drink the water’ for everyone’s benefit.

The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, IPS-Inter Press Service.

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Afghan “Torn” Women Get Another Chancehttp://www.ipsnews.net/2014/09/afghan-torn-women-get-another-chance/?utm_source=rss&utm_medium=rss&utm_campaign=afghan-torn-women-get-another-chance http://www.ipsnews.net/2014/09/afghan-torn-women-get-another-chance/#comments Tue, 02 Sep 2014 14:14:35 +0000 Karlos Zurutuza http://www.ipsnews.net/?p=136457 Rukia (in the foreground) recovers after a successful fistula operation at Malalai Maternity Hospital in Kabul (August 2014). Credit: Karlos Zurutuza/IPS

Rukia (in the foreground) recovers after a successful fistula operation at Malalai Maternity Hospital in Kabul (August 2014). Credit: Karlos Zurutuza/IPS

By Karlos Zurutuza
KABUL, Sep 2 2014 (IPS)

“The smell of faeces and urine isolates them completely. Their husbands abandon them and they become stigmatised forever” – Dr Pashtoon Kohistani barely needs two lines to sum up the drama of those women affected by obstetric fistula.

Alongside the health centre in Badakhshan – 290 km northeast of Kabul – Malalai Maternity Hospital is the only health centre in Afghanistan with a section devoted to coping with a disease that is seemingly endemic to the most disadvantaged members of the population: women, young, poor and illiterate.

“Given that a caesarean birth is not an option for most Afghan women, the child dies inside them while they try to give birth. They end up tearing their vagina and urethra,” Dr Kohistani told IPS. “Urinary, and sometimes faecal incontinence too, is the most immediate effect,” added the surgeon as she strolled through the hospital corridors where only women wait to be seen by a doctor, or just come to visit a sick relative.“Pressure mounts on them from every side, even from their mothers-in-law. They have to hear things such as `I had five children without ever seeing a doctor´. Many of these poor girls end up committing suicide” – Dr Nazifah Hamra

They are of practically all ages. Some show obvious signs of pain while others look almost relaxed. In fact, they are in one of the very few places in Afghanistan where the total lack of male presence allows them to uncover their hair, take off their burka and even roll up their sleeves to beat the heat.

According to Nazifah Hamra, head of Malalai´s Fistula Department, “malnutrition is one of the key factors behind this problem. You have to bear in mind that women from remote rural areas in Afghanistan always eat after the men. Girls often don´t get enough milk and essential nutrients for their growth. And add to it that they only get to see a doctor when they marry, and usually at a very early age.”

Dr Hamra told IPS that she attends an average of 4-5 patients suffering from a fistula at any one time. Rukia is one of the two recovering in an eight-bed ward on the hospital´s second floor.

“I was 15 when I got married and 17 when I got pregnant,” recalls the 26-year-old woman from a small village in the province of Balkh, 320 km northwest of Kabul.

“When I was about to give birth, I had a terrible pain but the road to Kabul was cut so I was finally taken to Bamiyan, 150 km east of Kabul.”

Sitting on the bed carefully in order not to obstruct the catheter that still evacuates the remaining urine, Rukia tells IPS that her son died in her womb. An unskilled medical staff only made things worse.

“What the doctors did to her is difficult to believe. She was brutally mutilated,” said Dr Hamra, adding that medical negligence was “still painful common currency” in Afghanistan.

In a 2013 report on the risks of child marriage in Afghanistan, Human Rights Watch claims that children born as a result of child marriages also suffer increased health risks, and that there is a higher death rate among children born to Afghan mothers under the age of 20 than those born to older mothers.

Brad Adams, Asia Director at Human Rights Watch, called on Afghan officials to end the harm being caused by child marriage. “The damage to young mothers, their children and Afghan society as a whole is incalculable,” Adams stressed.

Rukia´s husband left to marry another woman so she had no other choice but to move back to her parents´ house, where she has lived for the last nine years. But even more painful than her ordeal and the defection of her husband, she says, is the fact that she will never be a mother.

Dr Hamra knows Rukia´s story in detail, as well as those of many others in her situation. “Pressure mounts on them from every side, even from their mothers-in-law,” she told IPS. “They have to hear things such as `I had five children without ever seeing a doctor´. Many of these poor girls end up committing suicide.” However, preferring to look towards the future, she said that Rukia will do well after the operation.

“From now on she´ll be able to enjoy a completely normal life again,” stressed the surgeon, who also wanted to express her gratitude to the UN Population Fund (UNFPA) which “seeks to guarantee the right of every woman, man and child to enjoy a life of health and equal opportunity.”

Annette Sachs Robertson, UNFPA representative in Afghanistan, briefed IPS on the organisation´s action in the country:

“We started working in 2007, in close collaboration with the Afghan Ministry of Public Health. We train surgeons and we provide Malalai with the necessary equipment and medical supplies. Thanks to this initiative, over 435 patients have been treated and rehabilitated at Malalai Maternity Hospital and we have plans to extend the programmes to Jalabad, Mazar and Herat provinces,” explained Robertson, a PhD graduate in biology and biomedical sciences from the University of Harvard.

“You hardly ever see these cases in developed countries,” she added.

According to a 2011 report on obstetric fistula in six provinces of Afghanistan conducted by the country’s Social and Health Development Programme (SHPD), “the prevalence of obstetric fistula is estimated to be 4 cases per 1000 (0.4 percent) women in the reproductive age group. 91.7 percent of women with confirmed cases of obstetric fistula cannot read and write while 72.7 percent of fistula patients reported that their husbands are illiterate.”

“Twenty-five percent of women with fistula reported that they were younger than 16 years old and 67 percent reported they were 16 to 20 years old when they had got married. Seventeen percent of women with fistula reported that they were younger than 16 years old when they had their first delivery. Twenty-five percent of women with fistula reported that they developed the fistula after their first delivery, while 64 percent reported prolonged labour.”

Meanwhile, thanks to yet another successful operation, Najiba, a 32-year-old from Baghlan – 220 km north of Kabul – will soon be back home after suffering from a fistula over the last 14 years.

Born in a remote rural village, she was married at 17 and lost her first son a year later, after three days of labour. Despite the fistula problem, she was not abandoned by her husband and, today, they have six children.

“I was only too lucky that my husband heard on the radio about this hospital,” explains Najiba, with a broad smile hardly ever seen among those affected.

(Edited by Phil Harris)

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Arab Region Has World’s Fastest Growing HIV Epidemichttp://www.ipsnews.net/2014/09/arab-region-has-worlds-fastest-growing-hiv-epidemic/?utm_source=rss&utm_medium=rss&utm_campaign=arab-region-has-worlds-fastest-growing-hiv-epidemic http://www.ipsnews.net/2014/09/arab-region-has-worlds-fastest-growing-hiv-epidemic/#comments Mon, 01 Sep 2014 07:21:29 +0000 Mona Alami http://www.ipsnews.net/?p=136439 By Mona Alami
BEIRUT, Sep 1 2014 (IPS)

At a time when HIV rates have stabilised or declined elsewhere, the epidemic is still advancing in the Arab world, exacerbated by factors such as political unrest, conflict, poverty and lack of awareness due to social taboos.

According to UNAIDS (the Joint United Nations Programme on HIV/AIDS), an estimated 270,000 people were living with human immunodeficiency virus (HIV) in the countries of the Middle East and North Africa (MENA) region in 2012.

“It is true that the Arab region has a low prevalence of infection, however it has the fastest growing epidemic in the world,“ warns Dr Khadija Moalla, an independent consultant on human rights/gender/civil society/HIV-AIDS.With the exception of Somalia and Djibouti, the [HIV] epidemic is generally concentrated in vulnerable populations at higher risk, such as men-who-have-sex-with-men, female and male sex workers, and injecting drugs users

The United Nations estimates that there were 31,000 new cases and 16,500 new deaths in 2012 alone. “Infections grew by 74 percent between 2001 and 2012 while AIDS-related deaths almost tripled,” says Dr Matta Matta, an infection specialist based at the Bellevue Hospital in Lebanon.

However, both Moalla and Matta explain that figures can be often misleading in the region, due to under-reporting and the absence of consistent and accurate surveys.

With the exception of Somalia and Djibouti, the epidemic is generally concentrated in vulnerable populations at higher risk, such as men-who-have-sex-with-men, female and male sex workers, and injecting drugs users.

In Libya, for example, 90 percent of those in the latter category also live with HIV, notes Matta. Furthermore, adds Moalla, most Arab countries do not have programmes allowing for exchange of syringes.

The legal framework criminalising such activities in most Arab countries means that it is difficult to reach out to specific groups.  With the exception of Tunisia, which recognises legalised sex work, female sex workers who work clandestinely in other countries are not safeguarded by law and thus cannot force their clients to use protection, which allows for the spread of disease.

Lack of awareness, the absence of voluntary testing and of sexual education, social taboos, as well as poverty, are among the factors driving HIV in the region. “Arab governments and societies deny the epidemic and the absence of voluntary testing means that for every infected person we have ten others that we do not know about,” stresses Moalla.

People living with HIV or those at risk face discrimination and stigma.  “More than half of the people living with HIV in Egypt have been denied treatment in healthcare facilities,” explains Matta.

This bleak scenario is compounded by the security challenges prevailing in the region which not only make it difficult to deliver prevention and other programmes, but also restrict access to services by those on treatment and cause displacement and loss of follow-up according to the UNAIDS report.

The war in Iraq that began in 2003, for example, led to the destruction of most of the country’s programmes and facilities under the National AIDS Programme and, according to Moalla, the national aids centre in Libya was recently burnt down.

In addition, in some countries, conflict has significantly increased the vulnerability of women. By 2012, for example, only eight percent of the estimated number of pregnant women living with HIV in the MENA region received appropriate treatment to prevent mother-to-child transmission according to the UNAIDS report.

Meanwhile, only a few governments have worked on effective programmes to fight the epidemic, although there are signs of the emergence of NGOs tackling the problem with people living with HIV and providing them with support.

“North African countries and Lebanon have generally done better than others, while Gulf countries are doing the least,” says Moalla, adding that less than one in five people living with HIV are receiving the medicines they need in the Arab region.

While some efforts have been made with the UNDP HIV Regional Programme pioneering legal reform in several countries, as well as drafting an Arab convention on protection of the rights of people living with HIV in partnership with the League of Arab States, these are not enough.

“The Arab world attitude taking the high moral ground on the issue of HIV is no barrier for the epidemic,” says Matta. “The region’s governments need to address a growing problem that is only worsened by the general upheaval.”

(Edited by Phil Harris)

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Nepal Landslide Leaves Women and Children Vulnerablehttp://www.ipsnews.net/2014/08/nepal-landslide-leaves-women-and-children-vulnerable/?utm_source=rss&utm_medium=rss&utm_campaign=nepal-landslide-leaves-women-and-children-vulnerable http://www.ipsnews.net/2014/08/nepal-landslide-leaves-women-and-children-vulnerable/#comments Wed, 27 Aug 2014 01:50:55 +0000 Naresh Newar http://www.ipsnews.net/?p=136342 Relief workers and aid agencies are worried about the security, protection and psychological health of women and children in post-disaster settings. Credit: Naresh Newar/IPS

Relief workers and aid agencies are worried about the security, protection and psychological health of women and children in post-disaster settings. Credit: Naresh Newar/IPS

By Naresh Newar
DABI, Nepal, Aug 27 2014 (IPS)

Living in a makeshift tarpaulin shelter, which barely protects her family from the torrential rainfall or scorching heat of this remote village in southern Nepal, 36-year-old Kamala Pari is under immense stress, worrying about her financial security and children’s safety.

The family’s only house and tiny plot of farmland were completely destroyed by the massive landslide on Jul. 2 that struck the village of Dabi, part of the Dhusun Village Development Committee (VDC) of Sindhupalchok district, nearly 100 km south of the capital Kathmandu.

Dhusun was one of the four VDCs including Mankha, Tekanpur and Ramche severely affected by the disaster, which killed 156 and displaced 478 persons, according to the ministry of home affairs.

This was Nepal’s worst landslide in terms of human fatalities, according to the Nepal Red Cross Society, the country’s largest disaster relief NGO.

“My students are too scared to return to their classrooms. They really need a lot of counseling." -- Krishna Bhakta Nepal, principal of Jalpa High School
Though the government is still assessing long-term damages from that fateful day, officials here tell IPS the worst victims are likely to be women and children from these impoverished rural areas, whose houses and farms are erected on land that is highly vulnerable to natural catastrophes.

Left homeless and further impoverished, Pari is worried about the toll this will take on her children, who are now living with the reality of having lost their home and many of their friends.

“We’re not just living in fear of another disaster but have to worry about our future as there is nothing left for us to survive on,” Pari told IPS, adding that their monthly income fell from 100 dollars to 50 dollars after the landslide.

Her 50 neighbours, living in tarpaulin tents in a makeshift camp on top of a hill in this remote village, are also preparing for hard times ahead.

“We lost everything and now we run this shop to survive,” 15-year-old Elina Shrestha, a displaced teenager, told IPS, gesturing at the small grocery shop that she and her friends have cobbled together.

Their customers include tourists from Kathmandu and nearby towns who are flocking to destroyed villages to see with their own eyes the landslide-scarred hills and the lake created by the overflow of water from the nearby Sunkoshi river.

Protecting the vulnerable

Relief workers and protection specialists from government and aid agencies told IPS they are worried about the security, protection and psychological health of women and children.

An estimated 50 children were killed in the landslide, according to the ministry of women, children and social welfare.

“In any disaster, children and women seem to be more impacted than others,” Sunita Kayastha, chief of the emergency unit of the United Nations Children’s Fund (UNICEF) told IPS, adding that they are most vulnerable to abuse and violence.

Women and children are 14 times more likely than men to die in a disaster, according to a report by Plan International, which found adolescent girls to be particularly vulnerable to sexual violence in the aftermath of a natural hazard.

Senior psychosocial experts recently visited the affected areas and specifically reported that children and women were under immense psychological stress.

“The children need a lot of counseling [and] healing them is our top priority right now,” Women Development Officer Anju Dhungana, point-person for affected women and children in the Sindhupalchok district, told IPS.

Dhungana is concerned about the gap in professional psychosocial counseling at the local level and has requested help from government and international aid agencies based in Kathmandu.

Schools are gradually being resumed, with the help of aid agencies who are identifying safe locations for the children whose classrooms have been destroyed.

One school was totally destroyed, killing 33 children, and the remaining 142 children are now studying in temporary learning centres built by Save the Children and the District Education Office, officials told IPS.

A further 1,952 children who attend schools built close to the river are also at risk, experts say.

Trauma is quite widespread, the sight of the hollowed-out mountainside and large dam created close to the river still causing panic among children and their parents, as well as their teachers.

“I lost 28 of my students and now I have [the] job of healing hundreds of their school friends,” Balaram Timilsina, principal of Bansagu School in Mankha VDC, told IPS.

“My students are too scared to return to their classrooms. They really need a lot of counseling,” added Krishna Bhakta Nepal, principal of Jalpa High School of Khadichaur, a small town near Mankha.

International agencies Save the Children, UNICEF and the United Nations Population Fund (UNFPA) are helping the government’s efforts to restore normal life in the villages, but it has been challenging.

“We need to help children get back to school by ensuring a safe environment for them,” Sudarshan Shrestha, communications director of Save the Children, told IPS.

The international NGO has been setting up temporary learning centres for hundreds of students who lost their schools.

High risk for adolescent girls

Shrestha’s concern is not just for the children but also the young women who are often vulnerable in post-disaster situations to sexual violence and trafficking.

“The risk of sexual exploitation and trafficking is always high among the families impoverished by disaster, and during such situations, girls are often hoaxed and tricked by traffickers,” explained Shrestha.

Sindhupalchok, one of Nepal’s most impoverished districts, is notorious for being a source of young girls who are trafficked to Kathmandu and Indian cities, according to NGOs; a recent report by Child Reach International identified the district as a major trafficking centre.

“Whenever disaster strikes, the protection of adolescent girls should be highly prioritised and our role is to make sure this crucial issue is included in the disaster response,” UNFPA’s country representative Guilia Vallese told IPS, explaining that protection agencies need to be highly vigilant.

Government officials said that although there have been no cases of sexual or domestic violence and trafficking, they remain concerned.

“There are also a lot of young girls displaced [and living] with their relatives and after our assessment, we found that they need more protection,” explained officer Dhungana.

She said that many of them live in the camps or in school buildings in villages that are remote, with little or no government presence.

The government has formed a committee on protection measures and will be assessing the situation of vulnerability soon to ensure that children and women are living in a secure environment.

Edited by Kanya D’Almeida

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How Midwives on Sierra Leone’s Almost Untouched Turtle Islands are Improving Women’s Healthhttp://www.ipsnews.net/2014/08/how-midwives-on-sierra-leones-almost-untouched-turtle-islands-are-improving-womens-health/?utm_source=rss&utm_medium=rss&utm_campaign=how-midwives-on-sierra-leones-almost-untouched-turtle-islands-are-improving-womens-health http://www.ipsnews.net/2014/08/how-midwives-on-sierra-leones-almost-untouched-turtle-islands-are-improving-womens-health/#comments Tue, 26 Aug 2014 15:02:40 +0000 Joan Erakit http://www.ipsnews.net/?p=136350 The eight islands that comprise Turtle Islands, Sierra Leone, are remote and practically untouched by modern civilisation. Credit: Joan Erakit/IPS

The eight islands that comprise Turtle Islands, Sierra Leone, are remote and practically untouched by modern civilisation. Credit: Joan Erakit/IPS

By Joan Erakit
MATTRU JONG, Sierra Leone, Aug 26 2014 (IPS)

Emmanuel is a male midwife.

At the age of 26, he lives and works on one of eight islands off the southwest peninsular of Sierra Leone, an hour by speedboat from Mattru Jong, the capital of Bonthe District.

On a particularly hot Wednesday morning, IPS joins Marie Stopes, United Nations Population Fund (UNFPA) and Sierra Leone’s Ministry of Health to go and visit a population on one of the Turtle Islands that is practically untouched by modern civilisation.

Marie Stopes is a British-based non-profit that provides family planning and reproductive health services to over 30 countries around the world. They work as a back-up support system to the government, filling in the gaps in hard-to-reach areas that the government is still working to resource.

On the mainland of Mattru Jong there is a small market, situated on the river Jong which flows into the Atlantic ocean, and crowded with various kiosks boasting fish, vegetables and live chickens tied at their feet in straw baskets.

To reach the islands, one has to travel by boat. But all the islands don’t have landing docks and the boats sometimes stop in knee-deep water. Passengers — and midwives visiting the islands to provide reproductive health and family planning services — have to hoist their belongings and supplies above water, to make their way to the villages.

“Their [midwives] challenge is that they don’t have a boat. If you want to do this effectively, you need a good boat,” Safiatu Foday, a regional family planning coordinator for UNFPA in Sierra Leone, explained to IPS.

For island communities that have very little access to the mainland, basic health information is difficult to come by, therefore the risks — especially those pertaining to pregnancy, become inevitable.

With a population of over six million, where women of childbearing age are between the ages of 15 and 49, this West African country has refocused its health initiatives, working tirelessly to strengthen the capacity and training of skilled midwives — an exceptional tool in reducing maternal and infant mortality.

It Takes a Village

The village is inhabited by about a few hundred people — most of them large families, many of whom have just started utilising the peripheral health unit (PHU) that is onsite.

Emmanuel, one of the first men to undertake the position of midwife in this area, is the person “in-charge,” facilitating prenatal visits, deliveries, antenatal care, attending to illnesses and referring patients to a hospital when needed.  

“There are people who since their birth, have never left the island,” Fadoy said.

Some of the women say they have delivered 13 or 14 children prior to the work of Marie Stopes in their village.

Others recount having no time to “rest” or take care of their other children while being pregnant almost every year.

There are common reasons as to why women become pregnant so consistently.

One woman shares that there is a fear of being “abandoned” by one’s husband. The women say if they do not engage in sexual intercourse during the marriage, their husbands will look elsewhere. Therefore women feel they have no choice but to keep getting pregnant.

There is also the question of approval; many women must obtain permission from their husbands to start using contraceptives.

“We used to get pregnant all the time and our husbands would abandon us, so we had to fight for ourselves to survive. Since Marie Stopes came to the island and we now have access to contraceptives, we are able to take care of ourselves,” Yeanga, 33 tells IPS, adding, “It has created an impact in my life, one, because I now know about spacing births.”

Yeanga is the mother of five children with the oldest aged 25, and the youngest only three years old.

Before going on family planning, Yeanga admits to having difficulties with her husband, which were only heightened when he found out that contraceptives would help her not to get pregnant.

“Even when I wanted to join family planning, my husband was not agreeing, but I talked to him about it and we finally agreed to allow me to start family planning.”

In order to fully meet the demand of women who are in search of family planning and reproductive health services, the government has come up with an interesting strategy: recruit and train traditional birth attendants (TBA’s) to provide quality health care services in the villages.

Because they are from the village, they are both respected and valued, thus their insight, advice and knowledge are taken very seriously.

“Before midwives came to the island, there were just TBA’s doing deliveries in this area – and there were a lot of problems with these births,” Isatu Jalloh, 28, a nurse working in the village, told IPS.

Without skilled birth attendants, many of the women on the island suffered complications like preeclampsia, fistula and even death.

Though Sierra Leone has one of the highest maternal and infant mortality rates, 140 infant deaths per 1,000 live births, and 857 maternal deaths per 100,000 live births, Jalloh believes that the maternal death rate on the island has reduced due to the advocacy of midwives who travel to the island to promote family planning and reproductive health.

The ability to choose when to have children has allowed women on the island to pursue small economic ventures. They are able to produce an income to not only take care of themselves, but also their children.

The Future is Bright?

As the last few hundred days of the United Nations Millennium Development Goals (MDGs) come to a close, Sierra Leone stands at an interesting cross section: that of incremental success and challenges to come.

Demand for reproductive health and family planning services is high, the commodities are being supplied through partnerships with UNFPA and Marie Stopes, midwives are being dispatched to different districts, yet obstacles remain.

Most trained midwives deployed to health centres far from their homes don’t want to stay in those areas due to harsh working conditions and unfamiliarity with their surroundings.

And with the outbreak of Ebola, most midwives have been immediately evacuated, leaving patients, many of them pregnant women, without proper care.

Sierra Leone faces an opportunity to scale-up its reproductive health and family planning services by continuing its ability for form essential partnerships, most effectively illustrated in the one with civil society and advocacy group, Health Coalition for All.

“Our focus is on health and health-related issues. The key areas are advocacy and monitory, we work to ensure that services are available, accessible, affordable and that they reach the beneficiary,” Al Hassane B. Kamara, a programme manager for the coalition, shared with IPS.

Based in Makeni, in Northern Province, the Health Coalition for All has played an essential role in ensuring that women have access to healthcare, especially during pregnancy.

By addressing the issues such as lack of trained staff, delivery of commodities and most importantly, the high user fees during clinic visits, the coalition takes a proactive stand to ensure that women do not end up in unqualified hands.

“They pay very high fees to see a qualified doctor, especially for cesarean operations.  As a result they have no options but to work with the TBA or a “quack doctor.”

With programmes such as the Free Health Care Initiative (FHCI) that allows pregnant mothers, lactating mothers and children under the age of five to access services for free, Sierra Leone continues to put its focus on reproductive health.

 Edited by: Nalisha Adams

The writer can be contacted through Twitter on: @Erakit

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Bangladeshi Girls Seek Equal Opportunityhttp://www.ipsnews.net/2014/08/bangladeshi-girls-seek-equal-opportunity/?utm_source=rss&utm_medium=rss&utm_campaign=bangladeshi-girls-seek-equal-opportunity http://www.ipsnews.net/2014/08/bangladeshi-girls-seek-equal-opportunity/#comments Mon, 25 Aug 2014 04:08:07 +0000 Naimul Haq http://www.ipsnews.net/?p=136315 Adolescent girls in Bangladesh’s Mymensingh district meet once a week to discuss their rights. Here they talk about sanitation and personal hygiene. Credit: Naimul Haq/IPS

Adolescent girls in Bangladesh’s Mymensingh district meet once a week to discuss their rights. Here they talk about sanitation and personal hygiene. Credit: Naimul Haq/IPS

By Naimul Haq
RANGPUR, Bangladesh, Aug 25 2014 (IPS)

Until five years ago, Shima Aktar, a student in Gajaghanta village in the Rangpur district of Bangladesh, about 370 km northwest of the capital Dhaka, was leading a normal life. But when her father decided that it was time for her to conform to purdah, a religious practice of female seclusion, things changed.

The young girl, now 16 years old, says her father pulled her out of school at the age of 11 and began to lay plans for her marriage to an older man “for her own protection” he said.

Born to a hardline Muslim family, pretty, shy Shima might have taken these changes in stride – were it not for the support of a local youth advocacy group.

Called ‘Kishori Abhijan’, meaning ‘Empowering Adolescents’, the project is a brainchild of the United Nations Children’s Fund (UNICEF) and educates young people on a range of issues, from gender roles, sex discrimination and early marriage, to reproductive health, personal hygiene and preventing child labour.

“The absence of political will, conceptual clarity, appropriate institutional arrangements and allocation of adequate resources are challenges to the achievement of substantive equality between women and men […].” -- Shireen Huq, founding member of Naripokkho, a leading women's rights NGO
Now that she knows her rights, Shima is fighting hard to assert them, joining a veritable army of young women around this country of 160 million who are determined to change traditional views about gender.

Besides the Empowering Adolescents initiative, other grassroots schemes to educate communities on the rights of women include groups that practice interactive popular theatre (IPT), designed to address social issues at a local level.

Using a mix of popular folk tales and traditional songs and dancing, the actors perform for their parents, local officials and other influential community members, determined to have their voices heard by breaking out of the box.

The Centre for Mass Education in Science (CMES), an NGO working in a remote part of the Rangpur district, recently put on a public performance to illustrate the need to abolish the dowry system, and boost female participation in the public workforce.

Thousands of women here live under the shadow of dowry-related violence. The Hong Kong-based Asian Legal Resource Centre (ALRC) reported some years ago that the practice of dowry leads to torture, acid attacks and sometimes even murder and suicide.

The year 2011 saw 330 deaths of women in dowry-related violence. The previous year 137 women were killed for the same reason, according to the largest women’s rights NGO, Bangladesh Mahila Parishad. The NGO also reported 439 cases of dowry-related violence in 2013.

Very often, women are either killed or commit suicide when they are unable to pay the full price of the dowry.

Mohammed Rashed of CMES believes that educating people as to the impacts of traditional practices and ideas can stem such unnecessary tragedies.

“By involving parents, teachers, community and religious leaders and government officials in awareness campaigns we have been able to bring positive changes,” he told IPS.

Already, efforts to spread awareness are bearing fruit. According to UNICEF, some 600,000 adolescents around the country, 60 percent of them girls, are now educated on issues like the legal marriage age of boys and girls, as well as the importance of education and family planning, as a direct result of grassroots advocacy.

Between 64 and 84 percent of adolescents interviewed by the Dhaka-based NGO Unnayan Onneshan claimed that dowry practice had decreased in their communities since 2010.

Policies driven by demands to increase girls’ education have also enabled a much higher rate of female participation in schools.

In 1994 the government introduced the Female Secondary School Stipend Programme – funded by the World Bank, the Asian Development Bank (ADB) and the Norwegian government – that offered adolescent girls a small amount of money every six months to stay in school.

Although urban and rural disparities still exist, the average primary school enrollment rate for girls is now as high as 97 percent, one of the highest in the developing world.

The field of reproductive health and rights has also witnessed improvements. The presence of skilled birth attendants in rural areas has increased from less than five percent in the early 90s to 23 percent today, while contraceptive use among women has dramatically increased from a mere eight percent in 1975 to about 62 percent in 2011.

Despite these achievements, girls still lag behind their male counterparts throughout much of the country.

Child mortality, for instance, remains much higher among females than males, with 16 deaths per 1,000 live births for boys and 20 deaths per 1,000 live births for girls, according to a 2010 study by Unnayan Onneshan.

World Bank data from 2010 shows that 57 percent of women participate in the labour force, while men show a much higher rate of employment, at 88 percent.

Shireen Huq, a leading women’s rights activist, told IPS, “Despite the impressive gains, women and girls continue to be discriminated [against]. The result manifests in the unacceptably high number of maternal deaths [and] the dropout rate for girls in secondary schools.”

A 2013 ministry of health report found the maternal mortality rate (MMR) to be 170 deaths per 100,000 live births, down from 574 deaths per 100,000 live births in 1990.

Meanwhile, some 66 percent of girls in Bangladesh are married before their 18th birthday, giving the country one of the highest rates of child marriage in the world.

Huq, a founding member of Naripokkho, a leading NGO on the rights of women, also said, “The absence of political will, conceptual clarity, appropriate institutional arrangements and allocation of adequate resources are challenges to the achievement of substantive equality between women and men […].”

Experts believe it is important to involve women at every level of decision-making, including in Union Councils (UC) – the smallest administrative units in Bangladesh – which could enhance women’s participation in public life.

Some 67 percent of respondents to a survey conducted by UNICEF in 2010 felt that female members of the UCs should be given more representation and power to make decisions for their communities.

Edited by Kanya D’Almeida

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India: Home to One in Three Child Brideshttp://www.ipsnews.net/2014/08/india-home-to-one-in-three-child-brides/?utm_source=rss&utm_medium=rss&utm_campaign=india-home-to-one-in-three-child-brides http://www.ipsnews.net/2014/08/india-home-to-one-in-three-child-brides/#comments Wed, 20 Aug 2014 06:52:50 +0000 Neeta Lal http://www.ipsnews.net/?p=136218 In India, 27 percent of women aged 20-49 were married before they were 15 years old. Credit: Jaideep Hardikar/IPS

In India, 27 percent of women aged 20-49 were married before they were 15 years old. Credit: Jaideep Hardikar/IPS

By Neeta Lal
NEW DELHI, Aug 20 2014 (IPS)

Basanti Rani*, a 33-year-old farmers’ wife from the northern Indian state of Haryana, recently withdrew her 15-year-old daughter Paru from school in order to marry her off to a 40-year-old man.

“In an increasingly insecure social milieu, where rape and sexual abuse have become so common, marrying off my daughter was a wise move,” she told IPS.

“Who would’ve married her had she been abused or raped? Now, at least, her husband can look after her.”

Such a mindset, widespread across this country of 1.2 billion people, is just one of the reasons why India hosts one out of every three child brides in the world.

A recent United Nations report entitled ‘Ending Child Marriage – Progress and Prospects’ found that, despite the existence of a stringent anti-child marriage law, India ranks sixth among countries with the highest prevalence of child marriages across the globe.

The U.N. Children’s Fund (UNICEF) defines child marriage as unions occurring before a person is 18 years of age, and calls the practice a “violation of human rights.”

In India, 27 percent of women aged 20-49 claim to have tied the knot before turning 15, the survey states.

“The problem persists largely because of the patriarchal vision that perceives marriage and childbearing as the ultimate goals of a girl’s life,” explains Sonvi A. Khanna, advisory research associate for Dasra, a philanthropic organisation that works with UNICEF.

The increasing rates of violence against girls in both rural and urban India, adds Khanna, are instilling fear in the minds of families, leading them to marry their girls off as soon as they reach puberty.

According to the National Crime Records Bureau (NCRB)’s July 2014 records, there were 309,546 crimes against women reported to the police last year against 244,270 in 2012.

Crimes included rape, kidnapping, sexual harassment, trafficking, molestation, and cruelty by husbands and relatives. They also included incidents in which women were driven to suicide as a result of demands for dowries from their husbands or in-laws.

The NCRB said the number of rapes in the country rose by 35.2 percent to 33,707 in 2013 – with Delhi reporting 1,441 rapes in 2013 alone, making it the city with the highest number of rapes and confirming its reputation as India’s “rape capital”.

Mumbai, known for being more women-friendly, recorded 391 rapes last year, while IT hub Bangalore registered 80 rapes.

Obstacles to ending child marriages

The law, experts say, can do little to change mindsets or provide alternatives to child marriage.

A report by Dasra entitled ‘Marry Me Later: Preventing Child Marriage and Early Pregnancy in India’ states that the practice “continues to be immersed in a vicious cycle of poverty, low educational attainment, high incidences of disease, poor sex ratios, the subordination of women, and most significantly the inter-generational cycles of all of these.”

According to the report, despite the fact that child marriage as a practice “directly hinders the achievement of six of eight Millennium Development Goals, as an issue, it remains grossly under-funded.”

If the present trends continue, of the girls born between 2005 and 2010, 28 million could become child brides over the next 15 years, it states.

The increasing rates of violence against girls in both rural and urban India are instilling fear in the minds of families, leading them to marry their girls off as soon as they reach puberty. Credit: Credit: Sujoy Dhar/IPS

The increasing rates of violence against girls in both rural and urban India are instilling fear in the minds of families, leading them to marry their girls off as soon as they reach puberty. Credit: Credit: Sujoy Dhar/IPS

The 2006 Prohibition of Child Marriage Act (PCMA) seeks to prevent and prohibit the marriage of girls under 18, and boys under 21 years of age.

It states that if an adult male aged 18 and above is wed to a minor he shall be “punishable with rigorous imprisonment for two years or with [a] fine, which may extend to […] one lakh” (about 2,000 dollars).

Furthermore, if “a person performs, conducts, directs or abets any child marriage”, that person too shall face a similar punishment and fine.

Experts term PCMA a fairly progressive law compared to its predecessors, one with the rights of the child at its core.

It even allows for annulment of a child marriage if either party applies for it within two years of becoming adults. Even after annulment of the marriage, the law provides for residence and maintenance of the girl by her husband or in-laws until she re-marries.

“Any children born of the marriage are deemed legal and their custody is provided for, keeping the child’s best interests in mind, states this law,” a Delhi-based High Court advocate told IPS.

Yet, the legislation has not been adequately enforced due to its heavy reliance on community reporting, which rarely happens.

“Since reporting a child marriage could mean imprisonment and stigma for the family, immense financial loss and unknown repercussions for the girl, few come forward to report the event,” Khanna said.

“Adding to the problem is corruption among the implementers, or the police, who are insensitive to the need [to] stop child marriages.”

Small wonder, then, that convictions under PCMA have been few and far between.

According to the NCRB, only 222 cases were registered under the Act during the year 2013, compared to 169 in 2012 and 113 in 2011. Out of these, only 40 persons were convicted in 2012, while in 2011, action was taken against 76 people.

Young brides make unhealthy mothers

Apart from social ramifications, child marriages also lead to a host of medical complications for young mothers and their newborn babies.

According to gynecologist-obstetrician Suneeta Mehwal of Max Health Hospital in New Delhi, low birth weight, inadequate nutrition and anaemia commonly plague underage mothers.

“Postpartum hemorrhage (bleeding after delivery) is an added risk. Girls under 15 are also five times more likely to succumb to maternal mortality than those aged above 20.”

According to data released by the Registrar General of India in 2013, the maternal mortality rate (MMR) dropped from 212 deaths per 100,000 live births in 2007-09 to 178 in 2010-12.

Still, India is far behind the target of 103 deaths per live births to be achieved by 2015 under the United Nations-mandated Millennium Development Goals (MDGs).

Infant mortality declined marginally to 42 deaths per 1,000 live births in 2012 from 44 deaths in 2011. Among metropolitan cities, Delhi, the national capital, was the worst performer, with 30 deaths per 1,000 live births in 2012.

One in every 24 infants at the national level, one in every 22 infants in rural areas, and one in every 36 infants in urban areas still die within one year of life, according to the Registrar’s data.

This dire health situation is made worse by the prevalence of child marriage, experts say.

Activists point out that the main bottlenecks they encounter in their fieldwork are economic impoverishment, social customs, lack of awareness about consequences of child marriage and the belief that marriage offers social and financial security to the girl.

This is unsurprising since, according to the Global Hunger Index (GHI) 2013, India is one of the hungriest countries in the world, ranking 63rd in a list of 78 countries, behind Pakistan at 57, Nepal at 49 and Sri Lanka at 43.

Many parents also believe that co-habitation with a husband will protect a young girl from rape and sexual activity.

“Nothing could be further from [the] truth,” explains Meena Sahi, a volunteer with Bachpan Bachao Andolan (Save the Childhood Movement), a non-profit organisation working in the field of child welfare.

“On the contrary, the young girl is coerced into early sexual activity by a mostly overage husband, leading to poor reproductive health. Adolescent pregnancies do the worst damage – emotional and physical – to the mother as well as the newborn,” Sahi told IPS.

Social activists admit that to accelerate change, girls should be provided with robust alternatives to marriage. Education and vocational training should be used as bridges to employment for girls, especially in rural areas.

The 2011 census reported a nationwide literacy rate of 74.04 percent in 2011. Male literacy rate stands at 82.14 percent and female literacy hovers at 65.46 percent.

Engaging closely with those who make decisions for families and communities, explaining to them the ill effects of child marriage on their daughters, as well as providing information, as well as birth and marriage registrations, are some ways to address child marriages and track child brides.

Change is happening but at a glacial pace. In an attempt to eliminate child marriages in the Vidarbha district of the southern state of Maharashtra, 88 panchayats (local administrative bodies) passed a resolution this year to ban the practice.

Following the move, 18 families cancelled the weddings of their minor daughters.

Although annulment of child marriage is also a complex issue, India’s first child marriage was annulled in 2013 by Laxmi Sargara who was married at the age of one without the knowledge of her parents. Laxmi remarried – this time of her own choice – in 2014.

*Name changed upon request.

Edited by Kanya D’Almeida

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Helping Uganda’s HIV positive Women Avoid Unplanned Pregnancieshttp://www.ipsnews.net/2014/08/helping-ugandas-hiv-positive-women-avoid-unplanned-pregnancies/?utm_source=rss&utm_medium=rss&utm_campaign=helping-ugandas-hiv-positive-women-avoid-unplanned-pregnancies http://www.ipsnews.net/2014/08/helping-ugandas-hiv-positive-women-avoid-unplanned-pregnancies/#comments Mon, 18 Aug 2014 12:05:08 +0000 Amy Fallon http://www.ipsnews.net/?p=136181 Contraception is a smart choice but HIV positive women have to jump through the hooks to get it. Credit: Amy Fallon/IPS

Contraception is a smart choice but HIV positive women have to jump through the hooks to get it. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA, Aug 18 2014 (IPS)

Barbara Kemigisa used to call herself an “HIV/AIDS campaigner”. These days she would rather be known as an “HIV/AIDS family planning campaigner”.

“We need to reduce unplanned pregnancies and the HIV infection rate in our country,” Kemigisa told IPS during Uganda’s first national family planning conference on July 28. “It’s about dual protection.”

Raped by two uncles from an early age, Kemigisa later became promiscuous. When she was 22, she discovered she was HIV positive – and two months pregnant. Her daughter, Kourtney, now five, was born negative. But the mother couldn’t afford to buy her formula milk and, when she was just six-months-old, the baby tested positive, through breastfeeding.

Fast Facts About HIV AND Women in Uganda 2013

36.3m population
58 life expectancy
7.2% HIV prevalence
780,000 women living with HIV
6 total fertility rate
30% modern contraceptive use
57% births with skilled attendant

Source: UNICEF

Kemigisa, an informed activist who gets her ARVs the Infectious Diseases Institute at Mulago Hospital and works with KiBO Foundation in Kampala,never had any problem obtaining contraceptives.

The same can’t be said for many young HIV positive women Kemigisa regularly meets.

“Health workers tell them ‘you’re positive, you’re not supposed to be having children’,” she says.

In the last decade, Uganda’s modern contraceptive use among women has slowly increased from 18 percent to 26 percent.

Though low, this level of contraceptive use likely averted 20 percent of paediatric HIV infections and 13 percent of AIDS-related children’s deaths, says a study. Expanding family planning services can substantially reduce child infections, it concluded.

This is crucial. Uganda’s HIV infection rate of seven percent is steadily rising after a steep drop in the 1990s, when more than a quarter of the population was infected.

Uganda now accounts for the third largest number of annual new HIV infections in the world, after South Africa and Nigeria, according to the United Nations Joint Programme on HIV/AIDS (UNAIDS).

Turning women away

Contraception is the second pillar of preventing mother to child HIV transmission (PMTCT) but one that is often neglected although, at an average of six children per woman, Uganda has one of the world’s highest fertility rates.

Women trying to cope with HIV also struggle to get the “right and correct information” on family planning, says Dorothy Namutamba, of the International Community of Women living with HIV/AIDS Eastern Africa (ICWEA).

“Information doesn’t reach women living with HIV in their reproductive age,” she says.

Women may face violence at home for being HIV positive and for using contraception, only to be further mistreated when they turn to health workers, says Namutamba.

“Some are told ‘oh, this is best for you’ and brushed off at the health facility,” says Namutamba.

In the worst-case scenarios, some HIV positive women have undergone coerced sterilisation.

Namutamba says this may happen when the woman has a caesarean section or goes for family planning services: “They’re told that this is the best for you as a HIV positive woman.”

In Kenya, ICWEA and other groups have documented about fifty cases of coerced sterilisation and will release later this year a report about similar cases in Uganda.

Because of discriminatory attitudes, “a large percentage of women are hesitant to share their status with health workers when they come to receive family planning services,” Dr Deepmala Mahla, country director for Marie Stopes Uganda, told IPS.

Two services, one trip

Inadequate coverage, frequent stock outs of commodities, limited offer of contraceptive methods and lack of trained staff affect family planning services for all women in Uganda, says Dr Primo Madra, programme officer with the United Nations Population Fund (UNFPA) in Kampala.

But for women living with HIV, he says, the main problem is the time and effort required.

An HIV positive woman who goes to the clinic for a refill of ARV pills must line up at the HIV clinic and then at the family planning clinic, both likely with long queues. She may have to do two trips.

“Most often the woman will prioritise the ARVs,” says Madra.

In a number of districts, the government and UNFPA are setting up “one-stop-shops” that offer both HIV and reproductive health services, and training health workers in the new system.

“This will enable a woman who walks into an ARV clinic to access all services more conveniently,” Primo told IPS.

But, he adds, the nationwide rollout of one-stop-shops is constrained by lack of staff: “Many health facilities have vacant health worker positions and are overwhelmed by the patient load.”

Edited by: Mercedes Sayagues

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East Africa Breaks the Silence on Menstruation to Keep Girls in Schoolhttp://www.ipsnews.net/2014/08/east-africa-breaks-the-silence-on-menstruation-to-keep-girls-in-school/?utm_source=rss&utm_medium=rss&utm_campaign=east-africa-breaks-the-silence-on-menstruation-to-keep-girls-in-school http://www.ipsnews.net/2014/08/east-africa-breaks-the-silence-on-menstruation-to-keep-girls-in-school/#comments Fri, 15 Aug 2014 14:30:18 +0000 Amy Fallon http://www.ipsnews.net/?p=136145 Students from Great Horizon Secondary School in Uganda's rural Kyakayege village pose proudly with their re-usable menstrual pads after a reproductive health presentation at their school. Credit: Amy Fallon/IPS

Students from Great Horizon Secondary School in Uganda's rural Kyakayege village pose proudly with their re-usable menstrual pads after a reproductive health presentation at their school. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA, Aug 15 2014 (IPS)

When Peninah Mamayi got her period last January, she was scared, confused and embarrassed. But like thousands of other girls in the developing world who experience menarche having no idea what menstruation is, Mamayi, who lives with her sister-in-law in a village in Tororo, eastern Uganda, kept quiet.

“When I went to the toilet I had blood on my knickers,” she told IPS. “I was wondering what was coming out and I was so scared I ran inside the house and stayed there crying.

“I just used rags. I feared telling anybody.”For girls, “pads are as good as schoolbooks” -- Dennis Ntale, 18, a student at co-ed Mengo Senior School in Kampala, Uganda

Not having access to or being able to afford disposable sanitary pads or tampons like millions of their Western counterparts, desperate Ugandan girls will resort to using the local ebikokooma leaves, paper, old clothes and other materials as substitutes or even, as a health minister told a menstrual hygiene management conference this week, sitting in the sand until that time of the month is over.

“We always try to give them something to use at school, just at school,” Lydia Nabazzine, a teacher at Mulago Private Primary School in Kampala, where about 300 out of 500 students are female, told IPS.

“When they go home we don’t know how they go about it, because we cannot afford funding up to home level.”

But the 2012 Study on menstrual management in Uganda, conducted by the Netherlands Development Organisation (SNV) and IRC International Wash and Sanitation Centre in seven Ugandan districts, found that over 50 percent of senior female teachers confirmed there was no provision for menstrual pads for schoolgirls.

When some girls have their period, they may miss up to 20 percent of their total school year due to the humiliation of not having protection, according to separate research from the World Bank. This profoundly affects their academic potential.

“Those days when I was menstruating I could be absent for up to five days a month until menstruation had stopped,” recalled Mayami.

It’s a continent-wide problem. The United Nations Children’s Fund says one in 10 African girls skipped school during menstruation. Some drop out entirely because they lack access to effective sanitary products.

A number of recent initiatives have, however, tried to address this.

On May 28 this year, the world marked the first Menstrual Hygiene Day to help “break the silence and build awareness about the fundamental role that good menstrual hygiene management (MHM) plays in enabling women and girls to reach their full potential.”

On Aug. 14 – 15, East Africa’s first national menstrual hygiene management conference, which has the theme “breaking the silence on menstruation, keep girls in school,” has been taking place in Uganda’s capital Kampala.

At least 100 schoolteachers, schoolgirls – and boys – NGOs, including Network for Water and Sanitation (NETWAS) Uganda, civil society members and others are taking part in the two-day event. They’re calling on the government to put in place a menstrual hygiene management school policy. They also want the government to provide free sanitary pads to girls in schools, like neighbouring Kenya has done.

Despite keeping silent about the horrors of menstruation for months, Mamayi shared with the conference attendees the solution she found to that time of the month.

The student, now 13, had been walking home from school when some older pupils told her, “madam [the teacher] said menstruation is a normal thing for every girl.”

“So I asked them about it,” she told IPS.

“Now I’m using AFRIPads.”

Invented by the eponymous Uganda-based social business, AFRIPads are washable cloth sanitary towels designed to provide effective and hygienic menstrual protection for up to a year.

One Ugandan, Dr. Moses Kizza Musaazi, a senior lecturer in the Department of Electrical and Computer Engineering at Kampala’s Makerere University, has also invented the environmentally-friendly MakaPads, from papyrus reeds and waste paper. MakaPads are said to be the only trademarked biodegradable sanitary pads made in Africa.

Mamayi said the re-useable pads work out to be 5,500 Ugandan shillings (2.11 dollars) a year, compared to the 30,000 shillings (11.49 dollars) that disposable pads would have set her back.

“Now when I go somewhere [when I have my period] I sit and am comfortable,” said Mamayi. “I’m not bothered by anything. I don’t worry whether I’ve got anything on my skirt. I don’t miss school.”

She added: “I’m going to tell my friends that menstruation is a normal thing in girls.

“I want my friend also to be free, to tell their parents to buy for them pads. Let them not fear.”

Understanding and Managing Menstruation, was launched by Uganda’s Ministry of Education and Sports at East Africa’s first national menstrual hygiene management conference. The 50-page reader has photos and a section on how to make reusable pads at home, and sections for parents, guardians, peers, friends and schoolboys. Courtesy: Amy Fallon

Understanding and Managing Menstruation, was launched by Uganda’s Ministry of Education and Sports at East Africa’s first national menstrual hygiene management conference. The 50-page reader has photos and a section on how to make reusable pads at home, and sections for parents, guardians, peers, friends and schoolboys. Credit: Amy Fallon/IPS

Breaking the culture of silence around menstruation is the aim of a new book, Understanding and Managing Menstruation, launched by Uganda’s Ministry of Education and Sports at the conference. The 50-page reader has photos and a section on how to make reusable pads at home, and sections for parents, guardians, peers, friends and schoolboys.

Maggie Kasiko, a gender technical advisor at the Ministry of Education and Sports, told IPS that the government hoped the book would reach as many students, teachers and parents across the country as possible.

“Not many girls have the opportunities to have their mothers and aunties around, so they start their menstruation without knowing,” she said, adding many parents and relatives were busy trying to earn a living for their families.

Dennis Ntale, 18, a senior five student at co-ed Mengo Senior School in Kampala, said he didn’t know what menstruation was when he encountered a fellow student with her period in class earlier this year, and tried to comfort her. It was only sometime later when he relayed the incident to his male friends and they told him she was “undergoing her MP [menstrual period].”

“They’re [teachers] not teaching this to the boys in schools,” Ntale told IPS.

“I believe boys should be informed about this because there are many of them out there who have no idea about this.”

He said for girls, “pads are as good as schoolbooks”.

“If you don’t have that pad she won’t be able to do a thing,” Ntale said. “[We should] make sure she has what will keep her in school.”

Kasiko said the Ministry of Education and Sports was continuing to ensure schools had separate facilities for boys and girls, with the girls having washrooms and changing rooms where they could bathe and change, had access to clean water, extra pads and Panadol.

But she said she didn’t see the government providing free pads to girls “in the short-term or the long-term”.

“Starting to distribute sanitary towels to each and every girl, every month, is quite a cost for the ministry when you look at all the other areas that the ministry needs to take care of,” she said.

“That, our guidelines for Universal Primary Education (UPE) is very clear, is a role of parents. It’s sanitary wear. Just like you buy a panty for your child, you should be responsible for buying a sanitary towel for your child.

Kasiko added: “But we’ll support the parents and work together with the parents to give them knowledge to ensure the environment is clean and girls stay in school.”

Edited by: Nalisha Adams

The writer can be contacted on Twitter @amyfallon 

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One Woman’s Struggle to Find the Right Contraceptivehttp://www.ipsnews.net/2014/08/one-womans-struggle-to-find-the-right-contraceptive/?utm_source=rss&utm_medium=rss&utm_campaign=one-womans-struggle-to-find-the-right-contraceptive http://www.ipsnews.net/2014/08/one-womans-struggle-to-find-the-right-contraceptive/#comments Thu, 14 Aug 2014 15:18:29 +0000 Miriam Gathigah http://www.ipsnews.net/?p=136131 Because men wield power in decisions around pregnancy, family planning services should include them. Couple-centred family planning services are sorely needed in Africa. Credit: Mercedes Sayagues/IPS

Because men wield power in decisions around pregnancy, family planning services should include them. Couple-centred family planning services are sorely needed in Africa. Credit: Mercedes Sayagues/IPS

By Miriam Gathigah
NAIROBI, Aug 14 2014 (IPS)

Beatrice Njeri had just come home from her job as a janitor at a primary school in Nairobi. It was August 2009.

Arriving home earlier than usual, the married mother of two found her husband waiting for her in their shanty at Kisumu Ndogo, in the sprawling Kibera slums.

He had just discovered he was HIV positive. A week later, she too tested positive.

Both were 29 years old at the time. “We were very young and knew very little about HIV,” she says.

Having had two daughters, both HIV negative, they desired a son, but decided not to have another baby.

At the time, to prevent pregnancy, Njeri was on Depo-Provera, a hormone injection that lasts three months, and she needed a new shot.

On discovering that Njeri was HIV positive, the nurses encouraged her to undergo tubal ligation as a permanent birth control method – a step that neither Njeri nor her husband were prepared to take.

Unbeknown to Njeri, during this period, the country was facing a massive contraceptives shortage. It was so bad that rumours spread that women seeking the hormone injection, the most popular, family planning method, were injected with water instead of the hormone.

Njeri told IPS that the nurses said that they were giving priority to other women with pressing need of contraceptives.

“They said I was being selfish for not agreeing to have my tubes tied,” she says. “The nurses were forcing me to give up the only thing that made me feel like a real woman. I did not want that taken away from me.”

Sex became a chore

She was advised to use a condom to prevent a pregnancy. Condoms were new to them, and not easy.

“Using it all the time was very difficult. Sex became a chore. I hated it,” she says.

Fast Facts about Contraception in Kenya

Most Popular Contraceptives

14.8% Injectables
4.7% Pill
3.2% Female sterilization
3.2% Rhythm (safe days)
2.6% Male condom
1.3% Implant
1.1%: IUD
0.4%: Lactation
0.4%: Withdrawal
0.4%: Folk method
28%: Total married women using modern contraception
26%: Unmet need for contraception

Source: DHS 2009 http://dhsprogram.com/pubs/pdf/FR229/FR229.pdf

Price was another issue. “We are both casual labourers. In the slums, putting food on the table is the only priority,” she says. Their sole support comes from her church, parcels of clothes and food every now and then.

Njeri shared her predicament with a traditional birth attendant, who advised her to only have sex on safe days.

But neither knew that antibiotics can interfere with the menstruation cycle, and Njeri was taking them to fend off HIV-related opportunistic infections.  This made safe days ineffective as a contraceptive method.

Eight months later, Njeri found out that she had conceived. At her first antenatal visit, her CD4 count was a low 400. After delivering her baby boy in 2011, she was down to 180. She began using antiretrovirals, as did her husband.

But her son is infected with HIV.

Although Njeri was on the prevention of mother to child transmission program at the government’s Mbagathi Hospital near Kibera, she chose to deliver with a traditional birth attendant because they are kinder than hospital staff.

“Most government hospitals are too crowded; they don’t have time to show kindness or respect. You are lucky if a nurse actually attends to you,” she says.

Between 2012 and 2013, a series of labor strikes in the health sector resulted in shortages of injectables. Reluctantly, the couple resorted to condoms.

Being HIV positive, sexually active and young enough to get pregnant is a big problem, she says.

“Many health facilities are not able to take care of our needs,” she told IPS.

Some clinics have set aside a day of family planning services for HIV positive women but Njeri is not always able to attend because of work.

For now, Njeri is back on the injectable contraceptive. She prays that when she returns to the clinic in two months for another injection, it will still be available.

Edited by: Mercedes Sayagues

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Egypt’s Poor Easy Victims of Quack Medicinehttp://www.ipsnews.net/2014/08/egypts-poor-easy-victims-of-quack-medicine/?utm_source=rss&utm_medium=rss&utm_campaign=egypts-poor-easy-victims-of-quack-medicine http://www.ipsnews.net/2014/08/egypts-poor-easy-victims-of-quack-medicine/#comments Sun, 10 Aug 2014 16:41:18 +0000 Cam McGrath http://www.ipsnews.net/?p=136026 Many pharmacies and herbalists in Egypt prescribe their own 'wasfa' (secret drug or herbal elixir). Credit: Cam McGrath/IPS

Many pharmacies and herbalists in Egypt prescribe their own 'wasfa' (secret drug or herbal elixir). Credit: Cam McGrath/IPS

By Cam McGrath
CAIRO, Aug 10 2014 (IPS)

Magda Ibrahim first learnt that she had endometrial cancer when she went to a clinic to diagnose recurring bladder pain and an abnormal menstrual discharge. Unable to afford the recommended hospital treatment, the uninsured 53-year-old widow turned to what she hoped would be a quicker and cheaper therapy.

A local Muslim sheikh claimed religious incantations, and a suitable donation to his pocket, could cure the cancer. But when her symptoms persisted, Ibrahim consulted a popular herbalist, whose wasfa (secret drug or herbal elixir) was reputed to shrink tumours.

“I felt much better for a few months and thought the tumour was shrinking,” she says. “But then I got much worse.”

When she returned to hospital the following year, tests revealed that the tumour was still there, and the cancer had spread to her lymph nodes. Moreover, the herbal mixture she was taking had caused her kidneys to fail.“Successive [Egyptian] governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery” – Dr Ahmad Bakr, Egyptian health care reform lobbyist

Egypt is a “minefield” of bad medicine, says paediatrician Dr Ahmad Bakr, a health care reform lobbyist. He says successive governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery.

“Our health care system is deeply deformed,” Bakr told IPS. “It’s not just a matter of low funding and corruption, ignorance (pervades every tier of) the health system, from government and doctors to the patients themselves.”

He says Egypt’s lax regulation and poor enforcement has created room for unqualified doctors to perform plastic surgery out of mobile clinics, peddle snake tonic on satellite television, and dabble dangerously in reproductive health.

It is estimated that one in every five private medical clinics in Egypt is unlicensed, and thousands of medical practitioners are suspected of using false credentials or having no formal training.

“There are a lot of so-called doctors who practise medicine in Egypt,” says Bakr. “They mostly work out of small clinics, but you’ll even find them in the most prestigious hospitals.”

The incompetency goes all the way to the top.

In February, Egypt’s military announced it had invented a device to remotely detect hepatitis C – along with acquired immunodeficiency syndrome (AIDS), swine flu and a host of other diseases. The device, which is said to work by detecting electromagnetic waves emitted by infected liver cells, is based on a fake bomb detector marketed by a British con artist.

The military also claimed that it had invented a revolutionary blood dialysis machine that can cure hepatitis C, AIDS and even cancer in a single treatment.

“I was shocked when I saw these incredible claims were being made with barely any clinical evidence,” says Dr Mohamed Abdel Hamid, director of the government-run Viral Hepatitis Research Lab (VHRL). “With any new medical treatment you should perform peer-reviewed, double-blind clinical trials before announcing it.”

Critics say Egypt’s government contributes to a climate of medical irresponsibility. State media routinely exaggerates health threats and feeds public hysteria, while the knee-jerk reactions of government authorities – including high-ranking health officials – are coloured by popular sentiment and political motives.

Reacting to the global swine flu pandemic in 2009, overzealous parliamentarians passed a motion to slaughter all of Egypt’s 300,000 pigs.

There was no evidence that pigs transmitted swine flu to humans, nor had the virus been detected in Egypt. But officials, swayed by the Islamic prohibition on eating pork, appeared to seize the opportunity of a like-named virus to rid the Muslim-majority nation of its swine.

“The pigs were kept almost exclusively by poor Christian zebaleen (rubbish collectors), who used them to digest the organic waste,” says Milad Shoukri, a zebaleen community leader. “Thousands of families lost their livelihoods to this absurd decree, which had no scientific basis.”

Global pandemics such as severe acute respiratory syndrome (SARS), avian flu and the latest contagion, Middle East Respiratory Syndrome (MERS), have presented golden opportunities for Egypt’s myriad quacks and swindlers to fleece the uninformed masses.

“With each health scare we see the same patterns,” says Cairo pharmacist Amgad Sherif. “People panic and throw science out the window. The low level of education and high illiteracy among Egyptians makes them susceptible to believe even the most ridiculous medical claims.”

When a swarm of desert locusts descended on Cairo, enterprising charlatans took out ad space in local newspapers offering a “locust vaccine” to anxious citizens.

Not surprisingly, the injected serum, which turned out to be tap water dyed with orange food colouring, offered no protection against “locust venom”. But it did leave duped households poorer, and at risk of blood contamination or hepatitis C infection from jabs with unsterilised needles.

“The people doing this only care about getting money from people who don’t know any better,” says Sherif. “They know nothing about medicine and do not follow even the most basic hygiene practices.”

In one popular scam, people claiming to be state health officials troll low- and middle-income neighbourhoods offering costly “preventative medicine” for infectious diseases. The fake medical personnel, dressed in lab coats and wearing official-looking badges, administer bogus vaccinations to unsuspecting families.

“Sometimes they give people injections – who knows what’s in them,” says Sherif.

Health officials say the sham physicians create confusion that affects legitimate health campaigns, such as Egypt’s national door-to-door polio eradication campaign.

Egyptian authorities have also found themselves in a cat-and-mouse game with thousands of “sorcerers”, whose superstition-based folk medicine draws desperate working-class patients suffering physical and psychological ailments. The self-proclaimed doctors and faith healers are particularly difficult to catch, say prosecutors, because they tend to work out of rented apartments and advertise mostly by word of mouth.

An Egyptian judicial official told pan-Arab newspaper Al Arabiya that despite attempts to prosecute sorcerers for swindling and fraud, most cases are dropped when the sorcerers reach a settlement with their victims. “There is almost one sorcerer for every citizen,” he concluded.

(Edited by Phil Harris)

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Stigma Still a Major Roadblock for AIDS Fight in Africahttp://www.ipsnews.net/2014/08/stigma-still-a-major-roadblock-for-aids-fight-in-africa/?utm_source=rss&utm_medium=rss&utm_campaign=stigma-still-a-major-roadblock-for-aids-fight-in-africa http://www.ipsnews.net/2014/08/stigma-still-a-major-roadblock-for-aids-fight-in-africa/#comments Sat, 09 Aug 2014 00:12:39 +0000 Julia Hotz http://www.ipsnews.net/?p=136019 Rwandan children orphaned by AIDS in Muhanga village. Credit: Aimable Twahirwa/IPS

Rwandan children orphaned by AIDS in Muhanga village. Credit: Aimable Twahirwa/IPS

By Julia Hotz
WASHINGTON, Aug 9 2014 (IPS)

Though West Africa’s massive Ebola outbreak may be dominating the spotlight within the global health community, HIV/AIDS remains an enormous issue for Africa as a whole – a sentiment that Washington officials made clear this week in their discussions of legislative and technological setbacks plaguing progress in fighting the epidemic.

Despite the World Health Organisation’s announcement Friday that Ebola is now an “international public health emergency,” doctors, academics and policymakers met Thursday at the Washington office of Kaiser Family Foundation (KFF), a health-policy non-profit, to discuss the similarly urgent threat posed by HIV/AIDS, the subject of last month’s 2014 International AIDS Conference in Melbourne, Australia.Uganda’s anti-LGBT environment may explain the nation’s distinct increase in the number of new HIV infections, a trend that - with the exception of Angola - has been reversed in surrounding African nations.

Ambassador Deborah Birx, the global AIDS coordinator for the U.S President’s Emergency Plan for AIDS Relief (PEPFAR), echoed the threat’s urgency, explaining that “the AIDS pandemic in southern Africa is the primary cause of death for adolescents, and the primary killer of young women.”

President Barack Obama announced Wednesday at the end of his three-day leaders’ summit with Africa that PEPFAR and the Children’s Investment Fund Foundation (CIFF) will pledge 200 million dollars to work with 10 African countries to help them double the number of children on lifesaving anti-retroviral drugs.

But Ambassador Birx, along with other prominent HIV/AIDS activists in Washington, seemed to suggest that distributing anti-retroviral drugs to children would only address a fraction of the issue.

Fear of HIV/AIDS stigma

While making note of PEPFAR’s unprecedented  progress in moving towards an “AIDS-free generation,” a commitment that President Obama deemed possible in a 2013 national address, Birx suggested that countries with anti-LGBT laws may have disproportionately high rates of new HIV infections.

“People are afraid to be stigmatised,” Birx told IPS, explaining that gay people may refuse to seek diagnosis and treatment for HIV/AIDS if they are legally and culturally persecuted by their homeland.

Identifying nearly 80 countries with such discriminatory environments, Birx’s PEPFAR report highlights Uganda, where the recent passage of anti-LGBT legislation and discriminatory comments of Ugandan President Museveni has attracted substantial condemnation from the international community.

“This is a human rights question,” Birx told IPS, calling specifically on the community of faith- one she describes as “there to wrap its embracing arms in need”- to respond to such LGBT persecution.

Yet beyond humanitarian concerns, PEPFAR’s report notes how Uganda’s anti-LGBT environment may explain the nation’s distinct increase in the number of new HIV infections, a trend that – with the exception of Angola – has been reversed in surrounding African nations.

Birx stressed that the majority of HIV infections are transmitted through heterosexual sex, despite the common misperception that homosexual activity is the cause of HIV/AIDS.

It is perhaps this association, Birx reasoned, that incites fear of seeking diagnosis, and explains why approximately half of all people with HIV are still unaware that they are infected, despite the tremendous increase in HIV testing capacity.

“Incredibly powerful” potential of tech innovation

Panelists at Thursday’s conference spoke about the tremendous expansion of testing capacity, an noted how technological innovation is a leading force not only in HIV/AIDS diagnosis, but also in treatment, prevention and education.

“I think there’s actually a lot going on in innovations in technology,” Chris Beyrer, president of the International AIDS Society, told IPS. “And it’s not only internet technology and mobile technology, but it’s also in other domains, like self-testing and home-testing.”

Beyrer added how “getting testing out of the clinics and getting them directly to people” reduces the strain on medical personnel and funding, two areas in which panellists agree there are great shortages.

“Technology is moving to a place where there are much more local kinds of facilities that can actually do staging,” Beyrer explained to IPS.

“You don’t have these kinds of problems with people waiting forever to get a CD4, and then being told to go somewhere else with their CD4 result.”

“One size does not fit all”

Birx, who also participated in Thursday’s panel, added that technology can potentially be used to disseminate information about HIV/AIDS, and can potentially even correct some of the misconceptions about what causes HIV/AIDS.

She referenced the “incredible work” coming out of Cambodia, which utilises different internet strategies to cater not only to people of different ages, but also to people of different sexual practices, in an attempt to distribute key medical information.

The technique, she says, allows everybody to “click on the site and find the voice that resonates with them and gives them different knowledge [about HIV/AIDS] that they need.”

“I found that so incredibly powerful, and if we can figure out how to do that and get broadband throughout sub-Saharan Africa, it would be terrific.”

Beyrer reiterated the need for technology to offer individualised options for the transmission of knowledge about HIV/AIDS, telling IPS that “one size doesn’t fit all in these innovations.”

“It turns out, for example, from looking at interactive supports for treatment, there are very age-dependent differences even among population,” he said.

“Men under 25,” Beyrer explained, “really like SMS interactive messages, and want to be notified at all times, while older men [tend to say] no thank you, leave me alone…it’s very specific so we’re going to have to get that right.”

Yet despite Beyrer’s enthusiasm for more individually-tailored solutions to those seeking knowledge about HIV/AIDS, he also urges that there be more awareness-building for those not expressly seeking knowledge about HIV/AIDS.

“One sector that hasn’t engaged very much in HIV is social media,” he said, calling specifically on Facebook, Google, and others in Silicon Valley to engage more thoroughly.

“We need that, and we would love them to be way more engaged than they are.”

Edited by: Kitty Stapp

The writer can be contacted at hotzj@union.edu

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Nigeria Wakes Up to its AIDS Threathttp://www.ipsnews.net/2014/08/nigeria-wakes-up-to-its-aids-threat/?utm_source=rss&utm_medium=rss&utm_campaign=nigeria-wakes-up-to-its-aids-threat http://www.ipsnews.net/2014/08/nigeria-wakes-up-to-its-aids-threat/#comments Mon, 04 Aug 2014 07:07:25 +0000 Sam Olukoya http://www.ipsnews.net/?p=135905 Nigeria accounts for one third of all new infections among children in the 20 worst hit countries in sub-Saharan Africa. Credit: Sam Olukoya/IPS

Nigeria accounts for one third of all new infections among children in the 20 worst hit countries in sub-Saharan Africa. Credit: Sam Olukoya/IPS

By Sam Olukoya
LAGOS, Nigeria, Aug 4 2014 (IPS)

Tope Tayo’s marriage broke up 11 years ago after she tested positive for HIV. Her angry and embarrassed husband took away their only child. Three months later, when the one year old boy tested positive, the husband dumped him with Tayo and absconded.

 “He abandoned us as if we had committed a crime but I told him HIV is not a crime,” Tayo told IPS.

She was jobless and the husband paid no maintenance. “I walked the streets crying, I was living on charity,” Tayo recalls.

The runaway man who abandons his HIV positive wife and children is a common feature in Nigeria, says Rosemary Hua, coordinator of the First Step Action for Children, an organisation that advocates for child rights.

“Fathers withdraw their support because they feel there is no need to invest in a child that is likely to die young,” Hua told IPS.

Nigeria’s HIV infection rate of 3.2 percent appears low in comparison to southern Africa’s, but with a population of 173 million, it translates into huge numbers – 3.4 million Nigerians lived with HIV in 2013.

Source: Nigeria report to UNGASS 2014

Source: Nigeria report to UNGASS 2014

Of these, 430,000 are children under 14, according to a recent report of the Joint United Nations Programme on HIV/AIDS (UNAIDS). Nigeria accounts for one third of all new infections among children in the 20 worst hit countries in sub-Saharan Africa.

Fast Facts About AIDS in Nigeria in 2013
173 million population
3.2 % HIV prevalence
3.4 million Nigerians live with HIV
51,000 new child infections
220,000 new infections among all ages
190,000 HIV positive pregnant women
52,500 HIV positive pregnant women receive ARVs
70% of HIV positive pregnant women do not receive ARVs
47, 300 children on ARVs, or 12% of all infected children
593,000 people on ARVs, or 21% of all infected people
210,000 AIDS-related deaths
Little decline in deaths between 2005-2013
Source: UNAIDS 2014

The report says Nigeria faces “the triple threat of high HIV burden, low treatment coverage and no or little decline in new HIV infections.”

Moreover, the national HIV rate conceals sharp disparities among the 36 states: in four, prevalence ranges from eight to 15 percent.

Why women avoid testing

Tayo and her son have been taking antiretroviral drugs for the last 11 years. They are lucky. Fewer than 600,000 Nigerians are on treatment, or 20 percent of those who need it.

Low treatment coverage perpetuates misconceptions and stigma, as Tayo’s story show.

Abandonment usually translates into economic hardship. Half of women are unemployed in Nigeria.

“The desperation to take care of herself and her child could drive an HIV positive woman into sexual activities to raise money and this could further spread HIV,” says Lucy Attah, a gender activist who lives with HIV. She is executive director of Women and Children of Hope Foundation, which helps HIV positive women, and where IPS met Tayo.

Tayo told IPS she avoided testing for HIV while pregnant. Nigerian public hospitals do routine HIV testing of pregnant women but fear of discrimination if found positive led Tayo to a private hospital where testing was not required.

“It is the biggest regret of my life,” she told IPS.

One reason that pregnant women shun testing, says Hua, is health workers’  “lack of professionalism by not keeping HIV results confidential.”

“At times we had to transfer patients to other hospitals far from where they live because of the disclosure of their HIV status,” she told IPS.

Some health workers avoid any contact with HIV positive women because they mistakenly believe they can contract the virus by mere touching, says Attah.

“On the surface, it seems there is a lot of awareness among health workers but in reality there is a lot of stigma,” says Attah.

An anti-discrimination and confidentiality law has been approved by both houses and is waiting for President Goodluck Jonathan to sign it.

But Nigeria needs more than laws to address the epidemic.

In 2012, UNAIDS described the country’s response as “stagnant” and requiring “a massive effort.”

Nigeria accounts for 13 percent of all HIV positive people and 19 percent of all AIDS-related deaths in sub-Saharan Africa, according to UNAIDS.

Only Chad ranks lower than Nigeria in treatment coverage of HIV positive pregnant women. (see graph)

Source: UNAIDS Gap report 2014

Source: UNAIDS Gap report 2014

Some good news

Since that damning description, the government has taken bold steps to reduce transmission from mothers to babies (PMTCT) among the 12-worst hit states.

PMTCT coverage went up to by 27 percent in 2013, a significant increase from 19 percent in 2012, according to the United Nations Children’s Fund (UNICEF).

Some states doubled or tripled the number of clinics providing HIV services, bringing the number of PMTCT sites to 2,216 – still far from the 16,400 required for adequate coverage.

The annual number of new child infections went down from 60,000 in 2012 to 51,000 in 2013.

But, with two in three pregnant women shunning antenatal care, the challenge will be reaching them through improvement of services and outreach.

“We must go to them instead of waiting for them to come to the health facility,” Arjan de Wagt, chief for children and HIV with UNICEF in Nigeria, told IPS. “Otherwise, children will continue dying of AIDS unnecessarily.”

Edited by: Mercedes Sayagues

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‘Zero Tolerance’ the Call for Child Marriage and Female Genital Mutilationhttp://www.ipsnews.net/2014/07/zero-tolerance-the-call-for-child-marriage-and-female-genital-mutilation/?utm_source=rss&utm_medium=rss&utm_campaign=zero-tolerance-the-call-for-child-marriage-and-female-genital-mutilation http://www.ipsnews.net/2014/07/zero-tolerance-the-call-for-child-marriage-and-female-genital-mutilation/#comments Wed, 23 Jul 2014 18:43:04 +0000 A. D. McKenzie http://www.ipsnews.net/?p=135698 Fatema,15, sits on the bed at her home in Khulna, Bangladesh, in April 2014. Fatema was saved from being married a few weeks earlier. Local child protection committee members stopped the marriage with the help of law enforcement agencies. Credit: UNICEF

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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