Inter Press Service » Women’s Health http://www.ipsnews.net Turning the World Downside Up Fri, 21 Nov 2014 14:22:59 +0000 en-US hourly 1 http://wordpress.org/?v=3.9.3 Depression Casts Cloak of Infertility Over Kashmir Valleyhttp://www.ipsnews.net/2014/11/depression-casts-cloak-of-infertility-over-kashmir-valley/?utm_source=rss&utm_medium=rss&utm_campaign=depression-casts-cloak-of-infertility-over-kashmir-valley http://www.ipsnews.net/2014/11/depression-casts-cloak-of-infertility-over-kashmir-valley/#comments Wed, 19 Nov 2014 12:02:32 +0000 Shazia Yousuf http://www.ipsnews.net/?p=137817 Of the 100 patients seen at Kashmir’s psychiatric facilities each day, roughly 75 are women. Credit: Shazia Yousuf/IPS

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

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

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

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

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

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

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

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

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

Downward spiral of mental and maternal health

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

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

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

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

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

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

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

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

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

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

Stress and stigma

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Current trends predict a bleak future

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

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

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

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

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

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

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

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

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

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

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

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

*Patients’ names have been changed on request.

Edited by Kanya D’Almeida

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

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

By Miriam Gathigah
NAIROBI, Nov 7 2014 (IPS)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source: UNAIDS

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

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

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

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

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

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

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

But Kenya is not a unique scenario.

Shocking figures

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

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

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

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

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

Source: UNICEF

Source: UNICEF

A package of interventions

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

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

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

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

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

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

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

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

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

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

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

Edited by: Mercedes Sayagues

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

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

By Yury Fedotov
VIENNA, Oct 17 2014 (IPS)

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

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

Courtesy of UNODC

Courtesy of UNODC

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

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

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

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

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

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

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

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

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

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

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

Edited by Kitty Stapp

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Edited by Kanya D’Almeida

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

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

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

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

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

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

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

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

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

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

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

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

Currently, Assam is one of the worst hit regions.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Edited by Kanya D’Almeida

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

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

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

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

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

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

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

Excerpts from the interview follow.

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

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

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

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

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

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

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

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

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

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

A: We are already doing it!

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

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

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

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

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

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

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

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

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

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

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

Edited by Kanya D’Almeida

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Edited by Kitty Stapp

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

*Names have been changed

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

Edited by Kanya D’Almeida

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

*Not her real name

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

Edited by Kanya D’Almeida

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Edited by Kanya D’Almeida

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes

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

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

By Marianela Jarroud
SANTIAGO, Sep 24 2014 (IPS)

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

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

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

Latin America – stronghold of illegal abortion

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Edited by Kanya D’Almeida

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On Sri Lanka’s Tea Estates, Maternal Health Leaves a Lot to Be Desiredhttp://www.ipsnews.net/2014/09/on-sri-lankas-tea-estates-maternal-health-leaves-a-lot-to-be-desired/?utm_source=rss&utm_medium=rss&utm_campaign=on-sri-lankas-tea-estates-maternal-health-leaves-a-lot-to-be-desired http://www.ipsnews.net/2014/09/on-sri-lankas-tea-estates-maternal-health-leaves-a-lot-to-be-desired/#comments Tue, 23 Sep 2014 10:08:53 +0000 Kanya DAlmeida http://www.ipsnews.net/?p=136823 A pregnant woman waits in line for a medical check-up. Health indicators for women on Sri Lanka’s tea estates are lower than the national average. Credit: Amantha Perera/IPS

A pregnant woman waits in line for a medical check-up. Health indicators for women on Sri Lanka’s tea estates are lower than the national average. Credit: Amantha Perera/IPS

By Kanya D'Almeida
COLOMBO, Sep 23 2014 (IPS)

A mud path winds its up way uphill, offering views on either side of row after row of dense bushes and eventually giving way to a cluster of humble homes, surrounded by ragged, playful children.

Their mothers either look far too young, barely adults themselves, or old beyond their years, weathered by decades of backbreaking labour on the enormous tea estates of Sri Lanka.

Rani* is a 65-year-old mother of six, working eight-hour shifts on an estate in Sri Lanka’s Central Province. Her white hair, a hunched back and fallen teeth make her appear about 15 years older than she is, a result of many decades spent toiling under the hot sun.

She tells IPS that after her fifth child, overwhelmed with the number of mouths she had to feed, she visited the local hospital to have her tubes tied, but gave birth to a son five years later.

“If women are the primary breadwinners among the estate population, generating the bulk of household revenue in a sector that is feeding the national economy, then maternal health should be a priority." -- Mythri Jegathesan, assistant professor in the department of anthropology at Santa Clara University in California
Though she is exhausted at the end of the day, and plagued by the aches and pains that signal the coming of old age, she is determined to keep her job, so her children can go to school.

“I work in the estates so that they won’t have to,” she says with a hopeful smile.

Her story is poignant, but not unique among workers in Sri Lanka’s vast tea sector, comprised of some 450 plantations spread across the country.

Women account for over 60 percent of the workforce of abut 250,000 people, all of them descendants of indentured servants brought from India by the British over a century ago to pluck the lucrative leaves.

But while Sri Lankan tea itself is of the highest quality, raking in some 1.4 billion dollars in export earnings in 2012 according to the Ministry of Plantation Industries, the health of the labourers, especially the women, leaves a lot to be desired.

Priyanka Jayawardena, research officer for the Colombo-based Institute of Policy Studies of Sri Lanka, tells IPS that “deep-rooted socio-economic factors” have led to health indicators among women and children on plantations that are consistently lower than the national average.

The national malnutrition rate for reproductive-age mothers, for instance, is 16 percent, rising to 33 percent for female estate workers. And while 16 percent of newborn babies nationwide have low birth weight, on estates that number rises significantly, to one in every three newborns.

A higher prevalence of poverty on estates partly accounts for these discrepancies in health, with 61 percent of households on estates falling into the lowest socio-economic group (20 percent of wealth quintile), compared to eight percent and 20 percent respectively for urban and rural households.

Other experts say that cultural differences also play a role, since estate populations, and especially tea workers, have been relatively isolated from broader society.

“Many women are uneducated, and tend to be careless about their own health, and the health of their children,” a field worker with the Centre for Social Concern (CSC), an NGO based in the Nuwara Eliya district in central Sri Lanka, tells IPS.

“They have a very taxing job and so spend less time thinking about food and nutrition,” she states.

In fact, as Jayawardena points out, only 15 percent of under-five children on estates have a daily intake of animal protein, compared to 40-50 percent among rural and urban populations.

The same is true for daily consumption of yellow vegetables and fruits, as well as infant cereals – in both cases the average intake among children on estates is 40 percent, compared to 60 percent in rural and urban areas.

Breastfeeding patterns are also inadequate, with just 63 percent of estate workers engaging in exclusive breastfeeding for the first four months of a child’s life, compared to 77 percent in urban areas and 86 percent in rural areas, according to research conducted by the Institute of Policy Studies.

The situation is made worse by the demands of the industry. Since many women are daily wage labourers, earning approximately 687 rupees (just over five dollars) each day, few can afford to take the required maternity leave.

But even when alternatives are provided by the estate management, experts say, a lack of awareness and education leaves children without proper attention and care.

Jayawardena tells IPS that almost half of all women on estates drop out of school after the primary level, compared to a national dropout rate of 15 percent. Literacy levels are low, and so even awareness campaigns often fail to reach the targeted audience.

Many female estate workers are daily wage labourers, earning approximately 687 rupees (just over five dollars) each day. Credit: Anja Leidel/CC-BY-SA-2.0

Many female estate workers are daily wage labourers, earning approximately 687 rupees (just over five dollars) each day. Credit: Anja Leidel/CC-BY-SA-2.0

“Women on the estates do not believe they have many options in life beyond working on the plantations,” the CSC field officer says.

“Most are extremely poor, and from childhood they are exposed to very little – there are hardly any playgrounds, libraries, gathering places or social activities on the estates. So they tend to get married early and become mothers at a very young age.”

Though the national average for teenage pregnancies stands at roughly 6.4 percent, it shoots up to ten percent among estate workers, resulting in a cycle in which malnourished mothers give birth to unhealthy babies, who will also likely become mothers at a young age.

“If women are the primary breadwinners among the estate population, generating the bulk of household revenue in a sector that is feeding the national economy, then maternal health should be a priority,” Mythri Jegathesan, assistant professor in the department of anthropology at Santa Clara University in California, tells IPS.

“Any form of agricultural labour is hard on the body, and many of the estate workers in Sri Lanka work until they are seven or eight months pregnant. They need to be acknowledged, and more attention given to their wellbeing and health,” she adds.

Several NGOs and civil society organisations have been working diligently alongside the government and the private sector to boost women’s health outcomes.

According to Chaaminda Jayasinghe, senior project manager of the plantation programme for CARE International-Sri Lanka, the situation is changing positively.

The emergence of the Community Development Forum (CDF) introduced by CARE in selected tea estates is providing space and a successful model for inclusive development for estate communities, he tells IPS.

This has already resulted in better living conditions and health outcomes among estate communities while mainstreaming plantation communities into the larger society.

*Not her real name.

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

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Saving the Lives of Cameroonian Mothers and their Babies with an SMShttp://www.ipsnews.net/2014/09/saving-the-lives-of-cameroonian-mothers-and-their-babies-with-an-sms/?utm_source=rss&utm_medium=rss&utm_campaign=saving-the-lives-of-cameroonian-mothers-and-their-babies-with-an-sms http://www.ipsnews.net/2014/09/saving-the-lives-of-cameroonian-mothers-and-their-babies-with-an-sms/#comments Tue, 23 Sep 2014 08:23:01 +0000 Ngala Killian Chimtom http://www.ipsnews.net/?p=136820 According to an African proverb, “every woman who gives birth has one foot on her grave.” Cameroonians are attempting to make this proverb a historical fact and not a present reality through SMS technology. Credit: Mercedes Sayagues/IPS

According to an African proverb, “every woman who gives birth has one foot on her grave.” Cameroonians are attempting to make this proverb a historical fact and not a present reality through SMS technology. Credit: Mercedes Sayagues/IPS

By Ngala Killian Chimtom
YAOUNDE, Sep 23 2014 (IPS)

“You can’t measure the joy in my heart,” Marceline Duba, from Lagdo in Cameroon’s Far North Region, tells IPS as she holds her grandson in her arms.  

“I am pretty sure we could have lost this child, and perhaps my daughter, if this medical doctor hadn’t shown up,” Duba says, a smile sweeping her face.

The medic in question is Dr Patrick Okwen. He is the coordinator of M-Health, a project sponsored by the United Nations Population Fund (UNFPA) that uses mobile technology to increase access to healthcare services to communities “when they most need it.”

The World Health Organisation (WHO) recommends that a nurse or doctor should see a maximum of 10 patients a day. But according to Tetanye Ekoe, the vice president of the National Order of Medical Doctors in Cameroon, “the doctor-to-patient ratio in Cameroon stands at one doctor per 40,000 inhabitants, and in remote areas such as the Far North and Eastern Regions, the ratio is closer to one doctor per 50,000 inhabitants.”

Okwen was in Lagdo testing out the SMS system, which was just implemented a few months back, when Duba’s daughter, Sally Aishatou, went into labour.

Okwen and the medical staff at the Lagdo District Hospital received an SMS from Aishatou. She had been in labour for 48 hours with no signs that the baby was about to come.

“What happens when a woman SMSes a particular number, the GPS location blinks on the server, and then the server tries to identify her location, puts it on Google maps; then tells the driver to go there. [The system] also tells the doctor to come to the hospital; tells the nurses to get ready. So everybody gets into motion,” he tells IPS.

Okwen and the ambulance driver traced Aishatou to her home. They found her lying helpless on a mat, almost passed out. By the time the ambulance returned to the hospital, the operation room was ready for her and she was taken into surgery immediately.

Eight minutes later, her 4.71 kg baby boy was born. The midwife Manou nee Djakaou tells IPS: “The joy in me is so great that I don’t even know how to express it. I am so exited; very happy. This system put in place is very efficient. But for this innovation, we stood to lose this baby and its mother.”

Two hours after surgery, Aishatou regained consciousness and named her boy after Okwen.

According to the U.N. Children’s Fund (UNICEF), out of every 100,000 live births 670 women in Cameroon die. UNICEF figures also state that for every 1,000 live births, 61 infants died in Cameroon in 2012.

“Many women are dying from child-birth related issues. Women are dying while giving life. And this is something we are really concerned about, but we also know that with the coming of mobile technology, there is hope for women in Africa,” Okwen says.

“Most of the women in Africa today have access to a telephone. It could be her own, her husband’s own, or a neighbour’s. So if we had a way in which women could reach an ambulance using a phone that would guide the ambulance, it could indeed present hope for African women,” he explains.

Okwen says the project has benefitted “close to one hundred women in terms of information, evacuation, arrangements of hospital visits, deliveries and caesarean sections.”

The project has been dubbed “Tsamounde”, which means hope in the local Fufuldé language.

Mama Abakai, the Mayor of Lagdo, says the project’s impact has been far reaching.

“A lot of our sisters, wives and mothers in rural areas lose their lives and suffer a lot, because there is a communication gap, and a problem of rapid intervention and assistance. With this system, it suffices to send an SMS or a simple beep, and all the actors involved in saving lives are mobilised…its formidable,” Abakai tells IPS.

Dr. Martina Baye of Cameroon’s Ministry of Public Health calls the project a “revolution in Cameroon’s health care delivery system.”

She says that as a majority of women in the country’s far North Region have little access to healthcare services, the M-Health Project comes as a huge relief.

According to the 2010 Population census, the Far North Region has a population of three million people, 52 percent of whom are women.

“We look forward to using this technology in other parts of the country,” she tells IPS.

Edited by: Nalisha Adams

The writer can be contacted at: https://www.facebook.com/ngala.killian

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OPINION: Invest in Young People to Harness Africa’s Demographic Dividendhttp://www.ipsnews.net/2014/09/opinion-invest-in-young-people-to-harness-africas-demographic-dividend/?utm_source=rss&utm_medium=rss&utm_campaign=opinion-invest-in-young-people-to-harness-africas-demographic-dividend http://www.ipsnews.net/2014/09/opinion-invest-in-young-people-to-harness-africas-demographic-dividend/#comments Sun, 21 Sep 2014 22:09:25 +0000 Dr. Julitta Onabanjo, Benoit Kalasa, and Mohamed Abdel-Ahad http://www.ipsnews.net/?p=136771

Julitta Onabanjo is Regional Director, UNFPA East and Southern Africa. Benoit Kalasa is Regional Director, UNFPA West and Central Africa. Mohamed Abdel-Ahad is Regional Director, UNFPA North Africa and Arab States.

By Julitta Onabanjo, Benoit Kalasa, and Mohamed Abdel-Ahad
JOHANNESBURG, Sep 21 2014 (IPS)

Different issues will be competing for the attention of different African leaders attending the 69th United Nations General Assembly Special Session on International Conference on Population and Development (ICPD) Beyond 2014 in New York on Sep 22.

But the central question for Africa’s development today is this: How do we harness the dividend from the continent’s current youthful population?

Solving this issue has never been more fundamental to Africa’s development than it is today.

For decades many, African countries have come up with a variety of ‘development’ plans. But often missing in these documents is how best to harness the potential of the youthful population for the transformation of the continent.

Therefore, strategic investment to harness the potential of the youth population can no longer wait.“African governments must know that efforts to create a demographic dividend are likely to fail as long as vast portions of young females are denied their rights, including their right to education, health and civil participation, and their reproductive rights”

The groundswell for change

Africa is undergoing important demographic changes, which provide immense economic opportunities. Currently, there are 251 million adolescents aged 10-19 years in Africa compared with 1.2 billion worldwide, which means that around one in five adolescents in the world comes from Africa.

Africa’s working age population is growing and increasing the continent’s productive potential. If mortality continues to decline and fertility declines rapidly, the current high child dependency burden will reduce drastically. The result of such change is an opportunity for the active and employed youth to invest more.  With declining death rates, the working age population in Africa will increase from about 54 percent of the population in 2010 to a peak of about 64 percent in 2090.

This increase in the working age population will also create a window of opportunity  that, if properly harnessed, should translate into higher economic growth for Africa, yielding what is now termed a ‘demographic dividend’ – or accelerated economic growth spurred by a change in the age structure of the population.

Reaping the demographic dividend requires investments in job creation, health including sexual and reproductive health and family planning, education and skill and development, which would lead to increasing per capita income.

Due to low dependency ratio, individuals and families will be able to make savings, which translate into investment and boost economic growth. This is how East Asian countries (Asian Tigers) were able to capitalise on their demographic window during the period 1965 and 1990.

The impact of such a demographic transition on economic growth is no longer questionable – it is simply a fact.

But this transformation requires that appropriate policies, strategies, programs and projects are in place to ensure that a demographic dividend can be reaped from the youth bulge.

Seizing the moment

Without concerted action, many African countries could instead face a backlash from the growing numbers of disgruntled and unemployed youth that will emerge.

In the worst-case scenario, such a demographic transition could translate into an army of unemployed youth and significantly increase social risks and tensions.

To seize the opportunity, African states will need to focus their investments in a number of critical areas. A priority will be the education and training of their youth.

African governments must know that efforts to create a demographic dividend are likely to fail as long as vast portions of young females are denied their rights, including their right to education, health and civil participation, and their reproductive rights.

If these efforts are to succeed, this will demand addressing gender disparities between today’s boys and girls especially, but more specifically, addressing the vulnerabilities of the adolescent girl.

Beyond rhetoric

As we move toward the post-2015 development agenda, unleashing the potential and power of Africa’s youth should be a critical component of the continent’s developmental strategies, as reflected in the Addis Ababa Declaration on Population and Development – the regional outcome of ICPD beyond 2014 – and the Common African Position on the post-2015 development agenda.

This can no longer be reduced to election or political polemics. It requires urgent action.

Young people are central to the realisation of the demographic dividend. It is therefore important to protect and fulfil the rights of adolescents and youth to accurate information, comprehensive sexuality education, and health services for sexual and reproductive well-being and lifelong health, to ensure a productive and competitive labour force.

Africa cannot afford to squander the potential gains of the 21st Century offered by such an important demographic asset:  its youthful population.

Edited by Ronald Joshua

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Georgia’s Female Drug Addicts Face Double Strugglehttp://www.ipsnews.net/2014/09/georgias-female-drug-addicts-face-double-struggle/?utm_source=rss&utm_medium=rss&utm_campaign=georgias-female-drug-addicts-face-double-struggle http://www.ipsnews.net/2014/09/georgias-female-drug-addicts-face-double-struggle/#comments Sun, 21 Sep 2014 09:27:33 +0000 Pavol Stracansky http://www.ipsnews.net/?p=136769 By Pavol Stracansky
TBILISI, Sep 21 2014 (IPS)

Irina was 21 when she first started using drugs. More than 30 years later, having lost her husband, her home and her business to drugs, she is still battling her addiction.

But, like almost all female drug addicts in this former Soviet state, she has faced a desperate struggle not only with her drug problem, but with accessing help in the face of institutionalised and systematic discrimination because of her gender.

“Georgia’s society is very male-dominated,” she told IPS. “And this is reflected in the attitudes to drugs. It’s as if it’s OK for men to use drugs but not women. For women, the stigma of drug use is massive. There are many women who do not join programmes helping them as they would rather not be seen there.”

Women make up 10 per cent of the estimated 40,000 drug users in Georgia, according to research by local NGOs working with drug users.“Georgia’s society is very male-dominated and this is reflected in the attitudes to drugs. It’s as if it’s OK for men to use drugs but not women. For women, the stigma of drug use is massive. There are many women who do not join programmes helping them as they would rather not be seen there” – Irina, now in her 50s, who has been taking drugs for 30 years

However, because of very strong gender stereotyping, women users have very low access to harm reduction services – only 4 percent of needle exchange programme clients are women and the figure is even less for methadone treatment.

Local activists say this startling discrepancy is down to the massive social stigma faced by women drug users.

Dasha Ocheret, Deputy Director for Advocacy at the Eurasian Harm Reduction Network (EHRN) told IPS: “In traditional societies, like Georgia’s, there is a much stronger negative attitude to women who use drugs than to men who use drugs. Women are supposed to be wives and mothers, not drug users.”

Many female addicts are scared to access needle exchanges or other harm reduction services because they fear their addiction will become known to their families or the police. Many have found themselves the victims of violence as their own families try to exert control over them once their drug use has been revealed. Others fear their drug use will be reported to the authorities by health workers.

Registered women drug users can have their children taken away while they routinely face violence – over 80 percent of women who use drugs in Georgia experience violence, according to the Georgian Harm Reduction Network– and extortion at the hands of police helping to enforce some of the world’s harshest drug laws. Possession of cannabis, for example, can result in an 11-year jail sentence.

Irina, who admits that she arranges anonymous attendance at an opioid substitution therapy (OST) programme so that as few people as possible can see her there, told IPS that she had herself been assaulted by a police officer and that police automatically viewed all female drug users as “criminals”.

But those who do want to access such services face further barriers because of their gender.

Free methadone substitution programmes in the country are extremely limited and because levels of financial autonomy among women in Georgia are low, other similar programmes are too expensive for many female addicts.

Discrimination is not uncommon among health service workers. Although some say that they have been treated by very sympathetic doctors, other female drug users have complained of abuse and denigration by medical staff and in some cases being denied health care because of their drug use.

Pregnant women are discouraged from accessing OST, despite it being shown to be safe in pregnancy and resulting in better health outcomes for both mother and child.

Eka Iakobishvili, EHRN’s Human Rights Programme Manager, told IPS: “Pregnant women don’t have access to certain services – they are strongly advised by doctors and health care workers to abort a baby rather than get methadone substitution treatment because they are told the treatment will harm the baby.”

While some may then undergo abortions, others will not, instead continuing dangerous drug use and the potential risk of contracting HIV/AIDS which could then be passed on to their child.

Meanwhile, those harm reduction services accessible by women are not gender-sensitive, according to campaigners, who say that female drug users need access to centres and programmes run and attended only by women.

Irina told IPS: “On some [harm reduction] programmes, the male drug users there will abuse the women drug users for taking drugs. This puts a lot of women off attending these programmes.”

She said that she had asked for a women-only service to be set up at the OST centre she attends but that it had been rejected on the grounds that only a few women were enrolled in it.

Together, these factors mean that many women are unable to access health services and continue dangerous drug-taking behaviour, sharing needles and injecting home-made drug cocktails made up of anything, including disinfectants and petrol mixed with over the counter medicines.

But there is hope that the situation may be about to change, at least to some degree, as local and international groups press to have the problem addressed.

At the end of July, CEDAW (UN Commission on Elimination of Discrimination against Women) released a set of recommendations for the Georgian government to ensure that women obtain proper access to harm reduction services after local NGOs submitted reports on the levels of discrimination they face.

These include, among others, specific calls for the government to carry out nationwide studies to establish the exact number of women who use drugs, including while pregnant, to help draw up a strategic plan to tackle the problem, and to provide gender-sensitive and evidence-based harm reduction services for women who use drugs.

The government has yet to react publicly to the recommendations but local campaigners have said they are speaking to government departments about them and are preparing to follow up with them on the recommendations.

Tea Kordzadze, Project Manager at the Georgian Harm Reduction Network in Tibilisi, told IPS: “We are hoping that at least some of the recommendations will be implemented.”

The Georgian government has been keen to show the country is ready to embrace Western values and bring its legislation and standards into line with European nations in recent years as it looks to create closer ties to the European Union. Rights activists say that this could come into play when the government considers the recommendations.

Iakobishvili said: These are of course just recommendations and the government is not obliged at all to accept or implement any of them. But, having said that, Georgia does care what other countries and big international rights organisations like Amnesty International and so on say about the country.”

Irina told IPS that only outside pressure would bring any real change. “The European Union, the Council of Europe and other international bodies need to put pressure on the Georgian government to make sure that the recommendations don’t remain on paper only.”

But, she added, “in any case, the recommendations alone won’t be enough. The whole attitude in society to women drug users is very negative. It has to be changed.”

(Edited by Phil Harris)

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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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