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

By Linus Atarah
ISTANBUL, May 25 2012 (IPS)

While much of the world is facing a global financial crisis, made worse by government cuts in social spending, members of parliament meeting here Wednesday agreed the economic crunch is no reason for governments to relax their commitment to women’s reproductive rights and health, made 18 years ago.

Speaking at the opening session of the fifth International Parliamentarians Conference on Population and Development (ICPD), Babatunde Osotimehin, executive director of the United Nations Population Fund (UNFPA) said 250 million women around the world do not have access to much-needed family planning services.

“It is not acceptable because every life is worth more than the money that we talk about,” he told conference participants earlier this week.

“We cannot accept that, everyday, 1000 women die during child birth because we know what we have to do and we have the resources to do it.”

All that is needed is the courage to make those resources available to prevent unwanted deaths on such a massive scale, he added.

“We have what it takes to make a difference,” Osotimehin said, referring to the advances in global communications and medical science since 1994, when the world adopted the ICPD Programme of Action to empower women to claim their reproductive rights.

The conference in Turkey, which brought together nearly 300 members of parliament from 110 countries, aims at building on past commitments made in the first ICPD conference held in Cairo, Egypt in 1994.

The Programme of Action adopted nearly two decades ago set a target of reducing maternal mortality by 75 percent by 2015, complementing one of the most urgent targets of the Millennium Development Goals (MDGs).

The Parliamentarians’ conference has taken place regularly during the last ten years, bringing together MPs who are committed to population and development issues, the last one being in Addis Ababa in 2009.

According to Osotimehin, the good news is that maternal mortality has been reduced by 47 percent since 1990; still, governments are not doing enough to make reproductive health services widely available to women and young girls.

“Our work is not done,” he said, “until we are able to reach out to that little girl out there drawing water five miles away from her house, who, when she has her regular menstrual period, is sent out of the house because it is unacceptable in (her) culture to be the house.”

Thousands of girls around the world continue to be married off, at the very sight of their first menstrual cycle, to men who are old enough to be their grandfathers. Such girls are denied the opportunity to realise their full potential, Osotimehin told IPS.

Safiye Cagar, director of information and external relations at the UNFPA, said governments are not paying adequate attention to reproductive health services, which are considered “soft issues” and therefore tend to be the first on the budgetary chopping blocks, unlike roads and schools.

But as she pointed out, building infrastructure will have little impact unless it is done in tandem with building a healthy population.

“Even though funding is short, the objectives of the ICPD cannot be allowed to fall (prey) to budgetary cuts,” Cagar stressed.

“Full implementation of the Programme is not optional, it is essential, not just because of human rights but because so many other aspects of economic development hinge on its success,” she told IPS.

Therefore, one of the outcomes of this meeting will be a call for governments to allocate 10 percent of their national budgets to ICPD programmes.

However, Gita Sen, adjunct professor of global health and population at the Harvard School of Public Health, pointed out that the ICPD Programme is itself an unfinished agenda, suffering from fragmentation.

According to her, the ICPD adopted in Cairo had talked about a comprehensive sexual and reproductive health package bolstered by a set of laws and regulations that would protect and promote the reproductive health rights of women.

But she said family planning is still not integrated into issues like maternal mortality, and youth-specific sexual health needs are not being adequately addressed.

The best example of this fragmentation is the global HIV epidemic, which in most places is a “vertical silo sitting by itself” or, at best, running parallel to the rest of the health system.

In reality, however, HIV is as big a part of reproductive rights as anything else. If a woman contracts HIV, she could simultaneously be suffering from domestic violence, she may well have a maternity problem and, most likely, her children will be in dire need of support, according to Sen.

“So gender needs to be integrated around the woman, who (probably) has neither the time nor the capacity to go to different places to receive treatment,” Sen said.

All the different sexual and reproductive health services need to be integrated as one package, which should give priority to family planning.

As far as youth are concerned, the ICPD agenda has failed to deliver.

Despite all the talk about young people, the work being done on the ground to protect and preserve their rights is “next to nothing”, Sen said.

According to a preliminary draft Istanbul Declaration issued by conference participants, the world’s parliamentarians are determined to play their role in mobilising the necessary resources for the ICPD agenda, as well as strengthening parliamentary oversight in ensuring its implementation.

In the draft Declaration, to be finalised and adopted Friday, parliamentarians committed to looking ahead to ensure that future priorities are included in the goals and targets being developed through the Post 2015 development agenda processes.

(END)

Have women around the world become more empowered in their reproductive health and rights over the past 18 years? This is one of the questions that some 300 parliamentarians from around the world will be examining when they meet in Istanbul, Turkey, this week for the Fifth International Parliamentarians’ Conference on the Implementation of the International Conference on Population and Development (ICPD) programme of action.

At the event, on May 24 and 25, MPs from six continents will discuss “the progress the world’s governments are making in their efforts to protect and empower women in their reproductive health and rights: a promise they made at the International Conference on Population and Development in 1994 in Cairo”, says the European Parliamentary Forum (EPF), which is co-organising the event.

“This will be the biggest gathering of parliamentarians on population and development issues probably since 1994,” EPF Secretary Neil Datta told IPS. “Everyone from Norway to Mozambique, from Panama to Papua New Guinea is included, and from all different political horizons: the Left, Centre and Right.”

These are politicians who “believe that the protection of women’s reproductive health and rights is a human right that is vital for development,” he added.

The EPF says that the parliamentarians’ conference has taken place regularly over the past 10 years, but the Istanbul meeting is taking place at a crucial time, with the approach of deadlines that were set for completing the ICPD Programme of Action (2014) and the Millennium Development Goals (2015).

“The international community must act now to ensure that women’s reproductive health and rights remain high on the development agenda in the new framework that replaces them,” the group says.

The conference comes amid some positive news, as the World Health Organisation and other United Nations agencies released a report last week showing that the number of women dying of pregnancy and childbirth related complications has almost halved in 20 years.

The study ‘Trends in maternal mortality: 1990 to 2010’, shows that from 1990 to 2010, the annual number of maternal deaths fell from more than 543,000 to 287,000 – a drop of 47 percent, according to the agencies.

But the UN adds that while “substantial progress has been achieved in almost all regions, many countries particularly in sub-Saharan Africa will fail to reach the Millennium Development Goal target of reducing maternal death by 75 percent from 1990 to 2015.”

During their previous conference, in Paris last year, the EPF and their counterparts emphasised that focusing on girls and women is also a way to manage population growth in a world of 7 billion people, a number predicted to grow to 9 billion by 2050.

“It’s good to have children but we need to have children that we can feed, educate and keep in good health,” Maria-Goretti Agaleoue Adoua, a Burkina Faso parliamentarian told IPS then. “We have to invest in ourselves and get partners interested in the subject to help us as well.”

The Istanbul conference, co-organised with the UN Population Fund (UNFPA), will provide a means for MPs “to find support and forge common strategies to ensure that population and development issues remain a priority for their governments,” the EPF says.

The Paris-based Organisation for Economic Cooperation and Development (OECD) released a report earlier this month stating that “social and legal discrimination against women remains a major obstacle to economic development in emerging and developing countries.”

The OECD’s Social Institutions and Gender Index, produced by the organisation’s Development Centre, said that in some countries, like Niger or Mali, more than half of girls between 15 and 19 are married, leading to early childbirth, for instance.

“Legal reforms, economic incentives and community mobilisation are critical to rectifying social discrimination and economic injustice” against women and girls, said Carlos Alvarez, deputy director of the Development Centre.

The report says that women’s “reproductive autonomy is limited”, with one in five women on average having no access to family planning. It adds that despite new laws, attitudes perpetuating violence against women persist, “with some 50 percent of the women themselves believing that domestic violence is justified in certain circumstances.”

Several countries, however, have made progress in reducing discrimination against women since the Index was first released in 2009, even within the “most unequal” regions, the OECD says.

“In Rwanda and South Africa, for example, the introduction of political quotas has led to a greater representation of women in politics. South Africa and Morocco are among the countries where the social and legal status of women improved considerably over the past years,” the organisation says.

The OECD will address some of the inequality issues itself in the coming days when it launches its Gender Initiative during OECD week, attended by UN Women’s executive director Michelle Bachelet and Jordan’s Queen Rania Al Abdullah, among others.

“Opportunities for women are not equal in education, in the labour market, in business, or politics. This is a waste for the individual, but is also an obstacle to realise the full potential of our economies,” said OECD Secretary-General Angel Gurría.

On the subject of women and health, Datta of the European Parliamentary Forum says that over the past decade, the international community has not focused enough on funding for reproductive health, especially family planning.

“As a result of this, funds for reproductive health and family planning are nowhere near sufficient for keeping up with the needs of an increasing number of couples of reproductive age in developing countries. It has been calculated that there are more than 215 million women who are not able to access the modern forms of contraception that they want,” the EPF says.

Another meeting, the Family Planning Summit, being organised by the UNFPA and the Bill & Melinda Gates Foundation on Jul. 11 (World Population Day) will seek to achieve some solutions. The aim of that event is to “find the will, the money and the way to provide proper access to family planning information, services and supplies for an additional 120 million women in the world’s poorest countries, by 2020.”

(END)

The statistics have remained staggering: every two minutes, a woman dies of pregnancy and child birth-related complications caused primarily by severe bleeding, infections, high blood pressure and unsafe abortions.

A pregnant woman in Kenya's North Eastern Province with one of her children. Overpopulation in the area contributes to poor maternal health. Credit: Isaiah Esipisu/IPS

And 90 percent of maternal deaths occur in the world’s 132 developing nations, according to U.N. estimates.

Still, there are hopeful signs in the horizon, says a new report jointly commissioned by the World Health Organisation (WHO), the U.N. Population Fund (UNFPA), the World Bank and the U.N. children’s agency UNICEF.

According to new figures released Wednesday, the number of women dying of childbirth-related complications has almost halved in the last 20 years.

The study, titled “Trends in Maternal Mortality: 1990 to 2010”, points out that the annual number of maternal deaths dropped, from more than 543,000 to 287,000 – a significant decline of 47 percent over the last 20 years.

While substantial progress has been achieved in almost all regions, many countries, particularly in sub-Saharan Africa, will fail to reach the Millennium Development Goal (MDG) target of reducing maternal death by 75 percent through 2015.

“I am very pleased to see that the number of women dying in pregnancy and childbirth continues to decline,” said UNFPA’s Executive Director Dr. Babatunde Osotimehin.

This shows that the enhanced effort of countries, supported by UNFPA and other development partners, is paying off, he added.

“But we can’t stop here. Our work must continue to make every pregnancy wanted and every childbirth safe,” Dr. Osotimehin said.

Still, disparity exists within and across countries and regions, according to the report.

One-third of all maternal deaths occur in just two countries – in 2010, almost 20 percent of deaths (56,000) were in India and 14 percent (40,000) were in Nigeria.

Of the 40 countries with the world’s highest rates of maternal death, 36 are in sub-Saharan Africa.

And according to the report, 10 countries have 60 percent of all global maternal deaths: India (56,000), Nigeria (40,000), Democratic Republic of Congo (15,000), Pakistan (12,000), Sudan (10,000), Indonesia (9,600), Ethiopia (9,000), Tanzania (8,500), Bangladesh (7,200) and Afghanistan (6,400).

At the same time, 10 countries have already reached the MDG target of a 75 percent reduction in maternal death: Belarus, Bhutan, Equatorial Guinea, Estonia, Iran, Lithuania, Maldives, Nepal, Romania and Viet Nam.

The report also highlights the fact that in 2010, the global maternal mortality ratio was 210 maternal deaths per 100,000 live births.

Sub-Saharan Africa had the highest maternal mortality ratio at 500 maternal deaths per 100,000 live births.

In sub-Saharan Africa, a woman faces a one in 39 lifetime risk of dying due to pregnancy or childbirth-related complications.

In Southeast Asia, the risk is one in 290, and in developed countries, it is one in 3,800.

“An important challenge that makes it difficult to assess progress accurately is the lack of reliable information about maternal deaths,” the report notes.

In many developing countries, deaths may go uncounted and frequently the cause is not recorded correctly, particularly when women die at home.

This has been accounted for in the current analyses of estimates, according to the report.

In a statement released here, Osotimehin says his agency knows exactly what to do to prevent maternal deaths: improve access to family planning, invest in health workers with midwifery skills and ensure access to emergency obstetric care when complications arise.

“These interventions have proven to save lives and accelerate progress towards meeting the Millennium Development Goal 5 on maternal health,” he said.

Over a quarter of a million women still die in pregnancy and childbirth each year, and more than 215 million women lack access to modern contraceptives, he added.

Meeting the need for voluntary family planning for these women would not only fulfill a human right, it would also reduce the number of maternal deaths by a third, he added, pointing out that “this is a highly cost-effective public health strategy.

“It is excellent that improved access to family planning is getting back on the development agenda after being overlooked for too many years. We at the U.N. Population Fund will do our best to garner support for this critical investment to ensure the rights and health of women and girls.

“These new estimates demonstrate how maternal health is progressing globally and how the quality of data is improving. This also shows how the U.N. works together to improve the situation for women and girls around the world,” he said.

(END)

For over 90 years, a law in Argentina has allowed women who become pregnant as a result of rape to have an abortion. However, hospitals often refuse to carry out the procedure, instead referring the women to the justice system.

Argentine law penalises doctors who carry out abortions and the women who have them, with certain exceptions.

The 1921 criminal code states that abortion is not punishable when a doctor performs it because the life or health of the mother is in danger, or “if the pregnancy is the result of rape or sexual assault of a feeble-minded or demented woman.”

Nevertheless, cases periodically crop up where sexually abused or raped girls, teenagers and women are referred to the justice authorities for a decision about a procedure that in fact does not require authorisation.

“Abortion is a medical procedure. Doctors, not judges, should decide whether it needs to be done,” Natalia Gherardi, a lawyer and head of the Latin American Group for Gender and Justice (ELA), told IPS.

In spite of the legal ban, between 460,000 and 600,000 abortions a year are performed in this country, according to NGOs, and an estimated 100 women die every year from clandestine abortions performed in unsanitary conditions.

Aware of the difficulties in obtaining approval of a law legalising abortion, women’s organisations have long campaigned for at least an effective right to abortion in cases in which it is already legal.

Gherardi said “there is great uncertainty among doctors on how to interpret the article” in the law that establishes which cases of abortion are not punishable. And their confusion is understandable, given what happens when cases are referred to the justice system.

Some judges authorise the abortion; others rule that authorisation is unnecessary; and some judges rule, against the law, to prevent the procedure.

To avoid the referral of these cases to the justice authorities, in 2007 the Health Ministry issued a Technical Guide for the Comprehensive Care of Non-Punishable Abortions.

The guide book acknowledges that “for many decades” women have been prevented from exercising their right, enshrined in the criminal code, “to have access to an abortion in authorised circumstances.”

“The state is obliged to guarantee the exercise of that right,” says the guide, which adds that hospitals “have the legal obligation to carry out the procedure, and are not required to call for judicial intervention and/or authorisation” before acting, even in cases of under-age girls.

Nevertheless, there are regular instances of girls attending a hospital with their parents and being denied an abortion. The most recent case to have come to light occurred in January, in the province of Entre Ríos, where an 11-year-old girl who had been sexually abused became pregnant.

Doctors at the public hospital insisted on judicial authorisation, and a judge refused permission for the procedure. Furthermore, the provincial health minister, Hugo Cettour, publicly said that if the girl was capable of conceiving, she was capable of being a mother.

In the face of this pressure, and even more pressure from both the Catholic and evangelical churches, families give up the right to legal abortions. “This almost always happens to women who are poor or marginalised,” Gabriela Filoni, a lawyer, told IPS.

Filoni is in charge of the regional litigation programme of the Latin American and Caribbean Committee for the Defence of Women’s Rights (CLADEM), which in conjunction with other organisations succeeded in taking one of these cases to the international arena.

As a result of their intervention, in 2011 the United Nations Human Rights Committee ordered the Argentine state to provide “reparations, including an indemnity” to a mentally disabled young woman who was denied an abortion.

“The time period allowed for the state to respond has expired. We know the government asked for an extension, but what we want is a public policy or a legal measure that would prevent a repeat of these cases,” said Filoni.

The 2006 case involved a 20-year-old woman identified in the records as LMR, in Guernica in the province of Buenos Aires, who has a mental age of between eight and 10 as certified by her physicians. The young woman was raped by her uncle, and became pregnant. But when her mother took her to the hospital for an abortion, the doctors refused and sent her to another facility.

At the second hospital, the bioethics committee met and referred the case to the justice system. A court denied permission for the abortion, and the ruling was upheld on appeal.

The provincial Supreme Court finally recognised the young woman’s right to a legal abortion. Furthermore, the court stated that judicial authorisation should not have been required in the first place.

But even then, the hospital refused to carry out the procedure, claiming this time that the pregnancy was too advanced. In the end, the family had to arrange an illegal abortion to terminate a 20-week pregnancy.

By this time, LMR’s mother and sister had both lost their jobs because they stayed by her side throughout the whole process, and they had been harassed by Catholic groups applying pressure to prevent the abortion.

“Authorisation was not necessary in this case, yet the health providers washed their hands of the matter, and the problem here is that referring the case to the justice system takes time, and the pregnancy continues to advance,” said Filoni.

In a survey carried out by Ibarómetro, a polling firm, seven out of 10 respondents asked about the case of the 11-year-old girl in Entre Ríos said she should have been given a legal abortion.

When asked about the legalisation of abortion, 60 percent of respondents said it should be a woman’s right, and access should be guaranteed by the state. (END)

By Isaiah Esipisu
GARISSA, Kenya, Dec 19 2011 (IPS)

The Garissa Maternal Shelter in North Eastern Province, Kenya is the only such facility in an area with the country’s highest maternal mortality rate. At 1,000 deaths per 100,000 live births, it is almost double the country’s average.

A pregnant woman in Kenya's North Eastern Province with one of her children. Overpopulation in the area contributes to poor maternal health. Credit: Isaiah Esipisu/IPS

“The low attendance is largely due to poor awareness of the facility’s presence, ignorance, and lack of transport to the facility,” said Dr. Amal Alshabibi, the Deputy Medical Superintendent at the Garissa Provincial General Hospital, which hosts the maternal shelter.

The shelter is the only one in the province as the government is still assessing its sustainability.

According to the 2009 Kenya Demographic Health Survey, maternal mortality countrywide stands at 448 deaths per 100,000 live births. But the rate in North Eastern Province is double this.

“This rate is highly unacceptable. And the main reason is because women have little or no access to healthcare facilities due to the long distances (needed to travel), some cannot afford to pay for healthcare services and, sometimes, just because of ignorance,” said Alshabibi.

The region is also semi-arid and in some parts, arid. Many of the communities here survive only because of the food aid they receive. And many here, like Habiba Issak who has had four miscarriages, still rely on traditional birth attendants. For her four previous pregnancies, 37-year-old Issak miscarried in the care of traditional birth attendants in Mandera, some 500 kilometres from Garissa.

But when she was three months along with her fifth pregnancy, she was determined that her baby would live.

So Issak walked 50 kilometres from her village to a clinic in Mandera Township. Health experts there immediately referred her to the Garissa maternal shelter after learning her case history.

“Here we admit women who have a history of complications during pregnancy and delivery, or whose pregnancies have been described by health experts as potentially high risk, yet they cannot access a health facility near their homes,” said Alshabibi.

The shelter also admits women who have had teenage pregnancies, miscarriages, two previous Caesarean sections, a low-lying placenta, mild preeclampsia or high blood pressure, among many others.

Though this maternal shelter is unique. Unlike others in the country, it allows mothers to stay here with their children.

“These are not hospital wards. It is a home for expectant mothers who are likely to develop complications during pregnancies, or at the time of delivery,” explained Alshabibi.

“Being the only maternal shelter in the region, it serves women from hundreds of kilometres away. Yet it can only be fair if they come along with their young children because some of them have to be monitored at the facility for several months before their due date,” said Dr. Stephen Wanyee, the assistant country representative at the United Nations Populations Fund (UNFPA).

Though this facility was founded in 2007 and is supported by the Kenyan government, the U.N. agency has adopted it.

“We are taking it on as a pilot project because we have never tried it in such a community with numerous challenges. If it succeeds, then we might consider duplicating it within the region as a strategy to reduce the alarming maternal mortality rate here,” said Wanyee. Hawa Ali is one of the women living at the shelter with her children. Sitting with her four youngest children, the mother of 11 patiently waits for her turn to be examined. She is here because she is expecting triplets.

“Since this facility was established, we have never lost a client or an infant,” Hamadi Muhumed, the deputy nursing officer at Garissa Hospital, said reassuringly.

“Through close monitoring by fellow health experts, all women who have passed through here have always gone back home smiling with their babies,” he said. He remembers a woman who was admitted to the shelter a year ago after she had 12 miscarriages because of cervical complications.

“But when she came to the facility, she was monitored until she gave birth to a baby boy, whom she named after Gullet Yusuf, the medical doctor who supervised her before and during delivery,” Muhumed said.

Sadia Abdirahaman has had three miscarriages but described it as a “dream come true” when she delivered a healthy baby girl here.

“Though this region is sparsely populated, there is definitely a need for maternal shelters in other areas like Awjir and Mandera so that people do not have to travel several kilometres in order to access this particular one,” said Muhumed.

Excerpt:

Iro-nsi Bose Credit: Miriam Gathigah/IPS

By Miriam Gathigah and - -
BUSAN, South Korea, Dec 1 2011 (IPS)

Gender champions have lauded the Fourth High Level Forum on Aid Effectiveness for providing gender equality and the empowerment of women a special session, but there is dissatisfaction with Thursday’s Busan outcome document.

Iro-nsi Bose Credit: Miriam Gathigah/IPS

“There has been progress since the Paris Declaration, which had no mention of gender equality. In the Accra declaration, gender equality achieved some recognition in relation to development. Today, we have moved slightly beyond Accra,” said Kate Lappin, regional coordinator of the Asia Pacific Forum on Women, Law and Development. But, she is emphatic that economic development is not a comprehensive indicator of human development.

Lappin said “women’s human rights were not integrated throughout the Busan outcome document.” Perhaps this explains why although the Busan conference coincided with two important global events on human rights, particularly in relation to gender, women’s rights did not form part of the Busan agenda.

Women account for more than half of the HIV/AIDS disease burden globally as also the burden of care, but the Busan Forum had nothing to say about how aid effectiveness can also mean life saving drugs reaching poor women.

United Nations statistics show that across the world, one in every three women has suffered some form of abuse, be it physical, emotional or sexual.

Campaigns for a world where women can be free and enjoy their rights without fear and intimidation are funds driven. It costs money to integrate Gender-Based Violence (GBV) awareness and sensitisation programmes in the health sector.

“Currently, Nigeria is still coming to terms with the brutal murder of Titi Omozojie, a young woman who is alleged to have been mutilated by her husband in a domestic quarrel,” said Iro-nsi Bose, executive director of Women’s Rights and Health Projects in Lagos, Nigeria.

“Civil society took to the streets and ensured that she was not hurriedly buried to impede proper investigation. This led to her husband being charged and is awaiting trial for murder,” Bose explained.

Prioritising the wellbeing of women is an important component of development, Bose said. “We cannot talk about real development when our women, young and old alike are butchered to death.”

Although a Joint Busan Action Plan on Gender Equality and Development is one of the outcomes of the conference, it is considered to be limited.

“The three E’s (education, employment, entrepreneurship) approach of the U.S. government was a very limited vision and disappointing – not a step forward,” said Lappin.

“It is nonetheless limited in the sense that it only looks into two outcomes: increasing the number of women in the labour force as well as improving their chances to access microfinance.

“There is no mention of, for instance, women’s labour rights. If we are to get more women into the workforce, then there are some practical needs to be put in place,” Lappin said.

Indeed, women are often at a crossroads between human production and economic production and when these two roles conflict, then they have to give up the economic venture to be able to look after the human resource.

It was expected that Busan will show a real commitment to women’s human rights as part of development effectiveness.

Bose said that “Omozojie’s untimely death is just the tip of the iceberg.

“There is still a great degree and extent of GBV across Africa. Yet, Busan offered no real commitment to champion women’s human rights as a development agenda. Instead, there was a strong focus to ensure that effective aid transforms poor countries into middle income nations.”

Excerpt:

Better Aid Can Save Millions of Lives in Africa. Credit: Miriam Gathigah/IPS

By Miriam Gathigah and - -
BUSAN, South Korea, Nov 29 2011 (IPS)

Although there has been considerable progress towards reducing maternal and infant mortality, millions of women and children in Africa are still in need of better health services, food and sanitation.

Better Aid Can Save Millions of Lives in Africa. Credit: Miriam Gathigah/IPS

Statistics by Save the Children, an international non-government organisation, reveal that African countries claim nine out of ten bottom places in a worldwide maternal health ranking that involves 164 countries.

Ben Philips of Save the Children says, “These reductions are not at the rate envisaged when the Millennium Development Goals (MDGs) were launched in 2000. Eleven years later, many countries are still a long way behind the set targets.”

As a consequence of the outcry provoked by high maternal and infant deaths, the 2000 United Nations summit bound every member state to achieve the MDGs – eight development targets.

Towards this end, MDGs 4 and 5 are geared towards reducing infant mortality and improving maternal health, respectively. Consequently, these countries were mandated to reduce by two-thirds the mortality rate among children under five and reduce by three-quarters the maternal mortality ratio.

This has not happened. In fact, Philips says, “African governments need to prioritise women’s and children’s health. They also need to speed up by four times the rate at which these deaths are declining in order to achieve MDGs 4 and 5 by 2015.”

As the Fourth High Level Forum on Aid Effectiveness (HLF 4) takes shape in Busan, one question is if women and children in Africa can expect any tangible results from the conference in this South Korean port city.

According to Philips, there is little for them. “Unfortunately, the Busan Outcome document, which basically summarises the Forum’s platform for action beyond the conference, isn’t ambitious enough to improve aid effectiveness. For instance, there is no strong commitment to untie aid.”

Experts on aid in Busan say that if donors had shown a strong commitment to untie aid as an outcome of the ongoing conference, this would have increased aid by 15 to 30 percent, consequently increasing the value of aid.

And this is not the only way in which donors are letting African women and children down. Although the G-8 countries, comprising the world’s richest nations, committed to ensuring that 0.7 percent of their budget goes to aid. None of them has actualised this commitment.

Britain has, however, promised to meet this commitment by 2013.

“There’s a clear aid deficit that makes it difficult for poor countries to channel money into sector budgets towards improving health services by employing qualified nurses and even having more health facilities in areas where the poor can easily access them,” said Dan Badoo, a policy researcher.

But donors are not the only ones letting women down. Eleven years since the Abuja declaration, where African heads of states committed themselves to allocate at least 15 percent of their national budgets to lighten the disease burden that women carry, there is little to show on the ground.

According to Save the Children, only six out of 53 African Union member states have so far met this commitment. They are: Rwanda, Botswana, Niger, Malawi, Zambia and Burkina Faso.

Despite the devastating impact that genocide had on the Rwandans, the country has become a model example of prioritising the health of women and children.

Consequently, according to UNFPA, the maternal mortality rate in Rwanda dropped from 750 per 100,000 live births in 2005 to 540 in 2008. Government statistics now show 383 deaths per 100,000 live births.

Philips says, “Malawi is one of the pioneer countries devoting 15 percent of its budget to health, saving an estimated 13,000 lives.”

Kenya is one of the countries lagging behind in this commitment with a paltry budget allocation of about five percent and the results are as expected. In the recent MDG progress report of 2010, Kenya is one of the countries which has made the least progress in achieving MDG 5.

Say Badoo: “Against this background, the connection between aid and saving lives is clear. Aid effectiveness is about delivering social services that enable people to live decent lives and exploit their potential.”

Mothers dying while giving birth in a shanty in Old Fadama or the Jamestown slums in Accra, Ghana or Kibera slums in Kenya or Kyalisha in South Africa is a reflection that African heads of state are not taking the health of women and children seriously.

“When we say that this is the HLF 4, it all sounds so technical and elitist, but what the ordinary, poor persons really need is to experience how healthy aid can improve their lives, can give them better quality livelihoods and save dying mothers and infants,” Philips said.

Excerpt:

By Travis Lupick
BLANTYRE, Nov 4 2011 (IPS)

In Mbedza village, a remote rural community in southern Malawi, Fedson Feston beams an infant’s awkward smile and swings his tiny arms up towards the face of his mother. Four months old, Fedson is too young to know how lucky he is to be alive.

Manes Feston, flanked by her children, holds her four-month-old son Fedson. He was one of triplets but his siblings did not survive. Credit: Travis Lupick/IPS

One, a boy named Ezera, died in a hospital the next day. Shortly after, Fedson and his sister, Mandaliza, were discharged.

Premature and still weak, the newborns needed special care, Manes recalled the doctors telling her. “The children were always to be strapped to the belly and be in a warm place all the time,” she said.

But it was winter, and that proved difficult.

They are a desperately poor family, and Manes’s husband was always away looking for work. Moreover, the couple had five other young children to look after.

It was not long before Mandaliza passed away.

“The house that we live in is makeshift and does not provide enough warmth for premature children,” Manes said. “I think that contributed to our losing the other child.”

After Manes survived their difficult birth, the smallest semblance of a welfare state might have saved the second child.

A few hundred Malawi kwacha (roughly two dollars) could have bought the family extra blankets and kerosene, or even a meagre amount of unemployment insurance could have provided the family some financial security. (Manes’s husband was a seasonal worker and unemployed when the triplets were born.)

But in this small country in the Southern Africa region, such social safety nets largely do not exist.

“To me, this is the reason why women like me are suffering and reaching the extent where we (lose) children who should have otherwise lived,” Manes complained.

This family’s situation is not an isolated case. In Malawi, 74 percent of the population lives on less than 1.25 dollars a day, and nearly one in 10 children die before their fifth birthday.

Reflecting the fact that significant segments of the population are fundamentally excluded from society due to poverty and inequality, the 2010 Ibrahim Index of African Governance recently handed Malawi an abysmal score of two out of 10.

There is legislation aimed at protecting families from falling on hard times, such as the Employment Act and the recently amended Pension Bill.

However, according to a 2010 report by the International Labour Office in Geneva, 90 percent of Malawians – more than 13 million people – work outside the formal economy.

Minister of Labour Lucius Kanyumba argued that the government has attempted to bring such people under the protection of the law. Section 43 of the Employment Act refers to benefits for seasonal workers, he noted. And a 2010 amendment to the act reduced the qualifying period for the payment of long service benefits from 12 months to three.

“This is the drive that the government is making in an effort to address the imbalances for all workers in Malawi,” he said, “whether in formal or informal industries.”

But the evidence on the ground suggests that such efforts are failing to reach the most vulnerable people they are intended to help.

Jonathan Mbenje, 73, is a night guard. “For me, to be working at this old age is not out of choice,” he said. “Being a guard, especially at this age, is very dangerous.”

Mbenje claimed that when his employer and many others do pay out severance packages the amounts often fall far short of what the law requires.

“Most of the time, they give someone between (120 to 240 dollars),” he said, emphasising that that is a one-time severance payment. “With that kind of money, you cannot survive; hence I am still working at age 73.”

Enock Andaradi, 79, told a similar story. Found scavenging through a garbage dump in Blantyre, Andaradi explained that while he was also once a security guard, he is now forced to live off other people’s waste.

He said that he had never heard of any sort of social service that provides assistance to the elderly.

Chandiwira Chisi, Malawi campaign coordinator for Action Aid, a United Kingdom-based non- governmental organisation that focuses on poverty reduction, argued that such situations are the realities of a developing economy. “They (informal workers) are left out of the social support system,” he said.

Chisi argued that current labour laws in Malawi give little power to the average worker, and provide too many opportunities for employers to take advantage of staff.

Addressing concerns that people are falling through social safety nets, Kanyumba called attention to the Decent Work Country Programme, launched in August 2011.

He described the scheme as one that promotes meaningful work for those employed in the informal sector. It promotes business skills and awareness of labour rights, while providing start-up capital for small businesses, he explained.

Another initiative is the Malawi Social Support Policy.

“The ultra-poor and vulnerable have been inevitably excluded from benefiting and taking full advantage of the economic development process,” the document states. And so at the initiative’s core, said Minister of Gender, Child, and Community Development Reen Kachere, is a social cash transfer programme.

Eligible households are given an average of 12 dollars a month, plus additional allowances (roughly 1.20 to 2.40 dollars) for each child enrolled in school.

Piloted in a single district in 2006, there are now seven regions benefiting from the programme, delivering financial assistance to more than 30,400 households. Plans are in the works to expand into a further six districts next year, Kachere said. “And then after one more year, we want to apply it to even more of the country.”

The Social Support Policy is the exact sort of programme that might have saved Fedson’s brother and sister. Back in Mbedza village, Manes spoke of the pain she still bears.

“I fail to accept that I lost my children, who could have survived if somebody had done something,” she said. “When I was at the hospital, I met other women with similar problems. If only government could come in to assist vulnerable people who cannot assist themselves.”

Manes maintains that if she had had access to better social services, her two children would still be alive.

Excerpt:

By Thalif Deen
UNITED NATIONS, Oct 26 2011 (IPS)

When Adnan Nevic was born in Bosnia-Herzegovina back in October 1999, he was hailed as the world’s six billionth person, triggering a visit to Sarajevo by then Secretary- General Kofi Annan.

A young girl carrying a baby in a village in DRC. MONUC, Lake Albert Patrolling Mission. Credit: UN Photo/Martine Perret

Judging by growing population trends, the seven billionth boy or girl may well be born somewhere in Africa or possibly in Asia.

But the United Nations is not willing to stick its neck out to predict the continent in which he or she would be born – or even to identify the individual child as was done with Nevic.

Asked to be more specific about the world’s seven billionth person, U.N. spokesman Martin Nesirky told reporters Wednesday the event is much more about seven billion people as a whole, and how the world can sustain a population of that size and allow them to live in dignity.

While the rise in population is measured primarily in terms of its impact on food security, resources, reproductive health, international migration, growing unemployment and environmental sustainability, the Executive Director of the U.N. Population Fund (UNFPA) Dr. Babatunde Osotimehin looks at the growing numbers from a more positive angle.

“We are seven billion people with seven billion possibilities,” he said Wednesday during the launch of the UNFPA’s annual “State of World Population” report for 2011.

So, instead of asking questions like, “Are we too many?, we should be asking: “What can I do to make our world better?”

“What can we do to transform our growing cities into forces for sustainability?” he asked.

The UNFPA report points out that the seven billion milestone is marked by achievements, setbacks and paradoxes.

While women are on average having fewer children than they were in the 1960s, the numbers continue to rise.

And globally, says the report, pointing to another paradox, people are younger – and older – than ever before.

“In some of the poorest countries, high fertility rates hamper development and perpetuate poverty, while in some of the richest countries, low fertility rates and too few people entering the job market are raising concerns,” it says.

Secretary-General Ban Ki-moon picked up the same theme when he said last week that the seven billionth citizen will be born into a world of contradictions.

“We have plenty of food, yet millions are still starving. We see luxurious lifestyles, yet millions are impoverished. We have great opportunities for progress but also great obstacles,” Ban said.

“These are all the challenges that we can and must overcome,” he said. “If we invest in people, we will reap the best dividends.”

But is the international community making the right investments, including in education and reproductive health?

Tragically, no, says Barbara Crossette, the lead reporter of the UNFPA study, and a former U.N. bureau chief for the New York Times.

“If you take the UNFPA report together with the U.N. Population Division’s 2010 upward revisions published in the spring, the question isn’t so much whether the world with its seven billion is heading to an unsustainable population level – as if this happens all by itself – but why it is that more than 17 years after the 1994 International Conference on Population and Development (in Egypt), the promises of Cairo have not benefited women in some of the poorest places, where most of this century’s people will be born?” she told IPS.

These women – who know well how high fertility affects them personally, makes it hard to educate and feed their children, strains food and water supplies and denies to national development the skills and productivity of women – simply do not have the choices women in richer nations enjoy, she said.

“More than 215 million women are estimated to want family planning, so that they can have more control of their reproductive lives and general health – hundreds of thousands die of pregnancy related causes that are largely preventable – but they have no access to contraception for numerous reasons,” said Crossette who did all of the reporting for the UNFPA study, travelling to China, India, Egypt, Ethiopia, Nigeria, Mexico, Macedonia (FYROM) and Finland.

If current fertility rates continue at expected levels, the world’s population is projected to surge past nine billion before 2050 and then reach 10.1 billion by the end of the century, according to U.N. figures.

“During my lifetime,” said Dr. Osotimehin, a former minister of health in Nigeria, “I have seen world population nearly triple. And 13 years from now, I will see another billion added to our numbers. In my grandchildren’s lifetimes, there could be as many 10 billion people in our world.”

To create a sustainable and peaceful world, he said, “We must invest wisely.”

“By investing in health and education and moving to a green economy, we can improve the well-being of people and our planet. As lives improve, population growth tends to stabilise,” he added.

Asked if the United Nations is on the right track, Crossette told IPS, “Institutionally, the U.N. and its relevant agencies have been good in their analyses and recommendations.”

But member nations and governments have not always turned these ideas into action, she added.

“It seems to me that the interaction of population and development in its broadest sense and its many facets is what needs to be considered urgently, with special focus on women and their place in every aspect of society,” said Crossette, who had done two global reporting trips for UNFPA over the last two years.

In traveling around the world this year, she said, “I met women who still want larger families, or are persuaded to have more children by partners, culture or family pressures, and that should be their choice.

“But I also met many more who say that two, three or sometimes four children would be ideal – when they may already have five or six or more, and mourn that their daughters’ lives will be no different from their daily hardship.”

Give a generation of women everywhere the attention they were promised at the Cairo conference, and the tools they need to exercise their choices and rights, and they would bring fertility down for reasons of their own, not because of national targets or population policies, which the world abandoned once and for all decades ago, she stressed.

Crossette said even China is actively rethinking its one-child policy, seeing that when women have comprehensive reproductive health care with strong family planning programmes, educational opportunities and time to engage in economic activity beneficial to their families and communities as a whole, fertility rates come down as fast and without the coercion of population control.

And Taiwan, just across the straits, achieved a lower fertility rate than China without coercion – and sooner – as did numerous other Asian nations with successful, friendly family planning programmes.

Crossette said economic growth follows as well as precedes these changes. Listening to women, and helping them, should be a high priority in years to come, starting now. They are the key to stabilising global population growth in their own self-interest, she added.

Excerpt:

By Zofeen Ebrahim
KARACHI, Oct 26 2011 (IPS)

Pakistan’s population explosion is posing a greater danger than militancy and religious intolerance, says noted medical doctor and demographer Farid Midhet.

“It is the burgeoning population that poses a serious threat to Pakistan’s existence,” Midhet told IPS. “Imagine a Pakistan with a population of 300 million by 2030!”

A week before the world prepares to welcome its seven billionth child, on Oct. 31, a jobless Raja Khan, father of two, succumbed to burn injuries sustained when he set himself ablaze in front of parliament house in Islamabad.

Khan who had travelled all the way to the national capital from a village near Naushero Feroz, Sindh province, to carry out an act of extreme desperation left behind a letter saying: “I’m fed up with my financial condition.”

Khan’s gruesome death appeared to bear out warnings by the United Nations Population Fund (UNFPA), that the seven billion people milestone will be marked not only by achievements but also “setbacks and paradoxes.”

UNFPA country representative in Pakistan, Rabbi Royan, said the Fund’s report, ‘State of World Population 2011’, provides “policy ideas” as well as a “brush stroke of broad population issues”.

“Every country has its own set of peculiar population issues. The report provides ideas to these countries how to address issues related to population,” Royan said.

“There is a strong link between poverty, inequality and population, and the UNFPA believes sound planning is needed to overcome these glitches,” Royan told IPS

Where Pakistan is concerned, Royan recommends “investing in the young population and managing their expectations.” Two-thirds of Pakistan’s population is under 30 years old.

Noting that providing education and employment is the “foremost challenge faced by Pakistan,” Royan warns that if young people do not find their expectations met, “their energies may be directed towards undesirable activities, like radicalisation.”

Midhet explains that when birth rates suddenly decline, the number of young children (a liability) decreases and the number of elderly people (also a liability) is yet not too high, resulting in a bulge in the working population.

This, he said, is what contributed to the unprecedented industrial growth in countries like South Korea, Malaysia and Thailand.

“There is only one condition – the population has to be highly educated,” Midhet told IPS, adding: “Unfortunately, Pakistan does not meet this condition.”

In the last 64 years, he lamented, if those at the helm had given attention to population control and education, it would have resulted in a very different Pakistan today. “Imagine an active media and an effective, powerful judiciary in a country having 100 percent literacy!”

Economist Kaiser Bengali is also concerned about the huge “youth population bulge that will enter the labour force at an accelerated rate”. “It means the rate of labour force growth will be higher than the population growth rate,” he explained to IPS.

“Efforts must be made to adopt economic policies that create jobs at an accelerated rate and prevent an Algeria-like situation developing,” Bengali said.

“In Algeria, a significant part of the 15-40 aged male population was killed in the seven-year war of independence. Subsequently, the under-15s began to enter the labour market in hordes, creating mass unemployment – and radicalisation,” he explained. “Overpopulation in Pakistan has already led to unemployment of gigantic proportions – unemployed youth are sucked into militancy and religious extremism as well as into crime,” said Midhet.

With its current population estimated officially at 175 million (the United Nations believes it to be 185 million), Pakistan is well on the way to becoming the world’s fourth most populous country after China, India and the United States.

In 1950, Pakistan had a population of 37 million and was the world’s 13th most populous country. By 2007, it had moved to the sixth position with 164 million people.

Pakistan has the highest population growth, birth and fertility rates among the South Asian countries, including Bangladesh, Bhutan, India, the Maldives, Nepal and Sri Lanka.

“All hopes of development and economic prosperity would flounder if we as a nation lose the focus and do not keep (the) population issue in the spotlight,” Prime Minister Yusuf Raza Gilani declared on World Population Day on Jul. 11, designating 2011 to be “Population Year” in Pakistan.

This troubling population narrative can be corrected by lowering the fertility rate, says Zeba Sathar, country director of Population Council, the New York-based non-profit.

“The most glaring disconnect even today is that most educated Pakistanis, economists, planners and politicians remain unaware of how important the achievement of fertility transition is for Pakistan’s development,” Sathar told IPS.

Sathar emphasised the importance of family planning services “for achieving improvements in the health of women and children who are at the cornerstone of population policy.”

According to Sathar, Pakistan has one of the highest “unmet” needs for family planning services. “Seven million women have declared that they do not want more children or want to space births, but are unable to do so,” she said.

“Over four million more Pakistanis are added to the population annually, 2.7 pregnancies are unintended and one million pregnancies end in abortions. We could easily reduce our annual births by at least 1.5 million,” Sathar said.

Excerpt:

By Paul Carlucci and Henrietta Abayie
ACCRA, Oct 26 2011 (IPS)

Mary Mingle thought she had a boil on her breast, so she bought some medication and tried to treat it at home. Two months later, bothered by persistent pain, she went to the doctor.

Mary Mingle has kept her double mastectomy secret for 20 years, due to fear of stigma. Credit: Paul Carlucci/IPS

There were eleven lumps in her breasts. She had first stage cancer, and her breasts, along with her uterus, would have to be removed.

“The doctor encouraged me,” she says. “The earlier I got them removed, the better. Otherwise, I would lose my life.”

Now, years after her surgery, only five people in her personal life know about her double mastectomy: her three children, her sister, and her husband. She’s been carrying her secret for about 20 years, hiding it from her extended family with a padded bra because she is afraid she will be stigmatised. She also hides it from her church, for the same reason.

“I don’t want them to be aware,” she says, her voice a tiny whisper.

Health officials in Ghana say breast cancer is a growing problem compounded by untrained medical practitioners, a lack of equipment, and unhealthy, sometimes fatal, cultural beliefs.

Historically, breast cancer has received scant attention in this West African country. International donors and institutions have been focused on communicable diseases like malaria and HIV/AIDS. Despite the fact that, according to Ghana Health Services (GHS), non-communicable diseases are the leading causes of death.

“It’s only now that attention is being drawn to it,” says Dr. Kofi Nyarko, head of the GHS cancer control programme.

There aren’t any solid statistics yet. In the capital of Accra, the Korle Bu Teaching Hospital, one of two full service cancer facilities in the country, is building an in-hospital registry of cases. In Kumasi, the country’s second biggest city in Ashanti Region, Komfo Anokye Teaching Hospital is also working on a database.

According to Dr. Verne Vanderpuye, a clinical oncologist at Korle Bu, the hospital gets about 3,000 breast cancer referrals a year.

“The main problem is that people don’t come early,” she says. “In an untreated case, when it’s moved beyond the breast, the average lifespan is one-and-a-half to two years. It will move from the breast, to the lymphs, to the lungs, to the liver, to the bones, and to the brain.”

Nyarko says the hospitals have gathered enough information for officials to know that breast cancer is becoming more prevalent, and its victims are younger and younger.

“It’s no longer a disease for the old,” he adds.

About three years ago, a focus on non-communicable disease began to take shape. In 2008, in collaboration with the World Health Organization (WHO), the Ministry of Health set up a national Cancer Steering Committee. The following year, Nyarko became the government’s cancer chief.

Working with WHO, GHS has identified cost effective treatment and detection strategies. Radiology equipment is scarce in Ghana – there are 10 mammogram machines in the whole country, six of which are in private institutions – so there will be a focus on clinical examinations, with mammograms for follow ups. It is a strategy that will require training.

“You need human resources,” Nyarko says. “You need infrastructure. You need certain equipment in place. You need all these things and money for training. The fact that you are a doctor or you are a nurse does not mean you can examine someone and say, ‘You are free (of cancer).’ You need to be trained.”

Nyarko expects a comprehensive national strategy will be launched by the end of the year. In addition to increased clinical examinations, the government would also like to build a full service hospital in Tamale, the biggest city in Ghana’s relatively undeveloped Northern Region.

There is also a big emphasis on prevention and awareness, with a series of posters and leaflets produced in partnership with the Geneva-based Union for International Cancer Control. Aside from promoting exercise and fresh food diets, the campaign is also meant to chip away at Ghana’s cultural oppression of breast cancer victims.

“People think that cancer is a call to death, but we are telling them that cancer can be cured,” Nyarko says. “We are aware that awareness is very low, even amongst the social elite. So we are working on that.”

It is not uncommon for victims to be shunned by their husbands or families. And in a country where women do a good deal of work, both around the house and in markets, husbands are reluctant to lose their wives to months of treatment.

Furthermore, chemotherapy is not covered by health insurance and can cost almost 2,000 dollars in just two weeks.

According to the World Bank, Ghana’s 24 million people live on an average of 1,283 dollars a year. The Jubilee oil find in the country’s Western Region is expected to help push GDP growth to 13.4 per cent in 2011, but there is no guarantee that will influence the average annual income.

“There’s also the fact that you could lose your breast,” says Vanderpuye. “We have a polygamous society, whether we like it or not. They might say you are not a whole woman.”

Like many African countries, Ghana is hugely religious. Many pastors tell their flocks that cancer is a spiritual illness, and that the answer is prayer, not surgery. As a result, some women do not go to the hospital until the tumours have spread. And then they die.

“They say the surgery kills, but they wait so long that the cancer spreads, so it appears surgery kills,” says Gladys Boateng, a breast cancer survivor and the founder of Reach for Recovery.

Civil society groups like Reach for Recovery also play a role in spreading awareness. Formed after Boateng survived her own bout with breast cancer, the group has reached 3,000 sufferers in the past eight years. Survivors give back to the group, visiting women in hospitals and helping with screening missions in remote or rural areas.

But even advocates keep secrets. Boateng will not discuss her husband’s reaction to her ordeal. She just offers a tight smile and declines comment. Nyarko, who has been watching international dollars lean heavily toward infectious diseases, is predicting a continued sea change in donor awareness. He is ready – all he needs are resources.

“It’s just now that there’s an emphasis on non-communicable diseases,” he stresses. “You know the right thing to do. You know the right thing to say. But you do not have the resources.”

Excerpt:

By Zofeen Ebrahim
KARACHI, Oct 12 2011 (IPS)

A newborn baby dies every four minutes in Pakistan. It was not always so. With a sound population policy set out in the 1950s, Pakistan was second only to Sri Lanka in infant and neonatal survival rates during the 1960s and 1970s (compared to Bangladesh, India, Iran and Nepal).

But the country has seen considerable sliding down of its health indicators for mothers, infants and newborns.

According to a study spanning 20 years, conducted by the World Health Organisation, Save the Children and the London School of Hygiene and Tropical Medicine, and published in the medical journal PLoS Medicine on Aug. 30, Pakistan is one of five countries in the world that account for more than half of all neonatal deaths – the others are India, Nigeria, China and the Democratic Republic of the Congo.

Pakistan has a neonatal mortality rate of 42 per 1,000 live births, compared to a global average of 23.9 deaths per 1,000 live births.

The report said that with an increased global focus on maternal and child health, too often the newborns are overlooked.

But China, which in the 1950s had higher neonatal and infant mortality rates than Pakistan, has shown considerable progress. A new study has confirmed that China was able to bring down the deaths of newborns by two-thirds, from 24.7 per 1,000 to 9.3 per 1,000, between 1996 and 2008, a 62 percent decrease.

What did China do right to reduce its death rate And where did Pakistan fail?

A study carried out over a 12-year period by Peking University and the London School of Hygiene and Tropical Medicine found that this unprecedented success was achieved by stepping up intervention in two areas – increasing access to obstetric care in rural areas, and encouraging mothers to deliver in hospitals.

The study concluded that of the two interventions, hospital births proved much more successful. Where a mother gave birth made a difference, it said. But experts caution that hospital delivery will only save babies if “high-quality neonatal care is available and accessible” in the first few days after delivery.

In Pakistan, two in three women deliver their babies at home, usually at the hands of unskilled traditional birth attendants (TBAs). These home births, in addition to being a leading cause of maternal complications, also carry a high risk of the newborn dying.

Many birth attendants still use potentially unsafe methods of delivering babies. “In many parts of rural Sindh, the baby is provided harmful traditional care,” Fizza Qureshi, who has worked in Sindh province providing training to TBAs, tells IPS. “We never thought of bringing in mothers and mothers-in-law in our fold and telling them about the harm they were doing to the newborn by their customs.”

These harmful practices include a paste made of kohl (antimony), oil and cow-dung which is put on the baby’s umbilical cord supposedly to make it heal faster. Colostrum (the first milk after birth) is discarded, and the baby is given honey mixed with some herbal concoction, even butter or ‘kheer’ (milk cooked with rice and sugar), Qureshi says.

“Even today, for the first three days, in most villages in Sindh, the baby is given goat’s milk as it is considered lighter than cow and buffalo milk because it is believed the new mother cannot produce enough milk.” Villages where TBAs have been trained show a marked improvement, Qureshi says.

But Farid Midhet, founder of the Safe Motherhood Pakistan says evidence of the positive effect of TBAs on maternal and newborn mortality is scanty and questionable, “mostly arising from small, well-controlled projects.”

Midhet says that during the 1980s and 1990s, the government trained more than 60,000 birth attendants. “Over the years nearly every non-governmental organisation working in safe motherhood has trained TBAs at some point in time.”

He says similar training has been repeated in other developing countries. “Cumulative evidence universally suggests TBAs have no impact on maternal (or neonatal) mortality.” But training for TBAs still continues “mostly because they provide ‘some’ care where there is none.”

Dr Shershah Syed, a leading Karachi-based obstetrician and gynecologist, says the only way to bring down newborn deaths is to replace TBAs with skilled birth attendants (SBAs). Indonesia and Malaysia have done so successfully, he says.

Many TBAs still hold the baby upside down and slap it to help initiate breathing, he says. “Scientific knowledge of newborn resuscitation like rubbing the baby dry, keeping the baby warm and using a simple ventilation device to stimulate breathing can save many babies, but the TBAs are not aware of this,” he tells IPS.

He says that in one experiment, the results from using SBAs in Sindh district Tando Allah Yar were outstanding. “We placed a SBA in a government-run mother and child centre, where just one or two deliveries were taking place in a month; we were surprised when the numbers increased unusually.” If mothers get quality care, they will reach a birthing centre, he says.

But Farid insists a SBA alone cannot save the new baby or the mother “unless quality emergency obstetric and neonatal care is available at that health facility.”

Excerpt:

By IPS Correspondents
KINSHASA, Sep 27 2011 (IPS)

“Every quarter, more than a hundred women with fistulas – including many younger than 20 years old – are admitted for surgery in Maniema province,” says nurse Julie Mawazo. “The number of affected women who don’t have the means or awareness to come in must be far greater.”

Each year, sexual violence, early marriage and complications in childbirth lead to some 12,000 recorded cases of vaginal fistulas – in which a hole develops between either the rectum and vagina or between the bladder and vagina – according to the Democratic Republic of Congo’s Ministry of Public Health.

“A quarter of the national total is recorded in the province of Maniema alone, in the east of the DRC,” says Jules Mulimbi Kaboyi, who directs the United Nations Fund for Population office in Kinshasa, the Congolese capital. UNFPA works to provide medical care and support for these women.

This assistance is badly needed: just 3.5 percent of the DRC’s national budget is allocated to health, and in a country facing massive challenges from diseases like malaria, tuberculosis and AIDS, this leaves scant resources to treat women suffering from this debilitating and stigmatising condition.

Bernadette Kabukulu is a shopkeeper in the Bandalungwa neighbourhood of Kinshasa. “For nearly two years, I had persistent pain in my abdomen, and a reddish discharge from my vagina. And a smell, especially when I went to the toilet or if I remained seated for even a few minutes,” she told IPS.

“I had to wash all the time. I avoided drinking or eating in order to avoid going to the toilet. I was ashamed to go out, I felt as though people could smell the odour that I carried with me.”

“Vaginal fistulas are accompanied by the deformation, followed by abnormal swelling, of the private parts of a woman and the creation of openings – in the form of small abnormal ulcers – between the vagina and the anus, creating a connection between the pathways for urine and faecal matter,” says gynaecologist Elie Makuza.

“These ulcers and deformations produce strong, persistent odours in the lower parts of the sufferer,” Makuza adds. “This smell is often the cause of rejection or stigmatisation by the community.”

Fistulas can be caused by extended pressure against soft tissue in the pelvis during childbirth – young women or girls giving birth are particularly vulnerable – or by extreme sexual violence.

Relief for the afflicted

Germain Musombo, a human rights defender with the non-governmental organisation Maniema Libertés, says poor education plays a key role, particularly in Maniema where he estimates that nearly half of women have little or no formal education. “In Maniema Province, the increase in the number of affected women is essentially due to four causes. Poverty, early pregnancy, sexual violence, as well as women’s poor education and ignorance (of factors that put them at risk).”

“Thanks to awareness campaigns organised by the UNFPA, in collaboration with the government, women are becoming more aware of the dangers of this condition,” says Jean Bertin Epumba, Director of Research and Planning at the Ministry of Public Health. Modeste Shabani, a campaigner at the Sauti Ya Mkaaji community radio station in Kasongo (the name means “voice of the peasants” in Swahili) is less upbeat.

“Here in Maniema there is a practice against which public education can make little headway: early marriage. And once a little girl is married, often as the second or third wife, it is difficult to speak to her about the negative effects of this issue.”

Mawazo, who works at the general hospital in Kindu, Maniema’s provincial capital, says she herself developed a fistula after the birth of her first child. She was only 15, and went through the delivery without medical assistance. She went through reconstructive surgery two years ago at the Kindu hospital, thanks to doctors brought in with support from the UNFPA.

“I’m happy to serve other women who suffer from fistula now, and help them to quickly get screening and care, so they can avoid the worst consequences,” she told IPS.

“Too often, poverty and ignorance puts young girls without resources in a position of weakness with regards to men or young boys…, to the point where many get pregnant or marry early, or give birth in dangerous conditions which can be at the root of fistulas.”

Excerpt:

By Elizabeth Whitman
UNITED NATIONS, Sep 21 2011 (IPS)

Political, private sector and civil society leaders from around the world gathered here on Tuesday to recommit to a year-old initiative, Every Woman Every Child, which aims to prevent 16 million maternal and child deaths by 2015.

Though much progress has been made, they said, much more remains to be done.

Each day, over 21,000 children under the age of five around the world die, while 350,000 women die annually from complications in pregnancy and childbirth.

Launched one year ago by U.N. Secretary-General Ban Ki-moon, Every Woman Every Child is an effort to advance components of the Global Strategy for Women’s and Children’s Health, to which 200 organisations have pledged their commitment, by coordinating international and national actions across various sectors.

Those who spoke at Tuesday’s event not only shared stories of success related to their respective countries or organisations, but they also reiterated the call for greater resources and financial contributions.

“We have the knowledge, we have the expertise” to reduce mortality rates and improve women’s health, General Secretary of World YWCA Nyaradzayi Gumbonzvanda said at the event. “We know what works. We just need the resources.”

She called for countries to reallocate their spending to support health-related causes rather than, for instance, military pursuits, in a slight echo of Ban’s earlier warning that “political roadblocks litter the path ahead”.

Countries, many of them in the developing world, have already pledged to the cause an estimated 40 billion dollars for the next five years.

The Global Strategy, launched in April 2010, targets children and women’s health in order to bring countries closer to achieving Millennium Development Goals (MDGs) 4 and 5 by their target year of 2015.

MDG 4 calls for a two-thirds reduction, based on 1990 data, in mortality for children under the age of five, while the fifth MDG is universal access to reproductive health and a 75-percent reduction in maternal mortality.

Ban said that the private sector would play a “central role” in helping countries reach these MDGs. Indeed, under Every Woman Every Child, public-private partnerships have thrived, with several new initiatives between the private sector and U.N. agencies such as the World Health Organisation, and between governments and private foundations.

Several developing countries have been hailed for their efforts to reduce infant, child, and maternal mortality rates. Prime Minister Sheikh Hasina of Bangladesh told those who attended the event that since 1990, Bangladesh had reduced infant mortality by 45 percent and maternal mortality by 66 percent.

Every Woman Every Child also seeks to avoid 33 million unwanted pregnancies and protect 120 children from pneumonia.

Maternal and child mortality rates have declined at an accelerated pace since the signing of the Millennium Declaration aimed at improving child and maternal health, said a new analysis by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

The report by the IHME, “Progress toward Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis”, published in the leading British medical journal The Lancet, showed that since 2000, maternal mortality rates in 125 countries have declined at a faster pace.

In 1990, approximately 409,100 women died from pregnancy and childbirth-related complications, whereas in 2011 the number is estimated at 273,500.

Similarly, mortality rates of children young than five have declined faster since 2000 than in the past 11 years than they did the decade prior, from 11.6 million deaths in 1990 to 7.2 this year. The data indicates that efforts to decrease maternal and child deaths through education and health initiatives are succeeding.

Nevertheless, the initiatives have not ensured that countries will be on track to meet MDGs 4 and 5 by 2015, the report said. Though 31 developing countries will achieve MDG 4 and 13 developing countries MDG 5, only nine will achieve both. They are China, Egypt, Iran, Libya, Maldives, Mongolia, Peru, Syria and Tunisia.

Haidong Wang, assistant professor of global health at IHME and co- author of the report, commended the work of U.N. agencies, telling IPS that they “have played an important leadership role in improving child mortality and maternal mortality”.

Efforts in particular to fulfill the MDGs “have been a huge boon for public health” in developing countries, he said, and have had a significant impact child and female health there.

“Governments within those lower income countries have also, for the most part, increased their own spending on health,” Wang said. Those changes contributed to major improvements.

Still, education was “one of the biggest factors”, said Wang. “Half the reduction in child mortality can be tied to the education of young women. With more schooling, they make better choices about their own health and about the health of their families,” he explained.

Nevertheless, despite efforts on the part of the U.N. and individual countries, said Wang, “We need to acknowledge the fact that most countries are not on track to achieve either MDG goal.”

“In order to continue reducing child and maternal mortality to the targeted levels,” he concluded, “We must build on what has been working the past two decades.”

Excerpt:

By Isaiah Esipisu
DADAAB, Kenya, Sep 19 2011 (IPS)

Dr. Beldina Gikundi’s daily prayer is that the handful of malnourished pregnant Somali women who go into labour that day at the Dadaab refugee complex do not have complications, which might require a caesarean section. Because Gikundi knows that Somali cultural beliefs mean that she and her staff at Hagadera Hospital will most likely not be able to immediately operate on the women and save their lives and those of their unborn children.

Dr. Beldina Gikundi attends to a Somali mother in the Hagadera Hospital's maternity ward in Dadaab. Credit: Isaiah Esipisu

“We have, in the past, lost infants because of prolonged labour, which are lives we would have saved if it were not for these cultural beliefs,” said Gikundi, the doctor in charge of the maternity unit at the hospital. She said that each day between three to five women go into labour here.

Hagadera Hospital is a fully-fledged health facility at the Dadaab refugee complex, in North Eastern Kenya. Dadaab, the biggest refugee camp in the world, is divided into three camps: Ifo; Dagahaley; and Hagadera.

It is home to over 440,000, mostly Somali, refugees who have fled the famine and drought in their country. According to the United Nations Refugee Agency (UNHCR), 70,000 people fled to Dadaab from Somalia in the Horn of Africa in June and July and 1,500 arrived daily in the months to follow. The rate has since gone down.

Hagadera Hospital is run by the non-governmental organisation International Rescue Committee and has 120 beds. It provides free inpatient and outpatient services and has a 24-hour operating theatre for emergency surgery.

But despite this, the lives of Somali women with labour complications remain at risk.

Gikundi told IPS that under normal circumstances consent is needed from a patient for a caesarean section. But in Somali culture, this consent must come from the woman’s father in-law, and if he is not available then consent must come from the expectant woman’s husband. And herein lies the complication.

A majority of the refugees at Dadaab are women, as their husbands and men-folk either remained behind in their villages to protect their belongings, or were working in the Somali capital Mogadishu at the time the famine struck and their families were forced to flee the region in search of aid.

Gikundi told IPS that on many occasions the hospital has had to either send someone to Mogadishu, or to the women’s villages in south Somalia, to search for their husbands or fathers-in-law for consent.

“As a result, we have seen women remain in labour for two or sometimes more days before we get the right people to give the consent for a life-saving operation,” she said.

Apart from losing the unborn infants, said Gikundi, the women run a high risk of developing vesicovaginal or obstetric fistula.

Obstetric fistula is caused by extended pressure of the child’s head against the soft tissue in the mother’s pelvis during childbirth. The tissue eventually dies from the lack of blood supply, and a hole develops between either the rectum and vagina or between the bladder and vagina.

Women who suffer fistula are usually unable to control the flow of urine or faeces. They are often stigimatised by their communities and families because of their condition.

“We repair an average of three cases of vesicovaginal fistula every month, which is a very high rate,” said Gikundi.

“Delay in seeking care for pregnancy-related complications and delay in consent for life-saving procedures like caesarean sections, among other reasons, have hampered progress in reducing maternal mortality and morbidity among refugees in Dadaab,” said Ann Burton, a senior public health officer for UNHCR at Dadaab.

She said 14 women died during labour at Dadaab between January and July.

“This is a very sad situation because no woman is supposed to die while bringing forth a new life,” Burton said.

Other obstacles to maternal health are the practice of female genital mutilation (FGM) and the almost non-existent use of contraceptives.

According to public health experts at the UNHCR, almost all the Somalis at Dadaab practice FGM.

Studies in many countries have linked FGM to the increased risk of maternal and child morbidity and mortality due to obstructed labour.

“Women who have undergone FGM are twice as likely to die during childbirth and are more likely to give birth to a stillborn child than other women,” explained Dr. Joseph Karanja, a gynaecologist in Nairobi, Kenya.

Burton said that FGM is an emotive subject among the Somali refugees, and it needed to be addressed with caution.

Another obstacle to maternal health among the refugees is the failure of family planning.

The infant nutritional expert at Hagadera Hospital, Hadija Mohammed, said that many Somalis believed that family planning and using contraception was against their religion.

“Though, the truth is that Islam clearly permits family planning,” said Mohammed.

She added that many people wrongly believed that using contraceptives would cause infertility and other health complications.

A July survey by UNCHR of the three camps that make up Dadaab: Ifo; Dagahaley; and Hagadera, found that contraceptive uptake among refugees in the camps was two percent, three percent and one percent respectively.

As a result, the fertility rate at Dadaab is alarmingly high. On average women here have more than nine children in their lifetime.

“I do not have proper statistics, but the average fertility rate at the camp is likely to be more than nine children per woman,” said Gikundi.

However, UNCHR reports that there is a high attendance of antenatal care clinics.

“Between January and July, 95 percent of all pregnant women at Ifo and Hagadera camps attended antenatal clinics four times during their pregnancies, as recommended by the World Health Organization,” said Burton.

Also, between 84 to 94 percent of women at Dadaab gave birth under the supervision of a skilled birth attendant between January and July.

Gikundi said the hospital also had a 24-hour ambulance service to transport pregnant mothers.

“We also have informants, who are equal to community health workers, who keep monitoring pregnant women, reminding them of the importance of attending antenatal clinics. They will also call for an ambulance in case of any complications or labour pains,” said Gikundi.

Excerpt:

By IPS Correspondents
DEHRADUN, Sep 18 2011 (IPS)

India has been ranked the fourth most dangerous country in the world for women, but the widespread practice of selectively aborting female foetuses may make it the most hostile to the female gender.

A Kopal gender sensitisation meeting in Uttarkashi district. Credit: Nitin Jugran Bahuguna/IPS

Uttarakhand’s record is far worse than the unwholesome national child sex ratio which has declined to 914 girls per 1,000 boys, from 927 per 1,000 in the last decennial census, conducted in 2001.

Demographers extrapolate that where there were six million ‘missing girls’ in India’s 2001 census, the figure has risen to 7.1 million in the 2011 count – which puts India’s total population at 1.21 billion people.

“Technology and literacy have played a part in promoting female foeticide as also a lack of principles and ethics in the medical profession,” says Shashi Bhushan of the Shri Bhuvaneshwari Mahila Ashram (SBMA), a Dehradun-based non-governmental organisation (NGO) that helps protect the rights of women.

Bhushan’s reference was to the proliferation of illegally-run sex determination clinics using cheap ultrasound machines across Uttarakhand and their being patronised by educated people.

Rahmati Devi, 45, a dai (traditional birth attendant) in the picturesque lake district of Nainital, maintains that sex determination tests using ultrasound imaging are now routine in the villages of northern Uttarakhand.

“These tests always take place due to pressure from the husband or members of his family,” Devi told IPS.

“The addresses of ultrasound centres, where such services are provided clandestinely, are spread by word-of-mouth. These centres charge between Indian rupees 2,500 to 5,000 (52 – 105 dollars) to perform a sex determination scan,” Devi said.

Monitoring committees created under the Pre-conception and Pre-natal Diagnostic Techniques Act, that prohibits sex determination tests, are not active in most districts of Uttarakhand, except for sporadic raids on clinics suspected to be carrying out illegal procedures.

The SBMA has been campaigning for three years now to create awareness against the practice at the grassroots level under a programme called ‘Kopal’ (sapling). With support from Plan International and 13 other NGOs, the SBMA has focused on such issues as the adverse physical and psychological effects on women who undergo abortions to eliminate female foetuses.

When Madan Singh and his wife Radha Devi in Rampur, Chamoli district, were considering a sex determination test to avoid the possibility of having a third daughter a ‘nukkad natak’ (street play), mounted in their village under the Kopal project, convinced them against it.

Such successes encourage activists like Bhushan. “Our work with community-based organisations and youth groups has also seen an increase in birth registration rates and institutional deliveries.”

Bhushan believes that states like Uttarakhand are only now beginning to wake up to the enormity of the problem. “What is referred to as the ‘missing girls’ amounts to mass murder of girls or femicide,” he said.

Recognising that healthy attitudes to the girl child must begin early, the Kopal initiative includes mobilising youth groups to sensitise peers and elders about the vital role that girls play in any balanced community.

“The issue of dowry remains a powerful factor against having girls. A family with more men is considered strong and sons are perceived as assets,” observes social worker Bina Kala, 35, of Anjanisain village in Tehri district.

Under Kopal’s aegis, Bina helps organise ‘Mountain Children’s Forums’ which provide opportunities for gender relations to be discussed between groups of boys and girls.

“At these meetings we emphasise that in rural households the girl child contributes much more to the family economy than boys. She supports her mother in domestic chores and even sacrifices her dreams so that families can invest in the boys,” says Bina.

Health threats and cultural attitudes to women were factors in a poll by TrustLaw, a news service run by the Thomson Reuters Foundation, which ranked India as the fourth most dangerous country in the world for women, after Afghanistan, Congo and Pakistan, in results released in June.

At a Kopal meeting in Pithoragarh district, earlier this year, several girls complained that in spite of rising levels of literacy and education little has changed in the status of girls in the villages of Uttarkhand.

“At this meeting the boys responded by taking an oath that when they got back to their villages they would be more sensitive to their sisters and other girls,” recalls Bina.

At another Kopal meeting in the pilgrim district of Haridwar, a 17-year-old girl called Sonia emerged as a youthful voice in the fight against female foeticide in Uttarakhand.

“We meet regularly and discuss ways to bridge the gender gap. Our message is that girls must be heard and that they have the right to equal treatment,” says Sonia who nearly dropped out of school but is continuing with her studies with support from SBMA.

Such civil society initiatives are backed by central and state government schemes designed to enhance the value of a girl-child in the eyes of the community.

Three years ago, the Uttarakhand government announced the ‘Nanda Devi Girl Child Scheme’ under which every girl child born after January 2009 in families living below the poverty line is entitled to a fixed deposit worth 105 dollars that can be withdrawn with interest when the girl clears high school and reaches 18 years of age.

“Such schemes are slowly but surely making a change in a society where the desire to have a male heir is a difficult and complex social issue,” says Bhushan.

Excerpt:

By Kanya D'Almeida
WASHINGTON, Sep 14 2011 (IPS)

Kakenya Ntaiya was engaged at age five and would have been married by 13 if her mother had not insisted that she attend her small village school in Enoosaen, Kenya.

As she got older, Ntaiya made a bargain with her father that she would be circumcised only if he allowed her to finish high school, then negotiated with her village elders to be granted permission to travel to the United States for university.

“It was in college that I learned for the first time that genital mutilation and cutting were illegal, that I had rights, that I had always had rights and there were people out there ready to defend them,” Ntaiya told a group of human rights advocates in Washington D.C. Tuesday.

Ntaiya went on to found the Kakenya Center for Excellence for under- privileged Maasai girls, which grew from humble beginnings to a school of nearly a hundred pupils by 2010.

Ntaiya was one of several youth leaders and advocates who gathered at the National Geographic headquarters this week in an attempt to drum up awareness about the fact that next month the world’s population will hit seven billion.

“The world of seven billion presents us with the opportunity to talk about what former U.N. Secretary-General Kofi Anan described as ‘problems without passports'”, Peter Yeo, vice president of the U.N. Foundation, said Tuesday.

“And of these transnational issues, the most pressing question will be how to unleash the power of women and girls in the struggle to alleviate poverty and accelerate progress on global development targets such as the Millennium Development Goals (MDGs),” he added.

In 1804, the world’s population was a billion. Exactly 123 years later, it had doubled to two billion. At the current pace, human beings are populating the planet by an additional 78 million people a year – the equivalent of the total populations of Canada, Australia, Greece and Portugal combined.

Five people are born every second. By the time you reach the end of this article, the population would have increased by 167 people.

According to the United Nations Population Fund (UNFPA), the principle architect of actions directed towards meeting the challenges of future population, nearly all of that growth – 97 out of every 100 people – is occurring in the developing world, where rights for women and girls are particularly scant.

“Seven billion is a call to action,” Babatunde Osotimehin, executive director of the UNFPA, told IPS. “Together, as part of this historic movement, we can make a huge difference in the lives of girls and women, and promote human development for the benefit of current and future generations.”

However, global trends are not as optimistic as Osotimehin’s predictions.

By the UNFPA’s own figures, two-thirds of the world’s 776 million illiterate people are women, 101 million primary school-aged children are not receiving proper education, 134 million women are “missing” worldwide as a result of sex-selective abortions and neglect of infant girls, and over 350,000 women – about one every 90 seconds – dies from complications in childbirth, 99 percent of them in developing countries.

In addition, according to National Geographic, modern industrial production has radically altered the patterns of human settlement, pushing thousands of farming families and communities out of the countryside and into megacities – urban centers of more than 10 million residents.

National Geographic estimates that in 1975, the world was home to only three such cities. By 2010, 21 megacities had sprung up all around the world. By 2050, 70 percent of the world’s population will be living in urban areas.

Of this urban population, according to U.N. habitat, the slum population reached a staggering one billion last year, with “emerging market economies’ like India, Brazil and China being home to the some of the world’s biggest ‘hyper slums’.”

Given the fact that women comprise the majority of city-dwellers, and that 70 percent of women face gender-based violence – primarily in urban areas – in their lifetime, this development of human civilisation does not bode well for the women of the world. Despite these harsh and daunting realities, experts and activists believe that the moment can be catalysed to spur the world into action.

“Population itself is not the issue,” Osotimehin said Tuesday. “It is the disaggregation between communities and populations. We don’t lack space – we lack equity.”

“Nine hundred million young women are living without access to education and health, they bear children too early, are excluded from concepts of active, political citizenship and awareness of their place as possible leaders in the global community,” he added.

Monique Coleman, an actress-turned-U.N. Youth Champion who has traveled the world as an advocate for gender equality, described her own awakening to the power of an individual to impact huge change in society.

Coleman described her first trip to Kenya on a sanitation project with UNICEF.

“I was shown into a room where I expected to see sanitation equipment that needed delivering. Instead, I saw a woman sitting in a corner, sewing. I had no idea what this woman had to do with our project, until I realised that she was sewing reusable, sanitary napkins for girls,” Coleman explained.

“That was when it hit me that we, as outsiders, don’t know what’s best for a community. It’s the locals, and especially the women, who have the wisdom, skill and expertise to innovate creative, sustainable solutions for their own people,” she said.

“By empowering these women, I am completely hopeful that we can meet the challenges of a world of seven billion,” she added.

Excerpt:

By IPS Correspondents
UNITED NATIONS, Sep 12 2011 (IPS)

Cell phones and computer applications can help save the lives of thousands of mothers and children worldwide.

Tembli, a patient at Nolungile clinic in Khayelitsha, South Africa, receives an SMS on her mobile phone. Credit: Courtesy of United Nations Foundation

The report points to changes in health care delivery in some developing countries like India, Tanzania and Zambia. They are rooted less in development aid than in home-grown and self-sustaining solutions, including the use of communicative devices or the supply chains of large companies.

“Many of the ideas have come up from local entrepreneurs,” Dr. Tore Godal, special advisor to the Norwegian prime minister and co- author of the report, told IPS. “A large number of innovations are based on public and private sector cooperation, creating a potential for reducing maternal and child mortality.”

An example for an initiative highlighted by the report is the South African project Cell-Life. In this programme, short messages are used to remind HIV-positive mothers to keep appointments and bring infants for HIV testing or treatment.

Eight out of 10 of South Africans have access to mobile phones. Forty percent of the deaths of children under five in South Africa are due to AIDS-related illnesses – many because mothers are not able to bring their infants for treatment or drop out of programmes.

“It helps them to remember, it helps them to know when to take the pills, it helps them to know what to expect after taking the pills,” explains Pumla, a nurse at Nolungile clinic in Khayelitsha, South Africa, in an interview filmed by the United Nations Foundation in cooperation with the IWG and the Partnership for Maternal, Newborn & Child Health (PMNCH), the sponsors of the project.

“It has made a very big difference,” she says.

A difference that can also be felt by young women like Tembli, one of Pumla’s patients. “It’s like there is a friend, someone who is there for you, who is taking care of you, who is understanding what you are going through,” Tembli says.

Another project that uses communication technology to improve health care is D-Tree. Interactive software has been installed on the mobile phones of Tanzanian front-line health workers to correctly treat malnourished children. About six percent of children in the country are malnourished and as many as 30 percent die.

Guidelines for treating acute malnutrition are complex and may need to be highly individualised. The software-equipped phones help health workers calculate correct weights and treatment and communicate these with mothers. The phones, which cost about 120 dollars a month for each health worker and 1.33 dollars for each child, provide a low- cost way to treat malnutrition.

“Mobile technology is already delivering lifesaving health information to families in remote villages where access to health workers is limited,” says Kathy Calvin, CEO of the United Nations Foundation. “It has the potential to dramatically reduce maternal and child deaths in some of the most remote places with the greatest need.”

Besides the problem of delivering health information, one of the major problems in developing countries is the distribution of treatments. About 20 percent of children die of easily treated diseases, such as diarrhea, before the age of five, even though inexpensive and effective treatments are generally available, but not accessible in rural areas.

That’s why Simon Berry, former chief executive of rural regeneration charity Rural Net UK, started the ColaLife project. The idea is simple: As the popular drink seems to be available even in the smallest towns and most isolated areas, ColaLife uses the Coca-Cola supply chain to distribute anti-diarrheal kits to these places.

“I see a great potential for international companies to scale up local projects in neighbouring countries and even on other continents,” Godal said. “Other examples are Johnson & Johnson, working with the mobile health projects both in Africa and India, and mobile phone companies.”

Even though developing countries can benefit from this type of cooperation, the risk of an unwanted influence by the private sector is still a concern. “The responsibilities for regulation of the private sector rest with the government, often facilitated by international agencies,” Godal added.

But the cooperation with existing companies or the use of modern technology is not the only innovative idea highlighted by the report. In India, the founding of a hospital named LifeSpring that allows women to give birth for less than 100 dollars can deeply affect the rates of maternal and infant mortality.

The first pilot hospital opened in 2005. Within a year, LifeSpring grew to six hospitals. It now has nine and will open another six by the end of 2011. Each hospital aims to be profitable after 18 months. LifeSpring’s staff has delivered more than 10,000 babies to date.

“We are feeling very good about this hospital,” says Saroja, the mother of Lifespring patient Swathi, who delivered a child in a hospital in Chilkalguda, Secunderabad, Andhra Pradesh, India, in an interview.

“The doctors regularly advised my daughter about the progress of the pregnancy. Also, during the delivery, the doctors took good care of my daughter. The newborn child is being regularly visited by the paediatrician. The hospital is good and neat – much better than other hospitals.”

There are two main reasons why LifeSpring can provide good medical treatment about for about one-third to one-half of the fees charged at other hospitals, Godal said: “One, because they have adopted a singular focus, and two, they have really looked into how to cut costs everywhere without losing quality.”

“Simple and cheap methods can save many lives because they can be applied to reach the poorest people that are at the highest risk of dying,” he concluded.

Excerpt:

By Elizabeth Whitman
UNITED NATIONS, Sep 8 2011 (IPS)

Each day, one thousand women die in childbirth and one million people become infected with sexually transmitted infections (STIs), including 7,000 cases of HIV. Yet these numbers are preventable, experts insist, when countries possess the resources and willpower to address and deal with them.

Dignitaries and high-level officials gathered this week to discuss reproductive health commodity security (RHCS), or, simply put, ensuring that people have access to essentials of reproductive health including contraceptives and drugs for safer maternal health and childbirth.

Sponsored by the U.N. Population Fund (UNFPA), the two-day conference underscored the importance of reproductive and sexual health, especially in developing countries, to improve public health and quality of life as well as to empower girls and women.

RHCS is akin to the concept of food security, explained Jagdish Upadhyay, chief of UNFPA’s Commodity Security Branch, meaning that these commodities need to be consistently available and affordable to communities rich and poor, in areas urban and rural, to the educated and the undereducated.

Technology has made a remarkable difference in many countries to improve governments’ management of multiple aspects of reproductive health. CHANNEL is one such programme that been installed in countries such as Madagascar, Senegal and Sudan, enabling them to better track storage levels of contraceptives and medicines, so that when stock levels run low they are replenished.

A consensus from the 1994 International Conference on Population and Development in Cairo declared that reproductive health was a basic human right. In order to transform such a concept into reality, however, states must build the infrastructure that allows all individuals to obtain and use their choice of affordable quality productive health supplies whenever they need them, said Dr. Kechi Ogbuagu, a technical adviser to the Commodity Security Branch in UNFPA.

A starting point for global health and development

Security for reproductive health commodities is viewed as an area essential to human and economic development. It is “one element of many other processes that are going on that are all contributing to similar outcomes to improve the health and the lives of women and children,” said Julia Bunting of the UK’s Department for International Development, during a presentation to dignitaries and officials.

Closely connected to public health, healthcare systems, women’s rights, education, and several other areas marked crucial as priorities for development in the developing world, establishing RHCS can help begin or contribute to development in those areas for several reasons.

Ideally, not only does reproductive health security rely upon infrastructure that can serve other health needs, but it also demands that communities engage with the topic of sexual and reproductive health, altering social and cultural dynamics and empowering women by allowing them to take charge of when they want children, and how many.

“Reproductive health commodity security is a tool, a tool for ensuring that we’re going to empower women to make choices for themselves,” Babtunde Osotimehin, executive director of UNFPA, told IPS.

The point at which women can make those choices “almost always correspondents to economic development” because it reflects the level of education and empowerment those women have, he said.

“Women are drivers of the economy in many developing countries,” he added.

Experts acknowledged, however, that despite the multiple benefits RHCS carries, many countries still have a way to go before they enjoy them or before they have security in reproductive health commodities.

UNFPA estimates that 215 million women in the developing world have an unmet need for. These women qualify as having “unmet need” because they want to delay or avoid pregnancy yet use traditional and less effective methods of contraception, or none at all.

UNFPA has also noted areas of success, citing work by its Global Programme to Enhance Reproductive Health Commodity Security, a framework to assist countries and provide them with support. In Ethiopia, the contraceptive prevalence rate rose from six percent in 2003 to 30 percent in 2009.

Challenges to RHCS

Though some countries have demonstrated, measurable success in RHCS, speakers and officials acknowledged the many challenges that lie ahead in securing reproductive health commodities, especially for communities in developing countries.

Challenges tend to vary from country to country, said Osotimehin, but some parallels include cultural or political “gatekeepers” who can either hinder or facilitate the ability to make their own choices, governments who don’t pay health commodities the necessary attention or resources, and health systems that don’t work.

Public health sustainability derives from governments’ putting domestic resources to reproductive commodities on a continual basis, Osotimehin elaborated. If governments don’t contribute the necessary resources or political will, change – ranging from cultural norms and beliefs to health infrastructure – will be quite limited.

Speakers emphasised the fact that unmet need is greater in rural or poor areas and populations with lower levels of education, where social and cultural norms may threaten open discussion or action towards ensuring RHCS.

Experts also noted that additional financial resources are always needed for RHCS.

In spite of the challenges ahead, Osotimehin stressed that RHCS was absolutely crucial and one of the most important issues countries could focus on. “It saves lives, and it helps people to develop,” he concluded.

Excerpt:

By Isaiah Esipisu
NAIROBI, Sep 7 2011 (IPS)

Agnes Kalunda’s doctor feared that because of her slight frame there was a high chance of her developing complications during delivery.

Turkana Women in Kenya. Less than half of all Kenyan women give birth in a medical facility. Credit: Isaiah Esipisu/IPS

“My baby was almost falling off the bed when a woman in labour on the neighbouring bed shouted to attract the nurse’s attention. Other women in the ward were crying for help,” the 19-year-old Kalunda told IPS, adding that nurses did not bother to attend to the women in labour. “A nurse came to attend to me after I had already delivered.”

It is this lack of commitment from health workers, experts say, that are among the reasons why Africa may not succeed in achieving Millennium Development Goal (MDG) 5 on improving maternal health by 2015 by reducing maternal mortality by three quarters.

The MDGs are eight time-bound goals tackling poverty and its various dimensions that the United Nations member states agreed in 2000.

MDG 5 was one of the issues discussed at the ‘Multi Stake Holders Policy Dialogue’ of African policy makers, medical experts and development partners, which took place in Nairobi from Aug. 31 to Sep. 2.

Studies conducted by the African Institute for Development Policy (AFIDEP) in East, West and Southern Africa found that most countries are struggling to provide universal access to reproductive health. And only three countries in these regions are on track to achieving MDG 5.

“We can say that only three African countries could be on track to achieving the goal of ensuring safe motherhood in the region. They are Eritrea, Rwanda and Ethiopia,” said Dr. Eliya Zulu, the Executive Director of the AFIDEP.

Eritrea, a country in the Horn of Africa, had the highest rate of success and reduced maternal mortality by 70 percent, from 930 deaths per 100,000 women in 1990 to 280 deaths per 100,000 women in 2008.

Uganda registered reasonable progress towards achieving MDG 5, reducing the maternal mortality rate from 670 deaths per 100,000 women in 1990 to 430 deaths per 100,000 women in 2008.

However, in Kenya maternal mortality has increased from 380 deaths per 100,000 women in 1990 to 530 deaths per 100,000 women in 2008.

“Unlike other countries in East Africa, Kenya has not had political will for health care in general. This has seen the figures move in a negative direction,” Zulu told IPS.

Uganda’s success in reducing maternal mortality has been attributed to the direct involvement of President Yoweri Museveni and First Lady Janet Museveni.

Also, since 2006 funds have been allocated in the national budget to mitigate maternal mortality, and there is a legislative and advocacy initiative by the Ugandan parliament.

“We also have a maternal mortality audit, where all deaths are reported to the Ministry of Health … this is used to learn how such deaths can be avoided in the future,” Dr. Collins Tusingwire, the senior medical officer in charge of integrating reproductive health and HIV/AIDS services in Uganda’s Ministry of Health, told IPS.

In Kenya, however, findings from a survey conducted by the Kenya Service Provision Assessment (KSPA) in June found that 64 percent of all women who gave birth in public health facilities across the country were not given necessary medication. More than one third of all women who wanted to give birth at medical facilities complained of being neglected or mistreated by medical practitioners.

Also, only a mere 43 percent of all pregnant women in Kenya give birth under the supervision of a professional healthcare provider.

In Rwanda, traditional birth attendants play a significant role during delivery, especially in rural areas. However, this has contributed to maternal mortality, especially when traditional birth attendants attempt to handle complicated cases instead of referring them to professional midwives.

But Dr. Odette Nyiramilimo, a physician and Rwandan politician, told IPS that traditional birth attendants offered some services to expectant mothers that they did not receive in hospital, like taking care of the mothers’ personal comfort.

“All these small but very important things are sometimes ignored in many public healthcare facilities,” Nyiramilimo told IPS.

In West Africa Ghana has reduced maternal mortality by 44 percent from 1990 to 2008.

Experts say this is because of government’s commitment to effective policy, free antenatal care and delivery services, and expanded national health insurance schemes, which cover both formal and informal workers.

The country has a national policy known as the Community-based Health Planning Initiative – which aims to provide healthcare to those in rural areas.

“Communities in remote rural areas benefit from mobile community-based healthcare provided by a resident nurse, as opposed to conventional facility-based services,” Dr. Gloria Asare, the director of Ghana Health Service’s Family Health Department, told IPS.  

Excerpt:

By IPS Correspondents
NEW YORK, Aug 30 2011 (IPS)

“I just gave birth on the ground…I had no drugs for pain during delivery,” one Haitian mother tells Human Rights Watch (HRW) in a report released Tuesday that says a year and a half after the country’s devastating earthquake, women and girls are still facing gaps in access to available healthcare services necessary to stop preventable maternal and infant deaths.

Haitian women and girls living in makeshift camps run a high risk of sexual violence. Credit: UN Photo/Sophia Paris

The 78-page report, “Nobody Remembers Us: Failure to Protect Women’s and Girls’ Right to Health and Security in Post-Earthquake Haiti,” documents the lack of access to reproductive and maternal care in the aftermath of the catastrophe.

“They give birth unattended on the muddy floors of tents, or trade sex for food without any protection from unwanted pregnancy,” said Kenneth Roth, executive director of HRW.

Donors pledged 5.3 billion dollars in short-term recovery aid, with 258 million dollars dedicated to health care. Although only 118.4 million dollars of the health funding has been disbursed, 130.6 million more is committed and nearing disbursement.

“Some of this money is for reconstructing hospitals and the health system, which can take some time. There are many levels of planning required. But even with over half the money waiting to be disbursed, there are free services available. It’s a matter of making sure vulnerable women and girls benefit from what is already available,” Klasing told IPS.

Even though aid agencies are working hard to provide care, many women and girls have not benefited due to lack of information, poor transportation infrastructure, and unaffordable charges for services not covered by free care.

Extreme vulnerability and poverty in the camps has led some women and girls to form relationships with men for the sake of economic security, or to engage in transactional or survival sex, which is the exchange of sex for food, HRW reported.

This “exchange” sometimes happens without adequate access to contraception and other reproductive health services, increasing the chances of unplanned pregnancies and sexually transmitted infections.

The exposure of women and girls to being raped has dangerously increased after the earthquake. It is an even greater concern in the displaced persons’ camps, where there is a high incidence of sexual violence.

Emergency contraception and other post-rape care is available in some health facilities, but many women and girls are unaware of it. Others are too scared, ashamed, or traumatised by rape to seek care in the necessary time frame for emergency contraception to be effective, the report states.

What is more, lack of coordination and data sharing on the part of donors and nongovernmental organisations working to provide health services has made it extremely hard to keep track of progress.

“Accountability for women’s rights, including accountability in efforts to reduce maternal mortality, require good data on whether programmes are having an impact and what changes need to be made to increase benefits,” Klasing said. “This doesn’t currently exist. This is one important area for collaboration.”

At the same time, according to Klasing, to ensure that women and girls have the information they need to access services, the government, donors and NGOs need to have a global picture of what is available.

According to the report, the government should do more when it comes to protecting women and girls from violence, and ensure that they receive all the information they need. “Attention to human rights should be an essential part of Haiti’s recovery plan,” Roth said.

Roth called on the government, donors and NGOs to work together to provide women and girls the services, protection, and respect that they need, and establish the oversight needed to ensure that it happens.

According to Klasing, the government should adopt a strong gender policy across ministries and programmes to ensure women’s rights are considered in all matters.

“It also should take steps to make sure women and girls at public facilities understand what programmes and services are available for free and necessary to continue treatment,” she said.

“With almost 260 million dollars earmarked for health care, no woman should have to give birth on the street,” Roth said. “Women and girls have a right to life-saving care, including in adverse circumstances.”

Excerpt:

Eighty thousand tiny houses dot the countryside near this coastal city, located just west of the epicentre of the Jan. 12, 2010 earthquake that killed some 200,000 and displaced over one million.

Petit Goâve camp resident Louise Delva points to riverbed, which she and others use as an open latrine. Credit: Courtesy of Haiti Grassroots Watch

These mini-homes – one-room “T-Shelters” (transitional shelters), meant to last three to five years – cost over 200 million dollars to build and today reportedly house 80,000 of the families displaced by the earthquake that damaged or destroyed at least 171,584 homes.

The Bill Clinton-led Interim Haiti Recovery Commission (IHRC) has approved 254.5 million dollars worth of housing repair and reconstruction projects that will reportedly fix, upgrade or build about 41,759 housing units.

The new government – led by President Joseph Michel Martelly – recently organised “Reconstruction Week”.

Among other activities, Clinton and Martelly inaugurated a “housing exposition” with over 60 model homes and a new mortgage programme called “Kay Pa M” (My House).

Does all this activity mean the reconstruction is off to a good start? Will the 634,000 people still living in Haiti’s 1,001 camps, and the undoubtedly tens of thousands of others living in unsafe and even condemned structures, soon move to safe housing?

Louise Delva, a mother of five who lives in the Regal camp here, isn’t aware of any plans meant for her, or for tens of thousands internally displaced people (IDPs) like her.

“They’ve abandoned us,” Delva said, disdainfully, as she gave a tour to community radio journalists from the Haiti Grassroots Watch (HGW) consortium. “These are the sordid conditions we live in,” she said, pointing into a dark, fetid tent crammed with belongings, two mattresses, and a machete.

“When the rain comes, we’re in danger. Look how close we are to the riverbed,” Delva added, gesturing to the mostly dry ravine camp residents use as an open latrine. As she spoke, two children were hunched down over the rivulet.

This week, Hurricane Irene spared the part of Haiti where Delva and hundreds of thousands of others share makeshift camps. But that doesn’t mean the families aren’t in danger from the next hurricane, and from cholera which continues to rage through Haiti. Most of the country, and all of the 1,001 camps, lack adequate sanitation facilities.

“In early June we had 21 active cholera cases here,” Guyvlard Bazile, president of the Regal camp committee, told the HGW journalists.

Agencies Absent

Although it’s no longer making international headlines, the cholera menace still looms large here. Over 300 people are hospitalised each day, and as of Aug. 8, 2011, 426,285 people had been infected and at least 6,169 have died.

But early this summer, the humanitarian agencies that cleaned out latrines and provided healthcare and water had pulled out of most of the country’s camps because, they said, they lacked funding.

In fact, as long ago as last March, the U.N. Organisation for the Coordination of Humanitarian Affairs (OCHA), warned that “most of the funding to partners to support sanitation, water trucking activities and camp management will be exhausted by June 2011,” adding: “If sanitation activities come to an end, open defecation, indiscriminate disposal of faeces, cholera contamination and insecurity, particularly women seeking to find a private place to excrete, will increase.”

But, according to OCHA’s own tracking, humanitarian agencies’ “water and sanitation” programmes in 2011 have already received over 40 million dollars.

Bazile said he doesn’t understand where that money, and the agencies, have gone.

One agency – IEDA (International Emergency and Development Aid) – is at Regal. IEDA is the “camp manager,” but with only two latrines serving hundreds of people, no clinic, and one water spigot, it was difficult for HGW journalists to spot evidence of “management”.

“They come to see if we have pregnant women who have difficulties, how many people are sick, who needs to go the hospital,” Bazile explained.

In an email with HGW, the International Organization for Migration (IOM) – which also oversees all the camps – confirmed that IEDA has “one camp manager whose responsibility is to be each day on the camp, to get information through the committee and their community, and then to share it with the different actors.”

While IOM did not have IEDA’s budget figures available, public records indicate that so far this year, IOM has received over 20 million dollars for its work in camps and with camp populations.

Bazile said that IOM is also “present” at Regal. “IOM sometimes calls us, too. Like, if there is a storm, they call afterwards and ask ‘How are things? Did the rain do any damage?’ They ask a lot of questions, but don’t really do anything,” he said.

Horrific Conditions in Camps

There are hundreds of camps like Regal, and all of them lack adequate water and sanitation facilities. A March study by the agencies noted that: Only 48 percent of the camp residents had daily access to an adequate supply of potable water; Only 61 percent of that water had the correct amount of chlorine, meaning that it runs the risk of being contaminated by and transmitting cholera; On average, 112 people had to share a single camp latrine; Only 18 percent of camps had hand-washing facilities; and only 29 percent of camps had a disposal system for “solid waste.”

The numbers for Petit-Goâve are even worse: 141 people per latrine, 185 people per shower.

“Instead of getting better or even staying neutral, I think we’re going backwards,” Bazile said.

Plans Leave Out Haiti’s Poorest

In addition to living in subhuman conditions, most of the over 634,000 people still in the 1,001 camps are likely not part of the planned reconstruction projects – which include almost 70,000 new or repaired housing units – because most of them were renters, and renters are not part of the “Neighbourhood Return and Housing Reconstruction Framework”.

In addition, HGW journalists discovered: Even if all of the planned repairs and construction of 68,025 units takes place, that will account for only about 22 percent of the 304,060 victim families counted up in the camps last fall. (Today there are less people in the camps due to various factors, including the expulsions of over 50,000 people, and the return of thousands of families to unsafe lodgings.)

At least 5,400 of the planned new or repaired units are actually slated for Haiti’s North Department – far from the earthquake epicentre and its victims, but right next to the where foreign companies are planning a new industrial park with low-wage assembly factories.

The 116,000 T-Shelters have gone to many deserving families, but most were landowners or homeowners prior to Jan. 12, 2010, and over half of the 304,020 displaced families counted last fall – over 173,000 of them – didn’t own a home or land. They’ve been left out. Also, there have been numerous documented cases of “T-Shelter corruption”, where the houses are broken up and the lumber sold off or rented.

No single agency – national or international – is the point institution on reconstruction of housing, although it appears that progress is finally being made in that sense.

Delva, who didn’t get a T-Shelter, and whose rotting tent leaks, has practically given up hope. “They say we have leaders? We don’t have leaders in this country. They’ve abandoned us, like a stray dog.”

*This article is part of a four-part series, in French and English, at http://www.haitigrassrootswatch.org

Haiti Grassroots Watch is a partnership of AlterPresse, the Society of the Animation of Social Communication (SAKS), the Network of Women Community Radio Broadcasters (REFRAKA) and community radio stations from the Association of Haitian Community Media.

By Arsène Séverin
BRAZZAVILLE, Aug 24 2011 (IPS)

Marguerite Kassa feared she would find herself alone in the small crowd of a dozen other pregnant women at the integrated health centre in Mossendjo, in the southwestern Republic of Congo. “I am six months pregnant already, but I hesitated to come here before now, because there is so much contempt for us,” the thirty-year-old indigenous woman tells IPS. “Yet I was warmly welcomed.”

While around 80 percent of Congolese women give birth in health facilities, fewer than one in four indigenous women give birth at health centres.

Widespread discrimination

In 2007, indigenous people in Congo numbered 43,500, just under two percent of the country’s population of 3.7 million. To promote and protect their rights, a law was adopted in February 2011 which “forbids”, in its first article, the usage of the appellation “pygmy”. Article 22 of this law guarantees “access without discrimination” to health services for these populations.

According to the United Nations Population Fund (UNFPA), less than 20 percent of indigenous women in Congo visit a clinic even once during their pregnancy.

“They don’t go because of discrimination. The staff treat them like objects,” says Jean Nganga, president of the Association for Defence and Promotion of Indigenous Peoples, based in the Congolese capital, Brazzaville.

“The midwives leave us waiting, they laugh at us even before we reach the integrated health centre (CSI). This discourages us,” explains Kassa.

In a survey conducted in April and May 2011, the Congolese Association for Health in Cuvette-Ouest, a non-governmental organisation based at Mbomo, in the north of the country, found that of 520 women of child-bearing age, only eight had given birth at a health centre.

“They tell us they don’t have money to pay the consultation fee or for baby clothes,” says Thomas Okoko, the head of the NGO.

“We see them pregnant, but we don’t know where they give birth, because they don’t turn up in our maternity wards,” confirms Léonard Itoba, a doctor at the hospital in the northern town of Ouesso.

“I don’t think that a lack of baby clothes is the real reason,” says David Lawson, the UNFPA’s representative in Congo. “These are snapshots of the demeaning stigmatisation which pushes them away from health facilities.”

“Hostility towards indigenous women in the CSIs is what pushes them to give birth in the forest,” agrees Roger Bouka Owoko, executive director of the Congolese Observatory for Human Rights, an NGO based in Brazzaville.

Community cares for its own

In Paris, a village some 60 kilometres from Ouesso, a traditional birth attendant says that on average she helps five or six indigenous women give birth each month.

“I am sometimes forced to use a razor blade to ease the birth of the child, because of the lack of antenatal care, these women have very small/constricted uteruses,” she says.

“We still have confidence in our traditions,” explains a sexagenarian woman in the village of Ngouha II, in the south of the country. “For example, when a woman is approaching full term, she no longer walks alone in the forest. And once the birth pains start, she knows what needs to be done: she has to sit down at the base of a tree.”

Gyldas Ngoma-Mifoundou, a sociologist at the Université de Brazzaville tells IPS: “It’s a question of culture, and there are many herbs which help indigenous women to give birth more easily.”

Change beginning to be felt

To encourage more pygmy women to labour and give birth in the presence of a skilled attendant, the CSIs in two of the country’s twelve administrative departments, Lékoumou in the south and Sangha in the north, have waived consultation fees for pre and post-natal checkups. “We have directed that not a single franc should be asked from a pregnant indigenous woman,” Dr Marcel Elion, director for health for Sangha, tells IPS.

Supporting this initiative by the departmental directors, the UNFPA is supplying birth kits to indigenous women. “The bag has got baby clothes, medicine, gloves and syringes,” says Philomène Ipande, an indigenous woman.

Angélique Bounda, 24, is a young indigenous woman who gave birth at the Dolisie Maternity Unit in the southwest of Congo-Brazzaville at the end of July. “I came in to be weighed [prenatal checks] here and I followed the advice of the midwife right until the delivery,” she tells IPS with a smile.

Excerpt:

Only six sub-Saharan African countries have failed to reduce the number of women dying in childbirth over the last two decades. High-spending South Africa is among them, with maternal mortality rates more than quadrupling since 1990. Human Rights Watch researcher Agnes Odhiambo says this is largely due to a lack of accountability.

Maternal mortality rates in sub-Saharan Africa as a whole have been reduced by a quarter compared to 1990 levels. But the continent’s most developed economy is moving in the opposite direction: South Africa’s maternal mortality rate in 1990 was 150 per 100,000 live births; in its 2010 MDG progress report, the country reported this had risen to 625 per 100,000.

“HIV is a big factor in maternal mortality in South Africa,” says Odhiambo, adding that improved reporting means deaths that might have gone unrecorded in the past have also been added to the total.

“But even with all that, the kind of negligence that is happening in our facilities… from what women were saying, substandard care is a big problem and that is an issue that we truly have to think about.”

Health workers failing patients

The survey, ‘Stop Making Excuses: Accountability for Maternal Health Care in South Africa’, reveals a picture of serious neglect, including women in labour being sent home from hospitals without being examined, women ignored or made to wait for hours – even days – by nurses when they asked for help, women being physically and verbally abused by staff, and others forced to change their own sheets or carry their newborns around the hospital while still weak from giving birth. Women with HIV and those from other parts of Africa also reported experiencing discrimination.

“For me, that is failing women,” says Odhiambo. “You fail women when a woman loses her baby and you don’t even bother to explain to her what caused the death of that baby… Or when women are made to clean up their own blood, or when women are forced to sleep (in the same bed) with their baby barely three hours after a c-section, when they’re not yet strong enough.”

The provincial secretary for the National Education, Health and Allied Workers Union (Nehawu) in the Eastern Cape, Xolani Malamlela, acknowledged that health workers’ performance sometimes falls short, but said the union’s assessment is that the problem begins with poor management of health institutions.

Malamlela says that health workers are frequently overworked and are not always paid on time, leading to a demoralisation of staff. He also says procurement policies that have centralised control of stocks of medicine and equipment in the provincial capital have deprived individual hospitals of the capacity to manage vital supplies.

“But we cannot deny that you might here and there find those reckless staff… and we must also play our part in encouraging our members not to deal with patients in a very reckless manner,” he says.

Managers failing patients and health workers

Odhiambo’s report is critical of a failure to act on complaints – not only in sanctioning individual health workers but in recognising system-wide problems that contribute to abuse and neglect. She points out that South Africa’s health authorities are negligent on another level, in failing to collect appropriately detailed information about maternal mortality that would guide policy.

The country has not conducted a Demographic and Health Survey since 2003, for example. Cost is cited as the reason for the delay, but countries with lesser resources have more up-to-date statistics.

“Our health systems are challenged,” says Marion Stevens, a midwife and member of Women in Sexual and Reproductive Rights and Health. She says the main factor in maternal deaths is HIV/AIDS, but argues that the national health department’s focus on the pandemic is poorly executed.

“Accountability is an important issue, because it asks the question why. With all the resources that are being spent on AIDS, why are we not looking also at women’s health, and in particular at maternal mortality as a related issue?”

The focus on AIDS, she says, has come at the cost of considering a continuum of health care. For example, women are told not to go for antenatal care until they are 20 weeks’ pregnant because clinics are overwhelmed by other demands.

“So for women who are ill when they’re pregnant, if they want to get well, or if they are HIV-positive, or if they want to choose to have an abortion, then they essentially come in very very late, and that’s problematic.”

Stevens says the health department has designed a powerful new strategy for sexual and reproductive health rights which provides for greater accountability and integrating issues of HIV and AIDS into a holistic view of women’s health, but since it was completed in May, the document has been sitting on someone’s desk.

Restoring accountability

Odhiambo says that South Africa’s health system lacks adequate monitoring by patients. “A lot of monitoring of what is going on has been done from a provider point of view, but I think there’s a need to bring in patients to say what is not working for them.”

She envisions that this could help to break down the barrier between health workers and users of the system. “Health workers are feeling targeted by this notion of patient complaints, but they’re feeling targeted because the mechanism is not being used in the way it should.

“If patient complaints are implemented properly, then health users and health workers should be friends, because health users are complaining about the problems they’re facing in different facilities, as are health workers and nurses, so the two can really join forces and push the government to make the changes needed so that you’ve got happy users and happy providers.”

By Miriam Gathigah
NAIROBI, Jul 27 2011 (IPS)

On the road between the Kenyan and Somali border lie the dead bodies of children who have succumbed to the famine and the hardships of making the journey from their drought-stricken villages to Kenya.

A child from drought-stricken southern Somalia who survived the long journey to an aid camp in the Somali capital Mogadishu. Credit: Abdurrahman Warsameh/IPS

And it is the story of these children who die between Somali’s southern town of Dobley, which is the last border town before crossing into Kenya, that is yet to be told, aid workers say.

Ahmed Khalif, who works for a local non-governmental organisation in Kenya and regularly crosses the border between the two countries for his work to aid people in Somalia, talks of seeing the bodies of numerous children on the roadside.

“I am a regular on the route between the Kenyan and Somali border, anyone who has used this route will narrate horrific stories of dead bodies, mostly children.

“Their mothers are dying too. It’s not a heartless mother leaving a child behind, just a mother who wants to survive for the sake of living,” attests Khalif.

He says he sees droves of mostly women and children attempting to cross the border to Kenya. But when the children become too weak to walk any longer, they just fall down on the roadside while their mothers and families, half dead with starvation, continue to walk on in an attempt to reach the border and hopefully, aid.

“It is a shocking image to see (children) on the brink of death, their skin sagging from extreme dehydration, their frame too small for their height, their lips dry. They don’t talk, they just lie there.

“(Their) eyes sink into their sockets, but still they stare back at you. It is very disturbing. You think the others are heartless for abandoning them, but they too are in the same physical shape. Only the will to reach Dadaab keeps them going,” Khalif explains.

Those children who die along the way are not buried.

“Who has the extra strength to do so? Those moving on are very weak too, they just keep going…at the camp, that’s where they get buried. When they die there,” Khalif says adding that Dadaab has a makeshift graveyard.

Those Somali children who have survived and make it to the Dadaab refugee camp in Kenya have done so after enduring unimaginable levels of hardships, walking for at least 10 days in intense heat, through a hyena-infested no-man’s land, to get to the camp.

“The Al Shabaab (extremist group that controls much of southern Somalia) continues to make it difficult for people to access Kenya and Dadaab by making Dobley, the last border town in Somalia, inaccessible to Somalis who come from Al Shabaab-controlled regions,” Khalif says.

This is despite the fact that the town is now controlled by Somali government forces, who seized control from Al Shabaab three months ago.

So instead of walking 15 kilometres from Dobley to Kenya, many have to take a route that bypasses the town and walk an additional four to nine days just to get to the border.

But this longer route is dangerous. Roaming bandits rape women and steal the meagre possessions of those trying to find aid.

But at Dadaab, which has now become the largest refugee camp in the world with over 380,000 people, life is still difficult, especially for children. Four children die daily as almost 1,300 Somalis fleeing the drought continue to arrive everyday. This is according to United Nations (U.N.) agencies, which say over 300 million dollars are needed over six months to help save the children affected by the drought.

“The children are too small, too light for their age. Their condition has exceeded the global acute malnutrition rate. This drought is reversing gains made in reducing child mortality,” says Oliver Yambi, the United Nation’s Children’s Fund’s (UNICEF) representative in Kenya.

Yambi adds that U.N. agencies are now encountering malnutrition levels of up to 35 percent, a severe form of malnutrition characterised by extreme weight loss and children having a very small frame for their age.

The World Health Organisation has set a 15 percent threshold against which the extent of malnutrition is measured. Anything above the 15 percent mark shows an advanced state of acute malnutrition and children in this stage rarely survive. They are 10 times more likely to die before age five.

According to UNICEF, the number of acutely malnourished children under five years in Somalia increased from 476,000 in January to 554,550 in July.

And their mothers are not faring any better.

“Children are not the only ones dying at Dadaab. Maternal mortality is very high. We estimate that for every 100,000 live births, at least 298 women will die. But these figures are moderate. The numbers are rising due to the extreme anaemia as well as the ratio of patients to nurses. On average, there is one health facility for every 1,700 refugees and counting,” explains a source from OXFAM. Eighty percent of the refugees in the region are women.

The U.N. said in a statement on Jul. 27 that the famine can lead to complications during pregnancy and childbirth and increases the risk of maternal deaths and infant illnesses.

“Experts estimate that eliminating malnutrition among mothers can reduce disabilities in their infants by almost one third.

“UNFPA (the United Nations Population Fund) country offices in Somalia, Kenya, Ethiopia and Djibouti are carrying out emergency measures to distribute reproductive health care supplies, medical equipment and dignity kits to affected populations. This will ensure life saving treatment for mothers and their children, while also facilitating safe deliveries of newborns,” the statement said.

Excerpt:

By Danilo Valladares
GUATEMALA CITY, Jul 27 2011 (IPS)

María José Aceituno, who works at a public relations firm in the Guatemalan capital, has two children and says she is not having any more, in order to safeguard the financial position and security of her family. “I would rather have two happy children than 10 who are dissatisfied,” she said.

The countries of Central America have slammed on the demographic brakes by promoting sex education and access to family planning methods, in order to improve living conditions, which are marked by poverty and social inequality.

Other factors, like the high cost of living and soaring rates of violence and crime, especially in El Salvador, Guatemala and Honduras, have also acted as a disincentive to increasing family size. Aceituno belongs to the new generation of Central Americans who are choosing to have smaller families, in contrast to the situation over 10 years ago, when it was customary to have five or 10 children.

“I would really like to have another child, but schools are so expensive now, and besides you have to be so careful about the crime situation,” said the 33-year-old Guatemalan woman who says she is against repeating the life led by her parents, who had four daughters, and even less by her maternal and paternal grandparents, who had five and seven children, respectively.

Statistics confirm the trend. In Guatemala, the total fertility rate (the average number of children a woman will have in her lifetime) for women aged 15 to 49 dropped from five to 3.6 over the decade between 1998-1999 and 2008-2009, according to the National Survey on Maternal and Child Health (ENSMI) 2008-2009, carried out by the Health Ministry.

Over that decade, use of modern and traditional family planning methods by women with steady partners and aged 15 to 49 increased from 38.2 to 54.1 percent, according to the study, in this country of 14 million people.

These figures show that “the population is accepting” advice on family planning offered by non-governmental organisations, women’s and young people’s groups and the government, Dalila de la Cruz, of the Family Welfare Association of Guatemala (APROFAM), told IPS.

“Economic conditions for families could improve, since they won’t be sharing their income among 10 people, but among four. This means they will have more access to health, food and clothing,” she said.

De la Cruz said one success was the detailed regulation of the 2009 Guatemalan family planning law, which allowed sex education in primary schools and facilitated access to family planning methods via the Health Ministry, the Social Security Institute and other institutions.

But there are still great challenges to overcome. In 2009, 41,529 births were reported to girls aged 10 to 19, while in 2010 the number climbed to 45,048, according to the Health Ministry, which did not count pregnancies that did not reach term, nor home births attended by midwives.

Language is a difficulty in Guatemala, where in addition to Spanish, Garifuna and 22 Maya languages are spoken.

“In some cases, Maya women have been given contraceptive methods with an explanation in Spanish, which they did not understand. It’s like not having access to the methods at all,” Griselda Lorenzo, of the National Alliance of Indigenous Women’s Organisations for Reproductive Health (ALIANMISAR), told IPS.

Lorenzo said there is a need for information and access to more family planning methods, as these are ever more widely used in spite of the risks they sometimes pose. “Many women use injections (like Depo-Provera) so that their husbands do not find out they are using contraceptives, because they face the risk of being beaten or abandoned for using birth control,” she said.

Half of the 43 million people in Central America – made up of Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama – live below the poverty line.

Nicaragua, a country of 5.8 million people, is also making efforts to promote family planning. Its crude birth rate has in fact fallen from 46 to 24 live births per 1,000 population between 1970 and 2009, according to the United Nations Population Division.

Dr. Freddy Cárdenas, of the Nicaraguan Family Welfare Association (PROFAMILIA), told IPS his country “has achieved a high level of contraceptive use, with a relatively well-balanced mix of methods.”

He said the Education Ministry included sex education in school curricula in 2009, and produced and published a sex education manual and a basic information guide for teachers.

“Sex education, as taught, focuses on family life and HIV/AIDS prevention, but it does not include specific information on pregnancy prevention, abortion and sexual diversity,” he complained.

Lack of sex education, and expanding the distribution of family planning methods to the entire population, remain challenges in this Central American country, Cárdenas said.

“Women who can plan how many children to have, and when, enjoy better health, have fewer unplanned pregnancies and are at a lower risk of having an abortion. They also have more educational and employment opportunities,” Cárdenas said.

In contrast, Costa Rica has been promoting family planning for decades. “In the 1970s there was an intense campaign that had a powerful effect, with slogans like ‘Have the number of children you can make happy’,” Ana Caicedo of the Feminist Information and Action Centre (CEFEMINA) told IPS. “During the campaign the Catholic Church, for instance, took a leading role, holding courses on family planning.”

Caicedo attributes the “huge” fall in the birth rate in Costa Rica to the family planning movement. Today “the country has a fertility rate that, in some years, is below the replacement rate, which means there would be a decline, not an increase, in the population if it were not for immigration.”

But this country of 4.6 million people also struggles to teach sex education in schools.

“The Education Ministry drew up guidelines for sex education, but they have never been used because of interference by the Catholic Church leadership,” she said.

In Caicedo’s view, family planning “is a matter of basic rights, of self-determination.”

Meanwhile, the populations of Honduras and El Salvador are also growing more slowly, and these countries are making similar efforts in family planning and sexual health, in pursuit of a better quality of life and preventing premature births, maternal mortality, HIV/AIDS, abortions and unwanted pregnancies.

The crude birth rate dropped from 47 to 27 births per 1,000 population between 1970 and 2009 in Honduras, and from 43 to 20 in El Salvador over the same period, according to U.N. figures.

However, concern for the improvement of sexual and reproductive health persists.

“Some components of sexuality are addressed with an emphasis on preventing teenage pregnancies and HIV/AIDS, but the only form of contraception advocated is abstinence,” María de la Paz, of El Salvador’s Alliance for Sexual and Reproductive Health (ASSR), told IPS.

Excerpt:

By IPS Correspondents
JUBA, Jul 8 2011 (IPS)

Mother of eight, Jessicah Foni, 36, hopes that independence will mean a hospital will soon be built in her village. Foni, who has travelled from a remote village in South Sudan to the state’s capital to celebrate independence, lost two babies at birth because of the lack of medical facilities in her area.

“I come from a very remote village that is far away from any medical facility. I have lost two children due to problems related to delivery. Our new government should build hospitals close to us so that we can access medication,” she said.

South Sudan has one of the highest maternal and child mortality rates in the world. Out of 100,000 live births, 2,054 women die.

Dr. Abdinasir Abubakar, the medical officer in charge of the World Health Organization (WHO) office for South Sudan, said the harsh and unfavourable living conditions, coupled with very limited access to basic health services, contributes to the poor health status of the population

According to the Sudan Household Health Survey and the World Children’s Status Report 2008 by UNICEF, out of 1,000 live births in health institutions, 102 infants die.

It also found that only 48 percent of Sudanese women visit medical facilities during pregnancy while only 13 percent deliver at hospitals, attended to by skilled workers who constitute only 10 percent.

Grace Joan, 26, a mother of five says she has never delivered any of her children in hospital.

“When my time is due, I just call a neighbour who helps me deliver my children. But I am happy that we have our freedom, which will enable the government to provide health facilities to all people so that women and children do not die of preventable diseases,” she said.

Abubakar says only 25 percent of South Sudanese have access to medical facilities, making it hard to provide services to the population.

“Preventable infectious diseases like malaria, presumed pneumonia and diarrhoea account for the majority of the reported diagnosis in health facilities for all health groups combined. Preventable infectious diseases and malnutrition are the most common causes of morbidity and mortality for children under five years of age,” he said.

But as South Sudan prepares to celebrate its independence on Jul. 9, experts and policy makers all agree that urgent steps have to be taken to address the health sector in the country.

Dr. Olivia Lomoro, the Under Secretary in the ministry of health says government is aware of the situation and has put in place systems to address the problem.

“For the past five years since the Comprehensive Peace Agreement, the government has taken over the payment of salaries to all the workers in the health sector. The government also procures and distributes all essential drugs for all the medical facilities. We had our first ever health symposium last month to discuss ways to improve the health sector,” she said.

Robert Kimani, who owns a small pharmacy in Juba, said life is very expensive in the city and residents would rather buy food than drugs – even if they are sick.

Dr. Meshack Adan, who works at the Juba Referral Hospital, the country’s biggest and only referral facility, said government should encourage people to use existing medical services.

“Where are the 75 percent of our people who don’t get medical services?” he asked.

Lomoro said government, in collaboration with WHO, have drafted a five-year National Health Framework which commits government to addressing the health situation in the country. The policy framework will allow government to address the acute shortage of personnel by training health personnel to improve services.

Abubakar said only 10 percent of the staffing needs are filled by qualified health workers and there is an urgent need to train doctors, clinical officers, and midwives, among others, to offer the best services to the people.

He called on government to reconstruct the country’s dilapidated medical facilities and to improve infrastructure so that medical staff can respond to emergencies.

Excerpt:

By Rosebell Kagumire
KAMPALA, Jul 8 2011 (IPS)

When Valente Inziku’s wife, Jennifer Anguko, went into labour they had decided she would go to the local referral hospital just to ensure a safe delivery.

An elderly woman holds up a poster at the Constitutional Court where the maternal health case was postponed. Credit: Rosebell Kagumire/IPS

“We attended antenatal clinics and each time they advised us to be near the health center when the delivery time comes. We did just as we were told and when we arrived the services were not provided,” Inziku said.

He had arrived at the hospital after his wife did and found her bleeding. “All the nurses were telling me was I had to clean the blood myself. I had my sister so we cleaned the blood,” said Inziku. “It was purely negligence of the nurses I kept calling them and they would tell us it is not yet the time for her to deliver the baby.”

So Inziku and his sister literally sat down holding his wife as she bled to death. “She died in my arms. She told me: ‘We have children, we have love but all this seems nothing if we have no help.’” Inziku said.

Inziku says the only doctor appeared 12 hours after his wife was admitted. “When the doctor finally arrived he told me it was too late and he asked why the nurses had called him,” Inziku said.

Inziku, a primary school teacher, is now left to look after their three children, all under the age of 10, alone.

Inziku is part of a group that has petitioned the Uganda Constitution Court to pronounce the escalating maternal deaths in Uganda violates the Constitutional rights of Ugandans.

The case was brought to court in March by the Centre for Health, Human Rights and Development together with three individuals: Professor Ben Twinomugisha, a lecturer at Makerere University; and two health activists, Rodah Kukkiriza and Inziku.

They want government to address maternal mortality and compensate the families that have lost mothers to negligence or poor services.

In the petition, the activists argue that by not providing the essential services for pregnant women, and many others, the government of Uganda is in violation of the fundamental obligation of the country to uphold the Constitution and defend, protect and promote the right to health and the right to life.

“I am here today because I want the court to know there’s an injustice going on. I have pain in my heart,” said Inziku.

The court was scheduled to hear the petition on Jul. 7 but the case was postponed because they did not have the required quorum of five judges.

Noor Nakibuuka Musisi, the programme coordinator at Centre for Health Human Rights and Development said securing a court declaration would be a great start in getting government to act.

“We want a declaration that the non-provision of essential services in the government facilities is a violation of the right to life,” she said. “The reason many women die is because there are no maternal kits, there’s no blood in hospitals and we have poorly paid health workers not behaving in the most ethical way.”

In June the Ugandan government announced an increase in the health budget for the 2011/12 financial year. It increased from 270 million dollars to 412 million this year.

However, Francis Runumi, the commissioner of health services and planning at the ministry of health said most of the budget was going to infrastructure and would not address the human resource crisis that has contributed to maternal mortality figures.

Still activists question the political commitment and health sector accountability. Recently government spent 760 million dollars on fighter jets and other defense equipment, which many question as a priority for Ugandans.

Robinah Kaitiritimba, the executive director of the Uganda National Health Consumers Organisation, part of the coalition that brought the case to court, said Ugandans must fight for their rights.

“There are no rights which are given on a silver platter, we must continue to fight and ensure our government responds to the cries of mothers and families.”

Maternal death in Uganda has remained high over years, every day at least 16 women die in childbirth. Uganda’s maternal mortality figures are at 435 deaths of every 100,000 live births, which translate to 6,000 deaths annually. Also child mortality remains high with infant mortality rate at 78 per 1000 births.

Most of the maternal deaths in Uganda are preventable and mainly caused by the massive shortage of trained and motivated professional health workers to attend births, lack of access to emergency obstetric care for responding to emergencies, lack of access to quality antenatal care, and lack of access to family planning services.

The gap in access to life-saving HIV treatment and malaria prevention and treatment are also major causes of maternal deaths.

Excerpt:

By Poindexter Sama and Jessica McDiarmid
FREETOWN, Jun 20 2011 (IPS)

There is a brief bustle and then a woman wails as the small body is wrapped in cloth and set on a cot by the door of the paediatric ward. Nurses in pristine white uniforms continue to pad quietly around the large room at Ola During Children’s Hospital in Freetown, Sierra Leone’s capital city.

Infants are crammed two or three to a bed, sometimes more. Since the introduction nearly 14 months ago of free health care for pregnant women, lactating mothers and children under five, the number of people coming to seek treatment has shot up. Staffing and equipment has not risen to match, leaving health workers struggling to deal with the influx.

Sierra Leone’s ambitious plan to tackle one of the world’s highest rates of maternal mortality and infant death has garnered much praise from both international donors – who fund the majority of the program – and from within the country’s own borders.

In a country where one in five children dies before their fifth birthday, and one in eight women dies from complications of pregnancy or childbirth, free health care is seen as a huge step forward – and an enormous challenge.

According to a recent report by Sierra Leone’s ministry of health and sanitation, government-run hospitals saw about three times as many children under five – nearly three million – in the first 12 months of the program as in the preceding year. More than 126,000 women gave birth in hospital in the first year of the program, compared to about 87,000 in the previous year. The number of maternal complications treated in hospital increased from about 8,000 to over 20,000.

“Although the number of health staff has been increased since the launch of (free health care) it is still insufficient to match the service delivery demand,” said the report, entitled “The Free Health Care Initiative: 1 Year On.”

At Freetown’s largest public hospital for women and children, Dr. Mahmoud Idriss Kamara says the pressure on staff posed by the patient increase is wearing everyone down. Kamara sits behind a battered table, answering questions in between instructing staff, shuffling files, answering phones and signing the death papers for the child who’d just died. He has more than 24 hours left in his shift before he’d be able to get some sleep.

Across the ward, nurse Lucy Macauley says staff exhaustion leads to a poor standard of care for patients. She says they need help and the increase in workload should be accompanied by pay raises. “We’re working harder, but for the same pay,” says Macauley. Much of the equipment is obsolete and there are chronic shortages of supplies, she says, and the complex, which houses a maternity hospital and a children’s hospital, has an inadequate water supply – often, there simply isn’t any.

The hospital has been under scrutiny since an incident earlier this year when a woman died there from severe complications while the doctors scheduled to be on duty were absent. Those doctors have since been suspended.

The cost of the first year of free health care is estimated at 36 million dollars, the majority of which is put up by donors. But reports of corruption within the system are widespread. Patients recount being asked to pay for services and medications that should be free, or having to buy drugs when hospital supplies are said to have run out.

Umu Fofanah says she went for an ultrasound during her pregnancy because her doctor was concerned about the position of the baby. “When I went to do the scan, I was asked to pay 35,000 leones,” says Fofanah. “Not only me, but about 10 of us who were present.”

Other expecting mothers paid the roughly eight dollars for a scan that should have been free, says Fofanah. “But I had no money to pay, so I was sent home.”

Fofanah told a friend who happened to be the wife of Amnesty International’s Sierra Leone country director, Brima Sheriff. When he learned what had happened, he sent monitors with her to subsequent appointments or accompanied her himself to ensure she received free treatment.

“People are still paying for a lot of drugs and a lot of services,” says Sheriff. “This is not a secret. Everyone knows that people are still being asked for money, and it’s going into the private pockets of someone, at the expense of the women. The free health care was supposed to be for women but cost is still stopping them.”

Jonathan Abass Kamara, the public relations officer for the ministry of health and sanitation, says the government is always ready to react to reports of “the contravention of the principles of free health care.” Kamara cited several examples of medical staff being disciplined for extortion of patients or otherwise breaking the rules.

He says the initiative’s aim of reducing maternal mortality and infant death has been achieved, though exact figures are not yet available.

A 2009 Amnesty International report identified cost as the largest barrier to women and children accessing health services. In a country recovering from a decade-long war that ended in 2002, 70 percent of the population lives on less than one dollar a day. There are fewer than 100 doctors for some six million people and most health facilities are poorly equipped and lack basics like water supply and electricity.

While calling for better monitoring and accountability measures, Sheriff applauds the initiative and points out that there are a lot of positives to the free health care system. “But we need to recognise that it needs to be improved. We need to ensure that gaps are not left that allow some to defraud others.”

Excerpt:

By IPS Correspondents
WASHINGTON, Jun 17 2011 (IPS)

By 2015, women demanding family planning products and services in the developing world will likely reach 933 million, a terrific increase from the current 818 million women demanding access to these basic reproductive commodities.

In addition, according to the Reproductive Health Supplies Coalition (RHSC), the number of family planning users will soar from 603 million to 709 million – an increase of 64 million users across 66 developing countries, and 42 million spanning 89 middle-income countries – by the middle of the decade.

The increased cost associated with this skyrocketing demand is an estimated 5.7 billion dollars per annum for both low- and middle-income countries – including the expenses of procuring more contraceptive commodities, securing transportation for the products, expanding communication capabilities to educate the public, and stepping up training for health providers to distribute reproductive products and services.

“Today, there are over 200 million women in the developing world who want to prevent or delay pregnancy, but are not using any means of modern contraception,” John Skibiak, director of the RHSC, wrote earlier this month. “This is, without a doubt, a horrifying figure. But the greatest tragedy for us – those of us who have dedicated our professional lives to ensuring global access to family planning – is that this figure has not budged in nearly two decades… Each step forward is more than matched by comparable increases in demand in new users, [so] despite our best efforts, we are caught in a deadlock.”

According to Skibiak, 424 million dollars worth of commodities will be needed to satisfy demand for contraceptives by the year 2020, in donor-dependent countries alone.

If donor funding continues at its current rate, the world can expect a shortfall of nearly 200 million dollars annually, or a total deficit of 1.4 billion dollars between 2008 and 2020.

“What we need now is a reinvigorated effort to ensure [reproductive health and commodity security],” Skibiak said. “True contraceptive security exists when every person is able to choose, obtain and use quality contraceptives and condoms for family planning and for the prevention of HIV and AIDS and other sexually transmitted infections.”

Simple Technologies, Huge Results

Coming on the heels of the successful Global Alliance for Vaccines and Immunisation (GAVI) pledging conference earlier this week, which raised over 4 billion dollars to push the global health agenda forward, a congressional hearing on public-private partnerships in Washington D.C. Thursday raised the bar a little higher.

The Program for Appropriate Technology in Health (PATH), Research!America, the Global Health Technologies Coalition, and Bioventures for Global Health, in collaboration with Congressmen Albio Sires and Mario Diaz-Balart, presented ‘Partnerships for innovation: Simple solutions that save lives’, which outlined the use of fast solutions to immense global issues.

“The briefing on the Hill is meant to highlight the benefits of investment by the United States government and the U.S. Agency for International Development (USAID) in innovation, and to spotlight how we’ve been able to use this funding to produce technology that is greatly improving people’s lives,” Christopher Elias, president and CEO of PATH, told IPS.

With 32 field offices spanning 23 countries worldwide, PATH employs a user-driven design process, whereby its innovation efforts are fed directly from the grassroots.

PATH believes that it is only by monitoring and understanding local and community needs that the characteristics of a particular solution can be properly identified.

“One of the problems our field staff encountered was that the basic contraceptive diaphragm was not available in developing countries because it required gynaecology exams to determine which size should be used on the woman,” Elias told IPS. “As a result, scores of women in low-income countries were missing out on a simple method of birth control because of the absence of the necessary intermediary.”

So PATH worked to design a new silicone “one-size fits most” contraceptive diaphragm that eliminates the need for gynaecologists and that has been welcomed by women from Africa to Latin America and South Asia.

“We worked on this for ten years and went through over 20 different designs in a totally interactive design process, so that the end product was something the women would definitely use,” Elias told IPS. “One thing we were not expecting was that colour mattered a lot to the women – and in fact the final product is a very soft shade of purple, almost lilac, something that was universally popular. This is something we could not have anticipated without worldwide feedback!” he added.

In addition to creating new products, PATH believes that public-private partnerships are essential for deploying already-existing technologies to the women most in need.

Last year, the United Kingdom-based HIV/AIDS charity, AVERT, reported that in 2009, over 400,000 children under the age of 15 became infected with HIV – the large majority of them through mother-to- child transmission (MTCT).

In fact, the absence of proper treatment means that HIV-positive pregnant mothers face a one in four chance of passing the infection to their newborns. Given the current statistic of 18 million HIV-positive women in the world today, these numbers portend an almost-certain tragedy.

Nevirapine, an antiretroviral that has been made available free of charge by the German manufacturer Boehringer Ingelheim, reduces the risk of MTCT by 50 percent; however most women – especially those in remote rural areas – have been unable to access the required dose, delivered in syrup form, since their last visits to health workers often take place several weeks before birth.

“So PATH worked with USAID funding and Kenyan health workers to create the nevirapine pouch,” Elias told IPS.

“We developed a very simple system where nurses in antenatal clinics could fill a syringe with the right dose, cap it and seal it in a foil pouch with very simple, low-literacy instructions on it so that a mother could safely and easily give her baby the six drops of medicine to prevent MTCT, in her own home, minutes after delivery.”

“All it took was a simple packaging solution to enable millions of mothers to prevent unnecessary transmission to their children,” he added. “This is just one more example of the immense possibility of partnerships in reaching the most vulnerable populations.”

Luckily, PATH is not alone in its efforts. Next week, various members of the reproductive health community will converge in Addis Ababa, Ethiopia, to observe the tenth anniversary of the 2001 Istanbul conference ‘Meeting the Challenge’, which pioneered the global reproductive health supplies movement.

The RHSC’s two-day-long ‘Access for All: Supplying a new decade for reproductive health’ workshop series will form the nucleus of the conference, harnessing voices and strategies from the health community to meet the challenges of the coming decade.

Excerpt:

By IPS Correspondents
BRUSSELS, Jun 15 2011 (IPS)

Twenty women from four continents consider the words discussion leader Anne Schoenstein, of the Association for Women’s Rights in Development (AWID), has written on a flip chart. She strikes out in blue ink a previous sentence. She begins writing a new one – a demand aimed at aid donors – dictated by Nurgul Djanaeva.

“Make human rights indicators compulsory in development cooperation and development results,” Djanaeva, a representative from the Forum on Women’s NGOs of Kyrgyzstan, dictated.

“We should add gender equality,” said Silvia Kuhla, from Austrian Care Osterreich, a group dedicated to development cooperation and humanitarian aid.

Schoenstein added a ‘+GE’ over human rights. The women collectively nodded their heads and continued to ponder how to best articulate the need for progressive change in development cooperation internationally.

A Consultation With Cooperation

Women in Development Europe (WIDE) and AWID, alongside the BetterAid Coordinating Group (BACG), and a handful of other international women’s groups convened in Brussels last week. They met to discuss and forge a unified statement to present to the High Level Forum on Aid Effectiveness (HLF-4) that will take place in Busan, South Korea in November.

“As feminists and women’s organisations, we want to put pressure to promote gender equality in development cooperation,” said Lisa Alpizar from AWID said in her keynote.

Many speakers spoke on the importance of a unified position to advance the women’s rights agenda in aid talks.

“We must collectively and jointly mobilise, unitise and lobby for development aid to include women and humans rights,” said Kaisa Staszewska of WIDE.

The Busan meeting, will be the forth-international summit on aid effectiveness, following up specifically on prior summits in Paris (2005) and Accra (2008). From these two summits stemmed the Paris Declaration and the Accra Agenda for Action – two declarations that largely omitted gender equality.

“Compared to the Paris Declaration, which was essentially gender blind, the Accra Agenda for Action brought some progress in terms of its recognition of gender equality, human rights, and environmental sustainability,” according to a statement by AWID.

But there is still progress to be made. Of the 32 paragraphs contained in the Accra Agenda for Action only three include commitments that might contribute to advancing gender equality and the empowerment of women.

“We tried to put those topics as development objectives,” said Alpizar. “It was very important to mobilise different women’s organisations to make sure our voice was heard at Accra.”

Although progress was made in 2008, Alpizar highlighted a common theme at the consultations: Accra was good on paper, but its goals were not being realised. “We really made great progress on these issues, but the paper is written one way and how it is implemented is another.”

A New Approach

Several speakers outlined the importance of moving away from the traditional donor-recipient structure of international foreign aid.

Mayra Gomez from the Global Initiative for Economic, Social and Cultural Rights outlined a new approach to aid implementation: the human rights approach.

“The human rights approach is based in five key principles,” said Gomez. “It’s linked in concrete ways to human rights standards. It provides accountability for powerful actors. It’s empowering for the beneficiaries. It promotes the participation of the beneficiaries to identify needs. It’s non- discriminatory, with prioritisation of the most marginalised, including women.”

This approach is not new. In 2003, the U.N. adopted a common understanding on human rights-based approaches to development cooperation and programming.

“It’s been around for a while, but hasn’t been fully utilised,” said Gomez. “The reason why many of the millennium development goals aren’t being achieved is because they don’t have a human rights framework.”

One of the key elements of the human rights based approach is fully inclusive participation. “Gender equality and women’s rights are infused in the human rights based approach. Participation would need to include women and girls so you have fully inclusive partnership,” said Gomez.

Not all participants at the consultation were eager to accept the new approach, and remained sceptical.

Others felt that for some groups it is too soon to move away from traditional donor-recipient aid.

“Without the essential precondition of a powerful and sustained national commitment to change, aid and aid reforms are limited in their capacity to address entrenched inequalities,” said Florence Etta of the Africa Gender and Development Evaluators Network.

A Resolved Stance

Regardless of the exchange, debate, and free flow of contrasting opinions, all participants agreed that a united stance for women’s rights on behalf of the billions of suffering women worldwide was needed ahead of the Busan meetings.

“The need of the woman is not felt seriously at a political level,” said Mama Koite Doumbia, past chairperson at FEMNET. “We live in a time of discrimination. We live in a society that is led by men. It’s a patriarchal society that is led by men, when in reality women in Africa represent more than 51 percent of the African population.”

Excerpt:

By Wambi Michael
KAMPALA , Jun 15 2011 (IPS)

Just a week after a group of civil society organisations petitioned Uganda’s constitutional court demanding that the government’s non-provision of essential services for pregnant mothers was a violation of the right to life; Margaret Nabirye lost her baby in childbirth.

Rose Nakanjako, the chairperson of Mama Club, a group of women Living with HIV/AIDS said she did not receive proper antenatal care. Credit: Wambi Michael

“I was roughly handled but when I complained, they told me to stop crying saying no one goes to the maternity ward when they are young” she said.

Her husband, Benjamin Schaf a German national who had flown back to Uganda for the birth, said he was disappointed by the health care services at the hospital.

“Coming to hospital is to ensure life is safe but that is not the case in that hospital. We lost our baby because of negligence by the nurses on duty. The only time we got attention from this hospital is after the baby passed on,” Schaf said.

“I just hate the whole thing. I bought everything since the hospital did not have the needed items to facilitate delivery. Now someone tells me if I want a post-mortem I have to give the pathologist transport,” he added in anger.

For many Ugandan mothers, childbirth continues to be dangerous and even deadly – for both mother and child. Uganda is facing a maternal health crisis. Maternal mortality rates have remained high in the last 15 years, with no significant decline. Sixteen women die of pregnancy-related complications every day – an estimated 6,000 women each year.

A group of civil society organisations have now petitioned the Ugandan Constitutional Court demanding a declaration that government’s non-provision of essential services for pregnant mothers and their newborns violates the fundamental obligation of the country to uphold, protect and promote the right to life and health services.

The petitioners; who include women activist groups, health experts, people with living HIV, want the court to force government to compensate all Ugandan families of mothers and children who have died due to negligence and non-provision of basic maternal health care. They have not asked for a specific sum.

The petitioners have also demanded that government adequately equip maternity wards and health facilities with drugs and personnel in order to provide better services.

The petitioners are using the deaths of two mothers, Sylvia Nalubowa and Jennifer Anguko, who both died in childbirth to argue their case. Sylvia Nalubowa died while giving birth to twins in 2009 at a government hospital in central Uganda. Nalubowa was allegedly taken to theatre where there was no medical doctor to attend to her. One of the twins also died.

Geoffrey Kisiga (21), Nalubowa’s son, has joined the coalition for better maternal health. “I lost my mother due (to) negligence and I don’t want that to happen to other mothers. All we are telling our leaders is to allocate more money and staff in hospitals to stop deaths.”

Jennifer Anguko, a local politician in Uganda’s West Nile region, also died due to neglect at a regional referral hospital.

Rose Nakanjako, the chairperson of Mama Club, a group of women Living with HIV/AIDS in Uganda told IPS that she also did not receive proper antenatal care. “My first born is HIV positive because I delivered from home. I was always insulted whenever I went for antenatal (services) so I stopped going there,” she said.

Kaitiritimba Robinah, the executive director of Uganda National Health Consumers told IPS that many mothers prefer to deliver from home because of inadequate or poor services offered at government hospitals.

“I don’t think any mother can refuse to deliver from hospital if everything (is) there and free of charge. Most of the mothers refuse to go to hospital because nothing is there. And if medicine is there, it is to be paid for,” she said.

Such cases are commonplace in Uganda’s government hospitals said Lillian Mworeko, an activist with the International Community of Women Living With HIV/AIDS.

“Health is a right but in this country, you would wonder whether we have any right to health when we have 16 mothers dying per day due neglect by health workers and lack of essential maternal health needs in hospitals,” said Mworeko.

David Kabanda, the petitioners’ lawyer said he was confident that the court will order government to devise and implement, within its available resources, a programme to realise the rights of pregnant women and their newborn children to access health services.

Kabanda told IPS that the government of Uganda has an obligation to allocate funding in priority areas in the health sector.

Richard Nduhura, Uganda’s minister for health told IPS that there are few ambulances in communities to respond to needs of women who need to deliver in hospital.

“I agree that provision of maternal health services has been one of the biggest challenges to our health system. But I think we are addressing that in the next financial year with substantial amount of money allocated to maternal health,” he said.

Maria Kiwanuka, the finance minister in June removed value added tax on the importation of ambulances. She also allocated 24 billion Uganda shillings for maternal health for the coming financial year.

Joachim Saweka, the World Health Organization country representative was happy that the government was finally responding to the call for better funding of maternal health. “I’m very happy became key issues like health, particularly maternal health have in the past not been squarely addressed by government. At least with 24 billion shillings in the budget, maternal health will be addressed.”

Excerpt:

By Marcela Valente
BUENOS AIRES, Jun 6 2011 (IPS)

Argentina is moving backwards in terms of maternal mortality, with a rate three times higher than those of its neighbours Chile and Uruguay. Maternal deaths, which are actually increasing, are often the result of unsafe abortions, in a country where the practice is illegal.

Young pregnant Argentine woman contemplates the risks and difficulties of pregnancy and motherhood. Credit: Carolina Camps/ IPS

Complications related to pregnancy and childbirth are the main cause of death among young women, and many of these deaths are the result of abortion, which is only legal in this country in specific circumstances, such as rape.

According to the latest Health Ministry statistics, from 2009, the maternal mortality rate that year was 55 per 100,000 live births, higher than the 2008 figure of 44 per 100,000 live births. The ministry attributed the rise to the H1N1 flu epidemic.

Under the United Nations Millennium Development Goals (MDGs) adopted in 2000, one of which is to reduce maternal mortality by 75 percent by 2015, from 1990 levels, Argentina’s target is 13 maternal deaths for every 100,000 live births by 2015.

As part of MDG 5, on maternal health, Argentina has also made a commitment to close the gap in the mortality rate between the different provinces. But the gap keeps growing, especially between Buenos Aires and northern provinces like Jujuy or Formosa, where maternal mortality is at least twice the national average.

The Foundation for Studies and Research on Women (FEIM) warned that there is also “a high level of underreporting” of maternal deaths, a large proportion of which she said are “preventable or avoidable.”

FEIM director Dr. Mabel Bianco told IPS that although Argentina has health and sex education programmes that are essential to addressing the problem, the public is still largely unaware of the services that are available, such as free birth control.

In neighbouring countries like Chile or Uruguay, where universal access to such programmes has been guaranteed “for decades,” the results are clear, she said. In Chile, the maternal mortality rate is 20 per 100,000 live births, while in Uruguay it is 15 per 100,000, she noted, citing statistics from 2005.

Latin America has a disproportionately high average rate of maternal deaths: 130 per 100,000 live births according to 2007 figures provided by the United Nations, which warns that of all the MDGs, this region is lagging farthest behind on the maternal health targets.

Argentina’s sexual and reproductive health programme, which began to be implemented in 2003, provides for free family planning advice and contraception at public health facilities.

But the plan has many shortcomings. “Ignorance weighs more than ideology in many health services, and there are no good training programmes for health professionals,” said Bianco.

Women, especially poor women, continue to run into doctors who deny them certain birth control methods because they consider them “abortifacients,” or make it difficult for them to acquire contraception. For example, they require young women who ask for condoms to come with an adult, even though adolescents over 14 years of age have the right to access these services without being accompanied by an adult.

“In some health centres, they ask you for your identity document to give you condoms,” Bianco complained. She added that in other centres, where the health care professionals fully support the sexual and reproductive health programme, there is a shortage of materials.

For instance, birth control is not always delivered in the quantities required, or there are not enough pamphlets and posters needed to raise awareness among women that even if they are not pregnant they can come in for free sexual health and family planning services.

Another major problem, said Bianco, is that abortions are still illegal, and many of them are thus performed in unsafe conditions. An estimated 500,000 abortions a year are practiced in this country of 40 million people, and among poor women the risk of death from complications is especially high.

She also criticised the fact that it is nearly impossible to obtain a legal abortion even in the limited circumstances under which it is permitted by an archaic law, due to the lack of a protocol for dealing with such cases in public hospitals.

Under the law, which dates back to 1922, abortion is only legal in cases of rape or risk to the mother’s life or health, or for women with mental disabilities, described by the law as “idiots” or “demented”.

However, many doctors refuse to perform abortions under any circumstances. Although the Health Ministry has drawn up a protocol for health professionals to follow in treating patients in such situations, it has been stalled in the ministry for three years, awaiting the minister’s signature.

A movement of 250 organisations carrying out the National Campaign for the Right to Safe, Legal and Free Abortion is behind a draft law that has gained increasingly wide support.

The bill was first introduced in 2007 by 22 legislators, but died in Congress. The campaign presented it again in 2010, and it now has the backing of 50 lawmakers prepared to sponsor it.

The draft law would make first-trimester abortion legal on demand, and would make free abortions available in public health centres. It would also extend the time frame for legal abortion in cases of rape, risk to the mother’s health, or severe fetal malformations.

Psychoanalyst Marta Rosenberg, one of the driving forces behind the campaign, told IPS that above and beyond the H1N1 flu epidemic, the number of deaths from abortion complications continues to rise in absolute terms in the official statistics.

But she said that over the next few years the number could stabilise, due to increasingly widespread use of misoprostol or RU486, also known as “medical abortion” – an easily accessible drug that provides a cheaper, lower risk alternative to surgical termination of pregnancy.

Rosenberg said it was difficult to predict whether or not the law legalising abortion would pass this year, as the campaign hopes. “What we want is for it to be debated, and in that sense we have managed to put the issue on the political agenda,” she said.

Excerpt:

For Janu, walking the streets to beg for alms is the only option for survival. After all, she has a two-year-old daughter to feed, and she herself, at 14 years old, is little more than a child.

Single mother Leela with her daughter. Credit: K.S.Harikrishnan/IPS.

The story of Janu, who lives in the Attappady tribal area in Palakkadu district in the southern Indian state of Kerala, is not an isolated one.

In tribal hamlets in the districts of Wayanad, Palakkadu and Kasargod, girls like Janu end up as unwed mothers after falling victim to sexual harassment and exploitation, sometimes by influential men who refuse to acknowledge their responsibilities. Now, these women face shame and starvation.

A survey conducted by the Kerala State Scheduled Castes and Scheduled Tribes Department found 563 unwed mothers in the state. But the Kerala Women’s Commission (KWC) puts the actual number at more than 2,000.

An investigation led by Deputy Police Inspector-General S. Sreejith had found that there were no less than 1,000 unwed mothers in the tribal areas of north Kerala.

According to the KWC, most unwed mothers are 14 to 20 years old. Oommen Chandy, the new chief minister of Kerala, has directed the police to go the extra mile to ensure justice to the victims of violence, trafficking, and sexual exploitation, particularly unwed mothers hailing from the tribal sector.

KWC member and senior woman leader T. Devi told IPS that there has been a steep rise in the numbers of unwed mothers in the tribal community in the past fifteen years. “The Commission is initiating a police inquiry into the cases of young unwed mothers and making arrangements to rehabilitate the affected women,” she said.

T. Devi pointed to forest officials, teachers, contractors, labourers and local leaders as among those accused of impregnating young girls. They lure teenage girls by giving them money, liquor, clothes, bags, and perfumes. They flatter the girls and then invite them to their homes or to see a movie. Some men offer marriage proposals.

Dr. K. G. Vijayalakshmi, director of the Thiruvananthapuram-based Women Empowerment and Human Resource Development Centre of India, who has studied the problem, told IPS that the issues of unwed mothers are mainly linked to social backwardness.

“Hunger, poverty, illiteracy, ill-health, lack of communication and financial constraints are leading tribal women to seek the help of non-tribal people,” she said. “These forest invaders, especially rich people, sexually exploit the women. Many unwed tribal girls are working free of cost in the residences of non- tribal people.”

Chennai-based anthropologist G. P. Paul told IPS the issue of unmarried mothers is as serious as the problem of displacement from tribal territory. Kerala tribes have lost thousands of acres to non-tribal people, who venture into the forest to grab their land.

“No steps were taken to restore their land. Migration of non-tribal people continues. Raped and ravaged by non-tribal people, tribal women in Kerala are paying a heavy price,” he added.

News reports cite a survey conducted in 174 hamlets in Attappady in 2000 by the volunteer organisation NAMU, which found 343 unmarried mothers, some of them with more than one child.

Earlier in 1997, a committee of the Kerala Legislative Assembly also examined the problem and submitted a report to the government, which failed to act on it.

Since then, officials and activists have demanded action and social programmes to address the issue of unwed mothers in tribal hamlets.

Pushkala Unnikrishnan, an activist in tribal issues and vice-president of the local self-government institution in Wayanad district, wants the government to implement special welfare schemes such as pensions for unwed mothers.

“It is a shame for a high-literacy state like Kerala that these unmarried tribal women continue to live in a state of penury and neglect, years after their problems came to public attention,” said Unnikrishnan.

Kerala Aadivasi Forum (KAF), a tribal organisation, is seeking justice from the government and social agencies for the rehabilitation of unmarried mothers and their children.

Bolan, a state committee member and KAF Wayanad district president, wants government to start planning a long-term programme for the welfare of these mothers. “Living conditions of children born out of wedlock are worst. Most of them have inhibitions to face others, fearing being taunted as the children of harlots.”

Experts point out that premature deaths of unwed tribal women were not uncommon, and several crude and inhuman methods have been employed to eliminate infants even after birth.

Kitty Lukose, a social researcher who has studied the condition of tribal unwed mothers in Wayanad, found out that many tribal girls resorted to abortion using traditional medicine. “They go to government hospitals for check-ups. Once they find that they are pregnant, they abort the fetus.”

Dr. K. Ramachandran Nair, a physician who has served in tribal areas for more than 45 years, told IPS that hypertension and diabetes are very common among unmarried mothers.

“Some of the unwed mothers later turn into sex workers since there is absolutely no income for survival. The mothers are isolated both from their family as well as from the community. The culprits escape from the net through their economic and political power,” Dr. Nair pointed out.

Dr. Beena Kannan, a health expert working in a government hospital in Kochi, a city north of the capital Thiruvananthapuram, suggested that regular medical checkups, both for the mothers and children, are essential for their survival.

“Besides imparting legal and emotional support, health organisations should give awareness on safe sex practices and condom usage,” she added.