"I'm happy being a prostitute," says the HIV/AIDS prevention campaign poster that was subsequently withdrawn. Credit: Beijo da Rua

Happiness, the subject of endless philosophical discussions, has now become the focus of controversy in an HIV/AIDS prevention campaign aimed at prostitutes in Brazil. The campaign chief has been booted out and a further question has been raised: What are the limits of popular participation in the definition of public policies?

Before the Health Ministry campaign was even broadcast, shocked conservative sectors complained that it condoned prostitution.

As part of a strategy against HIV/AIDS, the slogan “Sou feliz sendo prostituta” (I’m happy being a prostitute) arose from national debates and workshops involving the targeted participants.

“(The slogan) expresses the dignity of our profession. To remove that phrase is a violation of our rights, especially because of the social stigma we suffer,” said Leila Barreto, of the Group of Women Prostitutes in the northern state of Pará.

The campaign, run by the department of sexually transmitted diseases (STD), AIDS and hepatitis, resulted in the dismissal of the head of department, Dirceu Greco, and the resignation of two assistant directors.

“It was a great disappointment,” Barreto told IPS. “The stronger we are, the less vulnerable we will be to diseases, unless society says: these women do not exist. But they do exist, and their work contributes to society,” she said.

The anti-AIDS campaign, which had not been authorised by the ministry’s advisory office for communications, included other statements such as “O sonho maior é que a sociedade nos veja como cidadãs” (Our greatest dream is for society to see us as citizens). It had barely gone out over the internet on Jun. 2, International Sex Workers Day, before it was withdrawn.

The version that replaced it reverted to the old-fashioned style: advice to sex professionals about the importance of using condoms and encouraging them to seek preventive measures in public hospitals.

“Prostituta que se cuida usa sempre camisinha” (Prostitutes who take care of themselves always use condoms) says the new campaign, which seeks to “strengthen tolerance” and “eliminate prejudice”.

In Brazil, AIDS is concentrated in the big cities, where most of the at-risk groups are to be found. Prevalence is 5.9 percent among drug users, 10.5 percent among men who have sex with men and 4.9 percent among women professional sex workers.

Each year there are on average 37,000 new HIV/AIDS cases in this country of more than 198 million people, where an estimated 530,000 people are HIV-positive, 150,000 of whom do not know that they are infected.

“The preventive measures we advocate work for any person, whether they are ‘happy or sad.’ It is not the Health Ministry’s business to make assessments of the state of mind of individual persons,” a communiqué from the ministry said.

Some people complain of a “regression” in Brazil’s anti-HIV/AIDS strategy, which was considered one of the boldest and most effective in the world.

“Brazil taught the world, with the concept of AIDS prevention, that at-risk and historically excluded populations like homosexuals, prostitutes and drug addicts are citizens who have rights, and that this is the stance to take when speaking of prevention,” Agustín Rojo, an Argentine expert on communications and HIV, told IPS.

But in this country, where conservative evangelical churches have great political clout, “there is a risk of ‘killing the programme off’ by mixing religion with public health,” said George Gouveia, of the Grupo pela VIDDA, an HIV/AIDS patients self-help group.

That risk is already a reality in the view of Greco, who attributes his dismissal to disagreements “over a policy based on human rights and valuing the populations that are most at risk,” due to a conflict with “the conservative policy of the present government” of centre-left President Dilma Rousseff.

He mentioned other cases as examples, such as the banning of a carnival video that showed a relationship between two men, and a cartoon strip for schools on homophobia and sexuality.

“They can’t treat us as if we were in the closet. If they don’t grant us visibility, we will continue to feel that our rights are curtailed,” Julio Moreira, the president of the gay rights group Arco Iris, told IPS.

In Rojo’s view, the issue is that the state “should allow sectors that are discriminated against to have a voice and visibility, in order for society first to recognise their existence and then to listen to them – but it is not for the state to take on each and every one of their positions.

“When a woman who is paid for sex publicly says that she feels happy, she is expressing more than a personal feeling. To be perfectly clear, she is stating a political position,” said Rojo, a sociologist who has coordinated official policies in Argentina on AIDS and other STDs.

In this case, “being happy” with what one does, like being “proud” of one’s sexual orientation, is a legitimate vindication of a social group, he said.

But the expression “cannot be transferred automatically to a government-run mass media campaign, because it will not be easily understood by everyone. The state has no business telling prostitutes they cannot be happy, but it shouldn’t applaud, or not applaud, their choices,” Rojo said.

“On the other hand, if any citizen, whether a prostitute, transvestite or drug addict, does not have access to condoms to take care of his or her health, or does not know how to use them or where to go for help – this is a problem for the state to address, whether in the case of a sex worker or a homemaker, a homosexual or a heterosexual,” he said.

Brazilian Health Minister Alexandre Padilha made similar comments. “I respect the groups and movements who wish to send that message (about being happy), but that is their role,” he said.

Now discussions are centred on the scope of a call for social participation in real politics.

“Designing a campaign for gays, prostitutes or prisoners is in itself a recognition that grants dignity to these persons,” Rojo said.

“It puts them on a level with the rest of the citizenry…which is a powerful political decision. It confronts stigma from the heights of power, with the message that ‘we do not care only about rich heterosexuals, but also about poor gays, prostitutes, transsexuals and so on, because to us they are all equal’,” he said.

“By selecting only one particular message among those created by the workshops, the government is rejecting the concept of equality, because prostitutes are denied the right to express their dreams and ideals of citizenship, and the affirmation of their identity and social visibility,” said Gabriela Leite of Davida, a sex workers’ group.

She said it was “arrogant to believe that a prostitute can’t be happy.”

A profile of Brazilian prostitutes drawn up by the Health Ministry contributes to the quantification of this relative happiness.

The majority of female sex workers are between the ages of 20 and 29, have not completed primary school, and are proud of being able to support their children. They do not suffer discrimination in the public health service, they like the freedom of their work, and they consider that it pays better than other jobs.

However, they feel humiliated and discriminated against, they avoid telling others what they do, especially their children, and they are forced to put up with unpleasant clients and those who refuse to wear condoms.

Jane Meriwas (l) addresses women from the Samburu community, in Kipsing Plains in Kenya’s Rift Valley region, about harmful cultural practices. Courtesy: Jane Meriwas

When she was nine years old, Jane Meriwas, a Samburu from the Kipsing Plains in Kenya’s Rift Valley region, was considered of no use by her father. After all, nine of his goats had been eaten by hyenas under her watch.

But there was a chance that she could still redeem herself by being a second, third or fourth wife to an old man and earn her father more goats than the ones the hyenas had devoured.

“I went to school by chance. Having proven to be a poor herder, my father dumped me in school to bide my time till a suitable suitor came along,” Meriwas tells IPS.

“Of course school meant sitting under a tree. This cost my father nothing; a Catholic priest took care of the expenses,” she adds.

“Among the pastoralist community, ours was an unusual family,” Meriwas says of the family she was born into. Her parents only had two children – both of them girls. “But my father never married a second wife, even when my mother died.”

The Samburu are closely related to, but distinct from, the Maasai tribe of Kenya. While the Samburu account for only 1.6 percent of the country’s entire population of 41.6 million people, they have gained notoriety for their firm grasp on a long list of harmful cultural practices performed on girls, which include crude forms of abortion.

Lolonju Lerukati, a Samburu activist who speaks out against Female Genital Mutilation (FGM) in pastoralist communities, tells IPS: “The Samburu girl child has cried for help for far too long, and in keeping with this year’s theme (of the Day of the African Child, Jun. 16) to eliminate harmful cultural practices that affect children, society must heed her cry.”

Lerukati says that it is unfortunate that in this day and age, a girl born into the Samburu community has little chance, if any, of escaping FGM, an early marriage, crude forms of abortion, and multiple births before her 18th birthday, or of acquiring an education.

At the age of 12, Meriwas did not escape FGM; after all, the Samburu’s FGM practice rate is 100 percent, according to the most recent Kenya Health and Demographic Survey (KHDS). This is despite the fact that the Prohibition of Female Genital Mutilation Act of 2010 outlaws FGM in Kenya.

But attending school saved Meriwas from an early marriage. Upon completing college, rather than seek employment, she went back to her community to create awareness against the Samburu’s harmful cultural practices, and has been speaking out against the ills meted out on girls in her community for the last 10 years.

She has a reputation as a local rights activist and has started the Samburu Women for Education and Environment Development Organisation, which pays for the education of a handful of girls rescued from early marriages and FGM.

Lerukati says that Meriwas’ strength, resilience and bravery in the face of strong resistance from the community is leading to a change of heart among some.

The rite of passage known as beading is a cultural practice performed only among the Samburu. And thanks to Meriwas’ efforts, the practice is changing.

Traditionally, a Moran or warrior buys about 10 kilos of beads, which are made into necklaces for a girl he is interested in. Upon wearing the necklaces, the girl, who is usually between nine and 15 years old, is considered “beaded” and the Moran’s girlfriend.

Meriwas speaks about the effects of beading. “Since sex between the young girl and the Moran is usually unprotected, the girl gets pregnant at some point,” she says.

But, she adds, the pregnancy will be terminated at all costs, because sex between the Moran and the girl, though permitted by culture, is considered incestuous because they are both from the same clan. So the baby is not allowed to live.

There are possible dangerous outcomes when a young girl falls pregnant.

“The older women lure the girl into the forest once they suspect she is pregnant. They press her stomach until she bleeds and the foetus comes out,” says Meriwas.

If this fails, the girl, upon delivery, is forced to poison her newborn. If she refuses, then the child is to be left in the forest to be eaten by hyenas, or is given to a non–Samburu, often in the neighbouring Turkana community.

Lerukati adds: “Many deaths have resulted from this exercise. But no one in the community will speak about it.”

Due to Meriwas’ efforts, the community is opening up to the possibility of an alternative rite of passage for girls.

“Rather than have the Moran ‘beading’ the girl, women are slowly taking up the role. This means that the girl can wear her beads without being at the beck and call of a Moran,” Meriwas explains.

Lerukati adds: “The change is slow, but is happening. The practice of beading was little-known beyond the Samburu community. But Meriwas has blown the whistle at great risk to herself, and even her life.”

FGM activists such as Grace Gakii who are working in pastoralist communities say there is something to celebrate on the Day of the African Child. “There is a prominent decline of FGM among younger women aged 15 to 19 years.”

“I attribute this to a combination of factors. The push for the pastoralist girl child to attend school is definitely a contributing factor. But it is those people like Meriwas who have experienced harmful traditions who are bringing real change,” Gakii tells IPS.

According to KDHS, the overall prevalence of FGM in Kenya has gone down from 38 percent in 1998 to 32 percent in 2003, and to 27 percent in 2008, among women between the ages of 15 and 19.

“People like Meriwas understand this culture and have learnt to change it from within,” she adds.

Children in drought-struck Camotán, in Chiquimula province, Guatemala. Credit: Danilo Valladares/IPS

Kevin’s Carter’s disturbing picture of the 1993 famine in Sudan won him a Pulitzer Prize.

The image of an emaciated child being watched by a vulture was etched into the world’s memory forever, drawing attention to conditions where survival becomes the only priority.

Reducing the child mortality rate and improving maternal health prominently figure in the list of the U.N.’s Millennium Development Goals (MDGs) that were adopted by the international community in 2000 in New York with a 2015 deadline.

As the world body draws up a list of new Sustainable Development Goals (SDGs), the medical journal The Lancet published a series of reports Wednesday finding that,among other things, malnutrition is responsible for nearly half (45 percent) of all deaths in children under five.

Around three million deaths of children under five occur from malnutrition, which encompasses undernutrition and overweight, both global problems.

The focus of agricultural programmes should shift towards enhanced nutrition rather than just increasing crop yields, Professor Robert Black of Johns Hopkins Bloomberg School of Public Health told IPS.

“These programmes have not been set up in an ideal way,” he said.

Calling for the idea of “nutritional sensitive agriculture”, Black also emphasised the importance of actions at the community level to address issues on malnutrition.

Collaboration among civil society, humanitarian agencies and the commercial sector would make a difference at the local level, Black told IPS. “More engagement of organisations such as the Food and Agriculture Organization (FAO) is important,” he said.

Martin Bloem, senior nutritional advisor with the World Food Program (WFP), echoed a similar sentiment. He emphasised the role of Anganwadis, government sponsored child-care centres in India, in countries like India.

Reports suggest that lack of resources as well as unhygienic conditions in these centres have raised new challenges when it comes to addressing issues of malnutrition in a country like India.

But inspection and strict monitoring is paramount when local communities are involved, Bloem said.

The findings in The Lancet come ahead of the Group of Eight (G8) summit, which will be preceded by the UK and Brazilian governments co-hosting a high-level event on Nutrition for Growth.

The findings suggest that addressing the problem means addressing the underlying causes of malnutrition, such as, “poverty, food insecurity, poor education, and gender inequity”.

The study also stated that close to 15 percent of all deaths in children under the age of five could be prevented by providing vitamin A and zinc supplements to children up to the age of five, as well as taking care of dietary needs of pregnant women, among many other measures.

But, it is the time of pregnancy and the first 1,000 days that are most crucial for a child’s growth, Bloem told IPS. The health of the mother is equally important, he said.

“Also people do not realise the relation between stunted growth and obesity which can increase the chances of cardiovascular diseases. Also, there is an urgent need to link the health and the food system all around the world,” he said.

Public-private partnerships can help create products which are nutritional, affordable and accessible to vulnerable populations all over the world, Ellen Piwoz, senior programme officer for family health and nutrition at the Bill & Melinda Gates Foundation, told IPS.

But what is stalling the fight against malnutrition is “the lack of a real commitment and drive among international governments,” said Werner Schultink, UNICEF’s head of nutrition.

While reducing hunger and poverty have been leading priorities for the U.N., “if you look at the indicators, such as underweight, the progress is insufficient.”

According to the study, emerging problems of obesity and overweight are “resulting in a ‘double burden’ of maternal and child disease and illness,” in countries where undernutrition is already a huge problem.

A right balance of adequate nutritional diet and an affordable food industry spearheaded by public and private sectors as well as community-level initiatives could provide solutions to tackle this “killer”, said experts.

Every year, thousands of Afghan women cross the border into Pakistan in search of medical treatment. Credit: Ashfaq Yusufzai/IPS

Muzaffar Shah, a shopkeeper from Kabul, sits in a hospital waiting room, desperate for news. He has travelled nearly 300 km to get to the Khyber Teaching Hospital in Peshawar, capital of northern Pakistan’s Khyber Pakhtunkhwa (KP) province, where his wife is now in intensive care.

Just a few days ago, she delivered a baby boy who died within minutes. Shortly after, she started to experience severe vaginal bleeding.

“She was initially admitted to the Indira Gandhi Children’s Hospital in Kabul, where there was only an occasional supply of electricity and where a lack of water badly hampered patients’ treatment,” Shah told IPS.

“After two days my wife showed no signs of improvement so we rushed her here.”

Now his wife is receiving three pints of blood daily and her chances of survival have increased, but she is not yet fully recovered, most likely because she did not receive immediate medical attention during the birth process.

According to Dr. Muhammad Shaukat, a representative of the Khyber Pakhtunkhwa Health Directorate, doctors in the KP province are more than used to receiving desperate patients from across the border, particularly those seeking emergency obstetric care.

“Three teaching hospitals in this border town receive at least 1,000 Afghan patients every month, mostly those suffering from maternal and childhood diseases, from cities like Kabul and provinces like Jalalabad, Kunar and others, due to a lack of specialised medical facilities there,” he told IPS.

Most hospitals in Afghanistan are rudimentary and understaffed, while a shortage of life-saving drugs has fuelled the health crisis.

Afghan patients now occupy 10 percent of the beds in Peshawar’s hospitals. “They are becoming a burden…but we cannot deny them admission, so we treat them on humanitarian grounds,” Shaukat added.

Last year, teaching hospitals in the northern province treated approximately 34,888 Afghan patients. This year the number is likely to increase, with 20,000 Afghans having already received treatment as of May 20.

Meanwhile, facilities like the government-run Hayatabad Medical Complex (HMC) in Peshawar admitted 3,456 Afghan patients, mostly women and children, in 2012, Dr Hakimullah Khan told IPS.

“This year, we have already hospitalised about 3,000 patients,” the HMC specialist said, adding the influx will not slow down any time soon.

Dr. Sardar Ali, Pakistan field officer for the World Health Organisation, told IPS most Afghans seek treatment here due to a dearth of health facilities in their home, which is evident in Afghanistan’s maternal mortality rate of 500 deaths per 100,000 live births, as opposed to 250 deaths per 100,000 live births in Pakistan.

In comparison, the maternal mortality rate in the United States is seven deaths per 100,000 births, he said.

The infant mortality rate in Afghanistan is also a reflection of the near total lack of infrastructure, services and trained professionals like midwives and female nurses: over 152 infants die per 1,000 live births, since only eight percent of all deliveries are handled by skilled birth attendants. In Pakistan, trained attendants handle 35 percent of births.

Some experts blame the abysmal health situation on political instability.

Ahmed Jamal, a doctor from the eastern Afghan city of Jalalabad, told IPS that ever since U.S. troops deposed the Taliban government in 2001, the country has been almost entirely reliant on international funding for its health needs, with 70 percent of the population relying on health facilities set up by aid agencies like the WHO, the United Nations Children’s Fund (UNICEF) and the International Committee of the Red Cross (ICRC).

Since 2002 Afghanistan has received about 60 billion dollars in aid, much of which has gone towards improving basic infrastructure like schools and hospitals. But despite generous foreign donations, nearly 40 percent of the country’s 25 million people do not have access to health facilities.

Some sources estimate that the decade since the U.S. invasion has seen the child mortality rate drop by 50 percent. But 20 percent of newborns continue to suffer from low birth weight and acute malnutrition.

The WHO says Kabul, a city of 3.2 million people, has an estimated 1.28 hospital beds per 1,000 people, while other provinces have even fewer, with roughly two beds for every 10,000 people.

The few hospitals that exist often lack electricity and running water, and equipment is poorly maintained. As a result, the limited facilities are under-utilised, with an average occupancy rate of less than 50 percent.

Although the northwestern provinces of Pakistan provide an attractive option for well-heeled Afghans, not everyone can avail themselves of the services just across the border.

Aziz Ahmed, an automobile dealer in Kabul whose ailing father is now recovering in a private Peshawar hospital after an operation to remove a kidney stone, says that while he managed to scrape together the money to come here, “most of my countrymen cannot.”

In addition to hospital fees, anyone wishing to cross the border in search of medical treatment must pay about 200 dollars to rent a vehicle, and endure numerous checkpoints before entering Peshawar on rough and bumpy roads that doctors have described as “hazardous” to those already in precarious medical situations.

He said many people in Afghanistan blame the situation on 35 years of conflict, which has caused massive brain drain from the country, leaving the population without access to specialised services.

Dr. Abdul Shakoor at the Institute of Radiotherapy and Nuclear Medicines in Peshawar tells IPS that 15 percent of cancer patients treated in Pakistan come from Afghanistan, which does not have a single cancer treatment centre.

“Last year, we provided treatment to 3,000 patients from Afghanistan,” he said. This year, the KP provincial government registered 189 Afghan nationals for a free cancer treatment programme.

Afghans living with HIV/AIDS also receive free treatment at an antiretroviral therapy centre in Peshawar, which has “been providing treatment and counselling facilities to 250 patients from different parts of Afghanistan,” Dr Akhtar Nabi, a staff member at the centre, told IPS, adding that the centre also treats 600 Pakistanis.

The situation has bred resentment among communities in the northern provinces, which also host two of three million Afghan refugees currently living in Pakistan. Most locals look down on refugees, especially on those with whom they are forced to share the country’s limited medical resources.

For the past five years, babies have been born in health centres managed by humanitarian organisations in North Kivu, DRC. Credit: Kristin Palitza/IPS

“Many hospitals and health centres” that are not run by NGOs “do not meet health standards,” according to Dominique Baabo, provincial medical inspector for North Kivu province in eastern Democratic Republic of Congo.

The health sector in the DRC faces serious medical challenges including having to deal with obsolete biomedical equipment, the lack of cold rooms for vaccine storage, and a shortage of qualified personnel, Baabo told IPS. He added that a lack of maternity wards in the country posed an obstacle to health care here.

But a lack of maternity facilities is not what the people of Matanda, a region in North Kivu province, have to worry about any longer. Theophile Kaboy, the Catholic bishop of Goma, opened a maternity ward in Matanda’s local health centre on May 15. The local diocesan medical office manages the health centre.

“I am not used to giving birth in a maternity ward since one had to travel between two and three days before giving birth in Kirotse (30 km away) or to Masisi (25 km away),” Jeannette Uwera, the first woman to give birth at the new maternity ward in Matanda’s local health centre, told IPS.

Mado Uwiteka, another Matanda resident, told IPS that in the past she had to be “carried to the maternity hospital in Kirotse on a stretcher by foot to deliver two of my children.”

“My three other children were delivered at home,” Uwiteka said. Two of her three children that were delivered at home died before their first birthday.

“But it was easy to get to the maternity hospital in Matanda because it’s close by,” she added.

However, in North Kivu, where a long-running conflict has raged, civil society representatives point out that humanitarian agencies have replaced the state – which has practically abdicated responsibility in every sector.

For the past five years, babies have been born in health centres managed by humanitarian organisations. Along every road, you can see new or rehabilitated structures fitted out by humanitarian agencies, “in line with the provincial health inspectorate’s programme,” Baabo noted.

The State of the World’s Mothers 2013 report released on May 7 by international NGO Save the Children ranked the DRC last out of 176 countries on its Mother’s Index. It assesses the well being of mothers according to a number of factors, including maternal health figures and under-five mortality.

The report states that one in 30 women in the DRC is at risk of dying from pregnancy-related complications. In Finland, ranked first on the index, only one out of 12,200 women is at risk.

Speaking to health sector representatives on May 10 in DRC’s capital, Kinshasa, Congolese Health Minister Felix Kabange reacted to the report with an admission that this central African nation will not be able to meet its United Nations Millennium Development Goals to reduce infant mortality by two thirds between 1990 and 2015, or to reduce maternal mortality by three quarters over the same period.

The eight MDGs, adopted by all U.N. member states in 2000, aim to curb poverty, disease and gender inequality.

Although maternal mortality has fallen from 1,800 deaths per live birth to 549 since 1990, “if we continue to deal with the situation in the same way, the country will not even meet these goals in 2065,” the minister said.

Kalume Mushaba, an obstetrics lecturer at the University of Goma, believes that the DRC’s problem is one of leadership. He said that health allocations in this country have never exceeded five percent of the national budget.

The DRC is a signatory to the 2001 Abuja Declaration, in which African countries pledged to allocate 15 percent of their national budgets to health.

Together with Afghanistan, Haiti and the Darfur region in western Sudan, the DRC is amongst the world’s most volatile regions, and receives the most development aid. “Despite this, we are ranked last on the human development index,” Mushaba told IPS.

According to a 2009 study by the U.N. Development Programme (UNDP), health care remains unaffordable for eight out of 10 women. North Kivu has one doctor per 23,328 inhabitants and one nurse for every 1,100 inhabitants. The World Health Organization recommends one doctor per 10,000 inhabitants.

These figures show an overall poor quality of healthcare in North Kivu, the UNDP study said.

In order to improve maternal and infant health, Mushaba appealed to authorities to address the “three delays” that prevent women from seeking or obtaining care. These are the reluctance to use maternity hospitals for financial or cultural reasons; lack of transport to, or knowledge of, existing services; and inadequate equipment or shortages of qualified personnel.

A month ago, the government signed over 12 million dollars to the U.N. Children’s Fund to purchase radiology and ultrasound equipment, generators, operating tables and solar-powered refrigerators, for the 70 general referral hospitals in the DRC. This marks a new start, said Kabange.

Included in the equipment, which was received on May 10, were 200 gynaecological tables, 5,000 hospital beds, 7,200 examination beds, and pharmaceutical products, the health minister said. “We want to save the lives of more mothers and children, and to protect newborns,” he added.

At the Women Deliver conference in Kuala Lumpur, advocates shared strategies for breaking religious taboos on reproductive rights. Credit: Stella Paul/IPS

Liberian journalist Mae Azango says she spent a year living “like a bat, going from tree to tree” with her daughter in order to escape religious fanatics who were threatening to kill her for exposing the practice of female genital mutilation in her home country last year.

A senior reporter at the local FrontPage Africa publication, Azango told IPS that although the Liberian government signed a treaty in 2012 promising its citizens the right to information, it continues to hold back data on sexual and reproductive health and rights from journalists.

“With every story that I write, I take a great risk,” she says, adding that she is entirely dependent on “secret sources” within the government to gather information, since very little is shared in the public domain.

Her woes found echo among hundreds of women and health experts gathered in the Malaysian capital of Kuala Lumpur for the third annual Women Deliver global forum that ended Thursday.

Hailing from different corners of the globe, participants at the conference had no trouble identifying common goals: breaking taboos surrounding sex education and creating a safe climate for advocates, health professionals and educators to spread awareness on safe sex and family planning.

In Morocco, a country of 32 million people, schools are banned from offering sex education to young people because parliamentarians believe it to be an “evil concept, designed to promote promiscuity,” sexual and reproductive advocate Amina Lemrini told IPS.

She says progress on improving sexual health services in her country has been particularly slow due to taboos introduced by religious leaders.

With a government unwilling to challenge clerics, the job of providing crucial health services falls entirely on the shoulders of civil society, who are then threatened for their efforts.

Lemrini says she does not know a single reproductive rights activist who has not been threatened, yet the government offers them no protection.

Their distress has been recognised by leading experts in the field, including the executive director of the United Nations Population Fund (UNFPA), Babatunde Osotimehin, who told IPS that religious fundamentalism is a “indeed a worry” when it comes to progress on sexual health.

Still, he urged activists to continue their work, adding, “Fundamentalism exists in all societies and all religions – what matters is how we communicate our message.”

He believes that if more people are made aware of their rights and choices, they will not hesitate to defy archaic laws and so-called “cultural taboos.”

“The average person on the street does not want a situation where death comes calling every day for reasons that can be prevented,” he stressed.

Indeed, even a cursory glance at global statistics is enough to make a strong case for the need for better communication: according to the UNFPA, nearly 800 women die every single day as a result of pregnancy-related complications; in a year, that number is closer to 350,000 deaths, of which 99 percent occur in developing countries.

Sex-selective abortions and neglect of newborn baby girls have resulted in an estimated 134 million “missing” women worldwide.

Doing a wide sweep of global data, the UNFPA estimates that “millions of girls” practice unsafe sex and lack information on contraceptives. Osotimehin recently wrote that an “unmet need for family planning exists among 33 percent of girls between 15 and 19 years old…in Ethiopia, 38 percent in Bolivia, 42 percent in Nepal, 52 percent in Haiti and 62 percent in Ghana.”

Nyaradzayi Gumbonzvanda, head of the Young Women’s Christian Association (YWCA), told IPS that giving up on communication about sexual and reproductive health and rights was not an option.

“We need an operative environment for those who are discussing this issue,” she said. “We need to protect the media — this isn’t a choice. Governments must scale up the level of cooperation with the media and provide supportive legal backup where it is not yet available.”

Gumbonzvanda thinks that citizen journalism could be an effective way to mitigate the risk posed by fundamentalists, not only by amplifying the voices of those who often go unheard, but also by empowering common citizens to take action.

Nowhere was the power of citizen journalism more evident than during the revolution in Egypt in 2011, where blogs, tweets, and Facebook posts replaced TV channels, newspapers and radio stations in reaching millions of people.

Today, as Egyptians struggle against the conservative policies of the ruling Muslim Brotherhood, that network of citizen journalists has turned its attention to reproductive health and safe sex, topics that are frowned upon by Islamists.

Ahmed Awadalla, sexual and gender-based violence officer for Africa and Middle East Refugee Assistance (AMERA), told IPS that anyone discussing the issue risks detention, arrest, harassment and imprisonment.

As a result, the number of bloggers increases every day, as citizens and advocates flee to cyberspace in search of safe forums to share information and ideas.

“When I blog about the sexual rights of women I break two rules,” Awadalla said. “First, by speaking about a forbidden issue and secondly by speaking as a man, who is not supposed to take the side of women.” Though he faces harsh repercussions, nothing will persuade him to give up his advocacy.

But even while citizens innovate new ideas to get around the deadly threats of engaging in sex education, experts say governments must not be let off the hook for failing to provide these basic services.

Governments in Asia, Africa and Latin America must be held accountable by foreign funders, says Agnes Callamard, executive director of the London-based ‘Article 19′, an organisation dedicated to freedom of expression.

“Every government has committed to spending a certain amount of the funding they receive (on sexual health),” she said, so tracking aid flows could pressure governments to improve their track records on information sharing.

In fact, when the Mexico-based Grupo de Información en Reproducción Elegida (GIRE) started to track aid supposed to be allocated to providing information on sexual and reproductive health in 2011, “we found that nearly a million dollars were missing,” said GIRE Information Rights Advocate Alma Luz Beltrán y Puga. “We sued the government over that.  If the same tracking is done the world over, it can lead to greater accountability.”

According to a study done by the World Health Organisation (WHO), developed countries donated nearly 6.4 billion dollars to help provide access and information on reproductive health in developing countries. It is now up to civil society to ensure that money is responsibly allocated.

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

“If I am thirsty and want a bottle of Coca-Cola I can get it, no matter where in the world I am. Why can’t I get contraceptives or sexual heathcare?” asked Carlos Jimmy Macazana Quispe, a youth representative from Peru currently in Kuala Lumpur for the third edition of the Women Deliver global conference on the “health and well-being of women and girls.”

A member of the Lima-based Instituto Peruano de Paternidad Responsable (INPPARES), a non-profit organisation that helps young Peruvians learn about sexual and reproductive rights, Quispe was expressing frustration that 36 percent of sexually active Peruvians – the majority of them youth – do not have access to contraceptives.

There are over a hundred youth like Quispe participating in the three-day conference that started on May 28, most of them from developing countries in Asia, Africa and Latin America where “contraceptives” are equated with condoms, teen pregnancy is on the rise and child marriage is often considered a social norm.

One of these ambassadors is Shreejana Bajracharya, a youth consultant from the Nepal-based Ipas, an NGO working to prevent deaths and disease from unsafe abortions in a country where 21 percent of all mothers are aged below 18 years.

Bajrachayra, who counsels young married and unmarried women factory workers about safe sex, says that over 80 percent of sexually active young women practice unsafe sex and risk pregnancy because they fear that contraceptives could cause them physical harm.

“I meet youth who tell me that…(birth control) pills could damage their kidneys or their heart,” she told IPS, adding incredulously: “And these are women who live in the capital (Kathmandu). If awareness levels in the capital are so low, imagine what youth in rural areas are experiencing.”

According to Pablo Aguilera, head of the New York-based HIV Young Leaders Fund, the situation is particularly bad for minority communities like those who identify as transgender, or people living with HIV/AIDS.

Aguilera, himself a young person living with HIV, identified two simultaneous problems: not only are at-risk populations unaware of the most basic information regarding safe sex and reproductive health, but they are also unaccounted for, passing under the radar of surveys or other attempts to identify target populations.

“We need to engage more youth from marginalised and stigmatised communities, such as transgender (people),” he told IPS, adding that vulnerable youth must be included in studies and surveys “not as interviewees but as interviewer. This will not only help them receive information firsthand, but will also sensitise them on the issue instantly.”

Leading experts in the field are keenly aware of the need to step up efforts. Babatunde Osotimehin, executive director of the United Nations Population Fund (UNFPA), admits that there is a lack of hard data on sexual and reproductive health, but says the UNFPA is helping government agencies across the world recognise the need to overcome this.

Even in cases where data exists, governments do not utilise it for “practical purposes such as planning, and that is a big challenge,” Osotimehin told IPS.

Jyoti Shreshtha, a post-graduate student from Kathmandu, says the Nepali government “does not make a conscious effort to educate” youth on issues like HIV/AIDS and sexual rights.

In countries like Bangladesh, says student leader Umme Mahbuba, events and conferences around pregnancy, early motherhood, safe sex and contraceptives are targeted mostly at professionals, experts or academics. “Youth often stay away from these forums thinking ‘this issue is not for me’,” Mahbuba told IPS.

This can be attributed partly to the jargon that surrounds conversations about sexual health. According to Faustina Fynn-Nyame, country director for Marie Stopes International (MSI) in Ghana, young people are put off by “incomprehensible literature” and terms like “family planning”, which they cannot identify with.

“There is a need to take communication more seriously and coin terms that are youth-friendly,” she said.

But none of these tactics on youth engagement will go far without massive investment in this global effort.

“There is an urgent need to invest more (in)…creating effective tools of communication and building communication skills,” said Aguilera.

Some countries are feeling the financial crunch more than others. Sinthuka Vive, a student from the war-ravaged town of Jaffna in northern Sri Lanka, says the state is struggling to fund reproductive health services.

“During the war, many hospitals were damaged,” she told IPS. “The few that survived are struggling to provide care to married women. Youth, meanwhile, have nowhere to go, no one to provide them with counseling or information.”

The issue of funds has been a major topic of debate at the conference underway in Malaysia, particularly with regards to promises made at the July 2012 London Summit on Family Planning, where global leaders pledged a total of 2.6 billion dollars to provide 120 million more women and girls in the world’s poorest countries with voluntary access to contraceptive services, supplies and information by 2020.

It remains to be seen whether or not these funds will be leveraged to improve the sexual health and reproductive rights of youth around the world.

Laxmi Yarragantla, a 20-year-old mother of three, lives in the Warangal district, where over 50 percent of girls are married before they reach 18 years. Credit: Stella Paul

In the small village of Haldiyaganj in the northeastern Indian state of Meghalaya, 17-year old Injuara Begum is nursing her son who was born right here on the floor of her home three years ago.

She has never heard of Janani Suraksha Yojana (JSY), a government health scheme that provides free medicine, midwife assistance and 30 dollars in cash to all pregnant women who deliver at a government hospital.

Injuara comes from a poor Muslim family that migrated to India from Bangladesh in 1980. Her father, a brick kiln worker, says the early marriage was intended to “protect his daughter’s future” in this volatile border village where there are few opportunities for women beyond motherhood.

Injuara’s story is indicative of a worrying trend in India, where, according to a 2012 study by the United Nations Children’s Fund (UNICEF), 22 percent of women become mothers before the age of eighteen.

Research indicates that over 70 percent of these child mothers are from marginalised groups like the Scheduled Caste (Dalits) and other tribal communities, who comprise 24 percent of the country’s total population of 1.24 billion people, or refugees who have few economic opportunities.

Experts say lack of access to, and awareness of, health services compounds the problem.

Severe health repercussions

The exclusion of marginalised women from health services is holding India back from achieving the Millennium Development Goals, which set the target of reducing maternal mortality and achieving universal access to reproductive healthcare by 2015.

According to the UNFPA, 25 percent of the 56,000 maternal deaths in India in 2010 occurred within marginalised communities.

D C Sarkar, head of the Haldiyaganj Public Health Centre, tells IPS that most first-time mothers here are below 18 years. “Almost 70 percent of them suffer from low haemoglobin levels and weakness,” he said, which results in premature deliveries and miscarriages.

Since his own centre is ill equipped to deal with pregnancy-related complications, he often refers his patients to the district hospital. But it is an exercise in futility, since none of the village’s residents can afford to pay hospital fees.

Sunil Dhar, one of the leading gynaecologists in the northeastern region, says over 70 percent of his patients are from minority communities, while most are below the age of 20.

Drawing on his 50 years of medical experience in the border state of Tripura, Dhar told IPS, “Over 50 percent of my patients are as young as 14 and 15. Elderly female relatives, who want to know the health of the foetus, usually accompany the young girls who come here – but one look at the expecting mother tells me she is the one in need of treatment,” for conditions like jaundice, or swollen ankles.

He links poor health and early marriages to the socio-economic status of refugee communities in these northern border regions, where over two million people fleeing the bloody Liberation War in Bangladesh arrived in 1970.

The 1990s also saw an influx of refugees from Myanmar (formerly Burma) and the Chittagong Hill districts of Bangladesh. Still living in abject poverty in informal camp settlements, these communities “can’t be expected to go to the hospitals – the hospitals must come to them,” according to Dhar.

Further south, in the central Indian state of Chattisgarh, a Gond tribal woman named Khemwanti Pradhan tells IPS she was married at 15, and became pregnant shortly after.

A resident of the Sindurimeta village in the conflict-ridden Bastar region, she was forced to delivered both her sons at home because the closest health centres were shut when she went into labour late at night. “My mother-in-law helped me cut the umbilical cord,” she said.

An ongoing Maoist insurgency against the government keeps most people indoors for fear of being caught in the crossfire.

Though Pradhan was aware of the JSY government health scheme, violence prevented her from accessing the services. “Doctors and nurses will not work after dark because they are scared of the Maoists. No transport is available after four in the evening. If our men go out to fetch a car or a doctor, army personnel suspect them of being terrorists and arrest them for interrogation,” she lamented.

Integrated Solutions

According to UNICEF, over 52 percent of girls in the Warangal district of the southern Indian state of Andhra Pradesh are married in their teens. Experts say the region is in dire need of targeted interventions that can slow this trend.

Here, an NGO called ‘Thaurni’ trains adolescent girls from vulnerable communities, such as children of migrant labourers, landless farmers and nomadic tribes, to become anti-child marriage campaigners. In the past five years, the organisation has stopped 56 child marriages in the district.

Still, hundreds of girls continue to get married every year because existing laws do not cater to their specific problems, Mamatha Raghuveer, head of Thaurni, told IPS.

“According to the Prohibition of Child Marriage Act, anyone found guilty of planning or conducting a child marriage can be fined up to 2,000 dollars and also be jailed for a maximum of two years.”

But while this law has relevance for mainstream society, where families have other options, it does not address the specific problems in marginalised communities.

For people in dire economic and political straits, living in regions where rape and sexual abuse is rampant, “early marriage is the only way to…ensure a girl’s physical safety.” Unmarried teenagers face untold risks, including being kidnapped and sold to brothels. “We need a policy that focuses on reaching out to these people,” Raghuveer stressed.

According to Swapan Debnath, a local homeopathy practitioner and school teacher in Tripura, the prevailing “anti-immigrant” climate in India also forces many families to turn to early child marriages as insurance against deportation.

Therefore, policies to improve maternal mortality must necessarily tackle issues of violence and immigration, incorporating, wherever possible, cross-border solutions to prevent child marriage and early motherhood.

Debnath hopes that the Women Deliver global health summit, scheduled to run from May 28 to 30 in the Malaysian capital Kuala Lumpur, will provide the perfect opportunity to discuss such integrated strategies.

While activists and experts from around the world debate on what action can be taken, women in vulnerable situations have no choice but to rely on the support of their families.

At the moment, Injuara is happy that her husband Zakir Mohammed is not asking for another child just yet.  Since contraceptives and abortions are considered a sin, family planning means abstaining from sex – something that her husband has agreed to do until she regains her strength. “I am happy,” she says, “that he understands.”

About 99 percent of patients with obstetric fistula cannot afford to pay their doctors. Credit: Jugran Bahuguna/IPS

Sherhshah Syed is a highly qualified doctor and president of the prestigious Pakistan National Forum on Women’s Health (PNFWH) but his income does not match his qualifications.

He often spends long hours treating women with obstetric fistula, a severe reproductive health condition arising during childbirth that primarily affects women and girls who have no access to even the most basic medical care.

But since fistula is considered to be “the poor woman’s” disease, few of his patients can afford to pay him for his labour.

Dr. Sajjid Ahmed, who heads a PNFWH fistula project, tells IPS with a smile, “More than 99.9 percent of (our) patients are so poor, all they can offer us in exchange for giving them a new life is gratitude and an embroidered handkerchief.”

Labelled an “entirely preventable condition” by the international medical community, fistula develops during prolonged labour, “when the baby’s head puts pressure on the lining of the birth canal and eventually (rips) through the wall of the rectum and bladder, resulting in urinary or faecal incontinence,” Syed told IPS.

Fistula also causes stillbirths, kidney failure and a perpetual faecal odour emanating from the woman’s body.

The condition is rarely found in the developed world but is common in many Asian and African countries, affecting an estimated three million women, according to the World Health Organisation (WHO).

The fact that there are no country-specific statistics available for Pakistan is indicative of the indifference and stigma that surrounds the ailment.

Syed made a “conservative” guess that anywhere between 5,000 and 6,000 women in Pakistan are suffering from the condition, which can only be treated through reconstructive surgery.

“While we are able to (treat) 1,000 women each year, there are many more who suffer silently,” he said, attributing this silence to a sense of shame, a culture that does not allow women to make decisions about their own bodies and a lack of awareness among health practitioners.

Some experts blame this on flaws in medical colleges’ curricula. Dr. Qazi M. Wasiq, general secretary of the Sindh chapter of the Pakistan Medical Association (PMA), says colleges are “out of touch” with the needs of the country and the community.

“We train our young doctors to serve in countries like the United States, the United Kingdom and the Middle East, where fistula is non-existent. Most students have only a bookish knowledge of the condition, with hardly (any awareness) of the debilitating details.”

This oversight has heavy ramifications in Pakistan, a hotbed of maternal and infant mortality. According to official statistics in the Pakistan Demographic and Health Survey of 2007, the last time such data were gathered, the maternal mortality rate (MMR) of 276 per 100,000 live births is one of the highest in the region.

In comparison, according to the WHO, the MMR is 35 in Sri Lanka, 170 in Nepal, 200 in India and 240 in Bangladesh. Many other countries in South Asia are showing signs of progress, but Pakistan’s MMR has remained virtually unchanged since 1991.

In addition, the infant mortality rate is 78 deaths per 1,000 live births; for those under five the rate is even higher, touching 94 deaths per 1,000 live births. This means one in every 11 children born in Pakistan dies before reaching his or her fifth birthday.

The vast majority of these fatalities occur in the countryside, where women have little or no access to basic care. Most qualified female gynaecologists are reluctant to take up posts in remote rural areas, particularly in provinces like Balochistan and the northwestern Khyber Pakhtunkhwa (KP), according to PMA’s Wasiq.

According a recent report by the British medical journal ‘The Lancet’, evidence-based interventions can prevent roughly 58 percent of an estimated 368,000 deaths of mothers, newborn babies and children. In addition, 49 percent of an estimated 180,000 stillbirths could be prevented by 2015.

For years, Syed and his colleagues have urged the government to invest in providing basic emergency obstetric care by deploying trained birth attendants into rural areas to advise families against early child marriage, one of the leading causes of fistula.

According to Syed, dispatching an additional 400,000 nurses, paramedics and midwives to some 80,000 villages across Pakistan would have a huge impact on maternal mortality rates.  So far, however, there only 148 schools training 28,000 midwives.

With no official monitoring of the situation, women who develop conditions like fistula have to rely on concerned relatives to take action on their condition.

Ahmed says it is always mothers, fathers and brothers who accompany fistula patients to treatment centres – rarely, if ever, do husbands or in-laws volunteer to deal with the condition.

In 2006, the PNFWH in collaboration with the United Nations Population Fund (UNFPA) started the Fistula Prevention and Treatment Project with the aim of providing free treatment services to fistula patients all over the country, and training service providers.

On May 23, the UNFPA marked the first-ever International Day to End Obstetric Fistula, with the aim of building on local efforts to raise awareness of a condition that is not “understood even in societies where it is prevalent.”

In the eight years since the UNFPA project began, 13 fistula repair centres have been set up across Pakistan, all in government hospitals; but trained doctors, who currently number about three dozen, have not increased proportionately.

Ahmed says building an adequate medical force to deal with the problem requires commitment, compassion and sensitivity without the expectation of anything in return.

“Then again,” said Syed, “not everyone is mad enough to spend hours on something that earns you prayers but no economic benefits.”

Medical practitioners tell IPS that an obstetrician’s salary in a government hospital is anywhere from 600 to 1,000 dollars per month. In comparison, those with private practices earn the same by performing just one caesarian section.

Over 120,000 Afghan women and 60,000 children admit to being addicted to drugs. Credit: Anand Gopal/IPS

Located on a narrow street in a quiet neighbourhood in Kabul, the Sanga Amaj Women’s Treatment Centre is the only one of its kind in Afghanistan: named after the 22-year-old journalist who was assassinated in 2007, the facility caters exclusively to Kabul’s massive population of female drug addicts.

Out of respect for its residents’ privacy, the centre does not disclose its location and strictly monitors all visits. Here, a kind and professional staff dressed in white aprons attend to 25 women and an equal number of children between the ages of five and 11who spend most of their time in a cosy playroom filled with toys.

The entire facility is split between two floors, housing dormitory-style rooms with 12 beds each and an array of common rooms.

The clean, pleasant settings belie the desperate circumstances of the building’s occupants.

Most of the women here say they started out using opium and hashish, but turned to harder drugs like heroin in order to cope with “economic hardships, family violence, or psychological problems,” Storai Darinoor, one of the young coordinators at the facility, told IPS.

“In many cases husbands introduce their wives to drugs, often forcibly. When either one of the parents are addicts, the children generally become addicts, too,” she added. Women and children tend to favour oral intake of drugs, either eating or smoking their fix, but one 11-year-old in the centre was found to have been using injections.

Though the female residents declined to speak with IPS, staff members said that patients have admitted to taking heroin as “medicine” to ease the stresses of daily life.

“Young children are fed opium by their mothers to keep them quiet, while older children, in addition to consuming drugs themselves, provide drugs for their mothers,” according to Storai.

She says 80 percent of female addicts turned to drugs upon returning to the country from Iran and Pakistan, where they lived as refugees during the Taliban’s reign from 1996 to 2001.

The Sanga Amaj Centre receives funding through the drug advisory programme of the Colombo Plan – a U.S.-backed regional initiative designed to coordinate strategies for reducing demand and supply of narcotics in Asia – but only enough to provide the most basic therapy.

“Treatment typically lasts 45 days,” Dr. Huma Mansouri, director of the facility, tells IPS, beginning with a 10-day period of detoxification.

“After that we proceed to administering daily doses of buprenorphine (a semi-synthetic opioid) since we do not have access to methadone.” When this is inadequate to stop severe withdrawal symptoms – crying, screaming or beating their heads against a wall – staff members resort to “water therapy”: short, cold showers that help patients to relax.

After the first 10 days, medication is limited to daily doses of vitamins. The rest of the time in the facility is spent on rehabilitation, attending awareness sessions on the harmful effects of drug use and classes on different subjects including health, psychology and religion, “because drug use is forbidden in Islam,” Mansouri said.

The women then move into a three-month vocational programme, learning sewing and computer skills, which open up employment opportunities once they leave the centre.

One of the facility’s 12 staff members is then assigned to “follow” the women for a two-year period, making weekly house visits, offering support or advice, and providing counselling free of charge.

Not all of the women have a place to go after being discharged. Some are abandoned by their families as a result of their addiction and have no way of supporting themselves. Whenever possible, the centre hires its old patients to work as cleaners in the facility.

To date, the centre has treated over 1,100 women, of which “only 145 have relapsed,” according to Storai.

But the vast majority of women in Afghanistan have no access to such treatment, and often live out their days in a cycle of violence and poverty made worse by their addiction.

According to a survey conducted by the United Nations Office on Drugs and Crime (UNODC) in 2010, the last time such data were gathered, roughly one million Afghans between the ages of 15 and 64 were addicted to drugs, or three percent of the population of 35 million.

An estimated 120,000 of these addicts are women, and over 60,000 are children.

Experts attribute these dismal figures to numerous factors, including a 40-percent unemployment rate and an increase in poppy cultivation: in 2012, an estimated 154,000 hectares of farmland were dedicated exclusively to poppy.

The UNODC 2013 Afghanistan Opium Risk Assessment says cultivation in the main poppy growing areas – like the southern regions of Helmand and Kandahar, and northern provinces like Herat, Faizabad and Badakhshan – is expected to rise even further in the coming years.

The country, which used to supply about half of Europe’s heroin in 2001, now accounts for a full 90 percent of the global supply of opiates, making it the world’s largest producer by far. An estimated 26 percent of the country’s GDP comes directly from the narcotics trade, which the U.N. report says is “strongly” linked to economic insecurity and a lack of agricultural aid.

Though Afghanistan has a long history of opium use, with many families in the north taking moderate doses in order to work longer hours, addiction levels did not reach such heights until the U.S.-led invasion in 2001 forced warring mujahideen groups out of the cities and into rural areas, where they took over vast poppy fields and established “production centres and laboratories along the northern border,” Dr. Tariq Suliman, director of ‘Nejat’, one of the few drug rehabilitation centres in Kabul, told IPS.

Located in the impoverished Karte Char neighbourhood in western Kabul, Nejat sits in the middle of a huge concentration of drug users, who congregate in parks, crouch under bridges or trees, or even just sit in the middle of the road to get their fix.

While heroin is the most widely used drug – available at virtually every street corner for six dollars a gramme – hashish and opium are also readily available. For a population with an average income of just 500 dollars a year, this is a steep price to pay, and often pushes families deeper into poverty.

The government’s ministry of counter narcotics has no funds with which to implement prevention, treatment or rehabilitation programmes, leaving the onus for this work entirely on the shoulders of civil society, laments Suliman.

Experts say women bear the brunt of addiction, partly because religious and cultural taboos preventing women from consuming drugs mean that few actively seek treatment for fear of being stigmatised.

Female drug addicts here are a kind of “hidden population”, secreting themselves away in their homes, which, in turn, breeds a culture of violence against children and pushes the latter closer towards addiction.

Experts say that unless the government allocates more money for the creation of facilities like the Sanga Amaj Centre, the thousands of female addicts have no hope of a better future.