A family in New Delhi. Given India's high infant mortality rate, one of the highest in the world, many women are not keen on sterilisation since they feel that it shuts out their option of having children later if required. Credit: Neeta Lal/IPS

By Neeta Lal
NEW DELHI, Nov 29 2016 (IPS)

The Indian government’s decision to make injectable contraceptives available to the public for free under the national family planning programme (FPP) has stirred debate about women’s choices in the world’s largest democracy and second most populous country.

The controversial contraceptive containing the drug Depot Medroxyprogesterone Acetate (DPMA) is currently being introduced at the primary and district level. It is delivered in the form of an injection and works by thickening the mucous in a woman’s cervix which stops sperm from reaching the egg, thereby preventing pregnancy. It is also much cheaper than other forms of contraceptives available across the country.

Injectables have been part of family planning programs in many countries for the last two decades. They have also been available in the private sector in India since the early 1990s though not through government outlets. Advocates of injectable contraceptives say that their inclusion in the government’s programme will now offer women more autonomy and choice while simultaneously whittling down the country’s disquieting maternal mortality rate (MMR).

Nearly five women die every hour in India from medical complications developed during childbirth, according to the World Health Organization (WHO). Nearly 45,000 mothers die due to causes related to childbirth every year in India, which accounts for 17 percent of such deaths globally, according to the global health body. The use of injectable contraceptives is also backed by the WHO, which has considered the overall quality of the drug with evidence along with the benefits of preventing unintended pregnancy.

However, Indian civil society seems splintered on the issue. Several bodies like the Population Foundation of India and Family Planning Association of India support the government’s move. The Federation of Obstetric and Gynaecological Societies of India (FOGSI), an apex body of gynaecologists and obstetrics in the country, is also supportive of their use based on scientific evidence.

However, women right activists have opposed the initiative as a part of the national programme. They point to a report by the country’s premier pharmaceutical body — Drugs Technical Advisory Board (DTAB) — which has noted that DPMA causes bone loss. The report emphasizes that the osteoporotic effects of the injection worsen the longer the drug is administered and may remain long after the injections are stopped, and may even be irreversible. The DTAB had advised that the drug should not be included in the FPP until discussed threadbare with the country’s leading gynaecologists.

Several health groups, women’s organizations and peoples’ networks have also issued a joint statement protesting the approval of the injectable contraceptive. As far back as 1986, Indian women’s groups had approached the Supreme Court regarding serious problems with injectable contraceptives. based on a study by the country’s premier medical research organization — the Indian Council of Medical Research

Advocates of women’s health and reproductive rights add that the contraceptive is harmful to women as it leads to menstrual irregularity, amenorrhea, and demineralization of bones as a result of its long term use. Users have also reported weight gain, headaches, dizziness, abdominal bloating as well as decreased sex drive, and loss of bone density. The latest evidence from Africa now shows that the risk of acquiring HIV infection enhances because the couple is less likely to use a condom or any other form of contraception to minimise infection.

However, experts iterate that the real issue isn’t just about women’s health but about a human rights-based approach to family planning.

“Why should we control women’s access to choice? Is it not time to re-examine the issue and initiate a fresh debate?’’ asks Poonam Muttreja, Executive Director of the Population Foundation of India, who has opposed the introduction of DMPA.

Others say that while they are all for enlarging the basket of choices for women, and empowering them, pushing invasive hormone-based technology upon them is hardly the way to go about it. Besides, with the incidents of arthritis and Vitamin D deficiency in India already worrisome, demineralization of bones caused by DPMA will make matters a lot worse.

The total Contraceptive Prevalence Rate (CPR) in India among married women is estimated at 54.8 percent with 48.2 percent women using modern methods. This is comparatively lower than neighbouring countries like Bhutan, Bangladesh and Sri Lanka whose CPR stands at 65.6 percent, 61.2 percent and 68.4 percent, respectively.

In India, the primary method of family planning is female sterilization – at 65.7 percent, which is among the highest in the world. One of the key reasons for this is the limited availability of a wide range of contraceptive methods in the public health sector in the country, say family planning experts. Some fear that the new method might also result in poor women being used as guinea pigs for public healthcare.

“Women’s reproductive health has always been contentious and has had a fraught history, plagued by issues of ethics, consent, and the entrenched vested interests of global pharma companies and developed nations,” says Mukta Prabha, a volunteer with Women Power Connect, a pan-India women’s rights organization. “So we need to tread with caution on DPMA so that women can make informed choices and their health isn’t compromised.”

Indian women suffer from a host of problems associated with unwanted pregnancies from unsafe abortions to maternal mortality and life-long morbidity. The paucity of trained medical personnel in the public health system adds to their woes.. Besides, India has always had a troubled history of sterilisation. In 2014, over a dozen women died as the result of contaminated equipment in a sterilisation camp in the central Indian state of Chhattisgarh.

The resulting media uproar pressured the government to re-examine its policies and its long-held dependence on sterilisation. But in 2015-16 again there were 110 deaths due to botched sterilisation procedures. Given the high infant mortality rate, many women are wary of sterilisation. They also feel it restricts their choice of having children later if required. Despite this, over 1.4 m Indian women were sterilised in 2014 as against 5,004 men.

Worse, the controversial DPMA — which is aimed only at women — isn’t gender sensitive either. What should be pushed instead, say women activists, is male sterilisation which is a far simpler and minimally invasive procedure which also minimizes health risks for women.

As Prabha puts it, “Indian men’s participation in family planning has always been dismal even though they’re the ones who determine the number of children a women has. The current debate is a good opportunity to involve the men in the exercise and set right the gender skew.”

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

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

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

Dr. Babatunde Osotimehin. Credit: UNFPA

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Edited by Kitty Stapp

Excerpt:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Edited by Kitty Stapp

Excerpt:

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

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

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

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

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

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

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

In an interview with IPS, Dr. Babatunde Osotimehin, executive director of the U.N. Population Fund (UNFPA) said, “Twenty years ago, we were able to secure commitments from governments on various aspects of poverty reduction, but more importantly the empowerment of women and girs and young people, including their reproductive rights.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Edited by Kitty Stapp

The writer can be contacted at thalifdeen@aol.com

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

By Amy Fallon
KAMPALA, Aug 18 2014 (IPS)

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

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

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

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

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

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

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

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

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

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

Turning women away

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

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

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

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

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

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

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

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

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

Two services, one trip

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

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

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

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

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

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

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

Edited by: Mercedes Sayagues

Excerpt:

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

By Miriam Gathigah
NAIROBI, Aug 14 2014 (IPS)

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

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

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

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

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

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

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

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

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

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

Sex became a chore

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

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

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

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

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

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

But her son is infected with HIV.

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

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

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

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

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

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

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

Edited by: Mercedes Sayagues

Excerpt:

The contraceptive needs of HIV positive women are often put on the background. Credit: Mercedes Sayagues/IPS

By Miriam Gathigah
NAIROBI, Aug 14 2014 (IPS)

In the rush to save babies from HIV infection and treat their mothers, experts warn that a key element of HIV prevention is being neglected in Africa – contraceptives for HIV positive women.

Yet contraception is the second pillar of successful prevention of HIV transmission from mother to child (PMTCT), along with preventing infection among women and babies, and caring for those infected.

“The contraceptive needs of HIV positive women are often put on the background, the main focus is on keeping mother and child healthy,” Florence Ngobeni-Allen, a spokesperson with the  Elizabeth Glaser Paediatric AIDS Foundation, told IPS. A South African, she was diagnosed with HIV in 1996, lost a baby to AIDS and now has two healthy boys.

Contraception is crucial in East and Southern Africa, where high HIV prevalence combines with high unmet needs for family planning, and where eight in ten HIV positive women are within their reproductive years, according to the United Nations Population Fund (UNFPA). 

Studies suggest that women living with HIV have equal “if not more desire to limit childbearing compared with HIV negative women. Reducing unmet need for family planning among these women is critical for meeting the target of reducing new child HIV infections by 90 percent,” says the United Nations report Women Out Loud.

Surveys of HIV positive women in Kenya and Malawi show that nearly three-quarters did not want more children within the next two years or ever, but only a quarter used modern contraceptives.

Weakness in programmes

A study by Family Health International among HIV positive women in Rwanda, Kenya and South Africa showed that more than half did not plan their most recent pregnancy.

Although the women wanted family planning, access was difficult. One barrier was health staff: they were not trained on contraceptive options for women living with HIV; had misconceptions about contraceptive safety; most only offered male condoms, although women preferred long-acting implants and injections, and many were judgmental about the women’s sex lives

“Sometimes nurses forget that women are still sexual when they find out you are HIV positive,” says Ngobeni-Allen.

Kenya’s unmet need for contraceptives is 25 percent nationwide but 60 percent among HIV positive women, Dr John Ong’ech, assistant director at Kenyatta National Hospital, told IPS.

Low access to family planning for HIV positive women, who are six to eight times more likely to die from pregnancy-related complications compared to HIV negative women, “is a weakness in health programmes,” he told IPS, although it is cheaper and more effective to provide contraceptives than PMTCT.

Husbands and mothers-in-law

Mary Naliaka, who works in paediatric AIDS in Kenya’s health ministry, told IPS that family planning should be part of the HIV treatment package and offer a variety of contraceptive options.

But the health systems in East and Southern Africa often suffer commodity stock outs and many clinics lack adequate infrastructure.

“To insert an intrauterine device you need a sterile environment,” Ong’ech says.

Injection is the most popular method because women can use it without telling the husband, he adds.

Unequal gender relationships and weak negotiating power influence contraceptive use. Naliaka observes that in African culture, “the mother-in-law can engineer the end of a marriage if a baby is not forthcoming.”

Dorothy Namutamba, of the International Community of Women Living with HIV in East Africa (ICWEA), who is based in Kampala, Uganda, told IPS that women are raised to please husbands.

“If a man demands that you should have ten children [you must] and if you’re not able, he’ll look somewhere else,” she says. “Most men do not encourage women to go on family planning, it’s a big problem.”

Stigma and domestic violence compound the problem.  “Women fear to declare their HIV status because they may face gender violence, and this limits their access to family planning,” Anthony Mbonye, Commissioner of Health Services in Uganda, told IPS.

Given men’s power over decisions about pregnancy, couple-oriented reproductive health services are crucial, but “health facilities are too overcrowded to absorb the male partner,” Naliaka told IPS.

The coerced sterilisations of HIV positive women in Kenya, Malawi, Namibia, South Africa and Zambia, with lawsuits pending, further cloud the issue of reproductive rights and needs and HIV.

“This shamed the health sector,” says Naliaka.  However, she adds, “through these publicized cases, the health sector and the public have understood that these women have reproductive health needs similar to those of HIV negative women.”

One-stop shops

Moving forward, experts recommend integrating HIV, family planning and maternal and child health care services, saving time for both users and health staff.

Seven Southern African countries have set up such “one-stop shops” for reproductive health, where a woman can get ARVs, cervical cancer screening, breastfeeding advice and family planning in one visit, under one roof, sometimes in one room with one health worker.

Linking services is cost effective and efficient, says UNFPA. It makes “people sense”.

Edited by: Mercedes Sayagues

Excerpt:

In Nepal, many children who suffer from malnutrition belong to young mothers. In fact, teen marriages and pregnancies are common and over 23 percent of women give birth before they are 18 years old. Credit: Naresh Newar/IPS

By Joan Erakit
UNITED NATIONS, Oct 30 2013 (IPS)

Before we begin, perhaps we can set aside the stereotypes: no, she didn’t “mess herself up by following boys around”, and no, it is not in fact her fault that she became pregnant.

Adolescents rarely have children because they want to. Yet 7.3 million girls under the age of 18 give birth every year, with two million of those births to girls under the age of 14.

“The powerlessness girls experience is often a symptom of human rights violations of one form or another,” Richard Kollodge, editor of a flagship report launched Wednesday by the United Nations Population Fund (UNFPA), told IPS.

“When a girl is married against her will before 18, her rights are violated. When a girl becomes pregnant and is forced to leave school, her right to an education is denied,” he said.

This powerlessness affects young women deeply, and many are faced with excruciating choices that can lead to illegal abortion, social exile and even death.

Titled “Motherhood in Childhood: Facing the Challenge of Adolescent Pregnancy,” UNFPA’s annual report looks at the most important factors driving adolescent pregnancy: poverty, lack of education, forced marriage and inequality.

In his forward to the report, UNFPA Executive Director Babatunde Osotimehim writes that, “A pregnancy-prevention intervention, whether an advertising campaign or a condom distribution programme, is irrelevant to a girl who has no power to make any consequential decisions.”

The report sheds light on a key problem when it comes to adolescent pregnancy: the lenses used to view young women are tainted.  An unnecessary burden of being solely responsible for a pregnancy is put on the back of a young girl, and she is rarely looked at as a victim.

UNFPA is calling for a new perspective on adolescent pregnancy, one that includes not only the teen’s behaviour as a cause of early pregnancy, but also at the actions of their families, communities and governments.

Outside factors

Using a diagram, UNFPA describes five determinants (national, community, school/peers, family and individual) that can determine a teen parent’s path.

For example, when governments make laws limiting access to contraception, it contributes to negative views towards sexuality and women in the general community.  This trickles down to the schools, where sex education and available resources for young women are limited because they are not seen as necessary.

Parents can then develop negative views about sexuality and even about their own daughters, investing very little in their education and reinforcing a gender inequality in a young girl before she is even given a chance.

All this carries a high cost to national development aspirations as well. In Kenya, if the more than 200,000 teen mothers had jobs instead of children, they would have added 3.4 billion dollars to the economy – a sum equal to the value of Kenya’s entire construction sector.

If adolescent girls in Brazil and India had only waited to bear children until their early twenties, their nations would have greater economic productivity equal to over 3.5 billion and 7.7 billion dollars, respectively, the report says.

Meanwhile, just two cents of every dollar directed toward international development is spent on adolescent girls.

Powerful conversations

“One of the points the report makes is that the conversation cannot start in only one place,” Kollodge said. “The conversation has to occur simultaneously at all levels – at the national and policy levels, at the community level, in schools, among parents, among men and boys, and among peers.

“Research shows that interventions aimed at girls, and especially at changing girls’ behaviour, rarely have a positive impact,” he added. “No single intervention, or action by a single stakeholder, will make a real or lasting difference.”

Power is the most important aspect of a girl’s life – the power to stand up for herself, to protect herself and to choose when she is ready to have a family.

“The report makes the case that more often than not, pregnancy is not the result of a deliberate choice but rather, the result of an absence of choices and opportunities in life,” Kollodge said.

“When, for example, a 13-year-old girl is forced into marriage and is then expected by her husband, her parents, and her community to start having children right away, that girl clearly lacks power to decide whether, when and how often to have children.

Placing high emphasis on developing human capital of young girls, and giving them the opportunity to make sexual reproductive choices for themselves, not only promotes the health and protection of young girls, it also gives them a seat at the global development table.

A woman collapses in front of a police barricade during one of the Occupy Gezi protests. Credit: Arzu Geybulla/IPS

By Ariam Frezghi
ISTANBUL, Jul 13 2013 (IPS)

Among the many issues bringing protestors together at Gezi Park, the now-iconic site of struggle in Istanbul’s Taksim Square, is the demand for women’s liberation.

Coming from many walks of life and expressing a myriad of ideals and values, the women of the Occupy Gezi Movement have nevertheless voiced a collective desire: to fight the undercurrent of deeply entrenched patriarchal values and reclaim autonomy over their own bodies and lifestyles.

These demands are now coalescing around proposed legislation from the country’s Health Ministry that will call on pharmacies to limit the sale of oral contraception known as the morning-after pill only to those with a doctor’s prescription, a practice that is uncommon for most drugs available to the public here.

Under Turkey’s conservative-leaning Justice and Development Party (AKP) government, women are encouraged to have at least three children to help maintain population growth rates.

Feminists and women’s rights groups representing almost 400 people say the new legislation is part of government attempts to impose traditional values onto their lifestyle, and will only reinforce stereotypes about the “ideal” Turkish woman, while stigmatising those who stray from this image.

“I can’t go to the family doctor (for my contraceptive needs) because it is a secretive issue for me,” said Merve Kosar, a 26-year-old Istanbulite who relies on the pharmacy to replenish her supply of the drug.

In Turkey, most non-narcotic drugs are available for purchase over the counter. Insisting on a prescription from a family doctor, who can report to other members of the family, places added pressure on women to conform to conservative mores.

Women like Kosar, who make the conscious decision to have sex before marriage, are worried about having fewer options to guard against unwanted pregnancies.

Nearly 34 percent of once-married and currently married women said they use morning-after pills as their main form of contraception, according to the 2008 Turkey Demographic and Health Survey.

Still, the possibility of parliament passing the bill under a larger package of reforms sometime this year seems likely and concerns women’s rights groups who say the announcement will hinder some from asking pharmacies for pills.

An article in the Hurriyet Daily News cited a notice from the Health Ministry, which stated that “growth hormones, antibiotics, antidepressants, and antihistamines” must be sold with a doctor’s prescription to reduce the misuse of drugs.

According to Zerrin Guker, a pharmacist in the commercial neighbourhood of Karakoy who sells 15 to 20 boxes of the morning-after pill per month, some customers have been misusing the drug by purchasing it a few times per week, which can cause hormonal side effects.

A 27-year-old protestor named Elif, who declined to give her last name for fear of retribution, said she suffered blood clots and nausea after taking the pill once; yet she still believes in a woman’s right to choose and says the government’s proposed restriction is designed to prevent unmarried women from having sexual relationships.

“Most women can’t even buy tampons or feminine products from stores because they are ashamed,” she told IPS, stressing that the culture of shame has become entrenched in society.

A long fight to overturn these attitudes is slowly showing results: ideals about abstinence until marriage, for instance, are shrinking, as women continue to speak out about their grievances with men including harassment and sexist swearing, practices that have infiltrated the Occupy Gezi Movement.

At a recent meeting in Yogurtçu Park in Istanbul’s Kadikoy district, more than 100 women gathered to discuss their experiences at Gezi Park.

One protestor said a drunken man grabbed her buttocks one night, while bystanders justified his actions saying he had been under the influence.

Another woman read out a list of complaints with the governing party, which included attempts to get rid of “dekolte” (low-cut dresses) and state attempts to ban abortions and “keep women at home.”

A year ago, Prime Minister Recep Tayyip Erdogan called for tighter restrictions on reproductive health by drafting a bill that would shorten the time period in which women can have an abortion from 10 weeks to eight weeks.

“There is no difference between killing the foetus in a mother’s womb or killing a person after birth,” Erdogan said in a speech before female politicians in the capital, Ankara, last year.

His words drew the ire of around 3,000 to 4,000 protestors, mostly women, who marched against the anti-abortion law in Kadikoy last June, waving banners proclaiming statements such as: “It is my body, so who are you?”

When abortion became legal in 1983, the Turkish Population and Health Survey found that 37 percent of once-married Turkish women had at least one abortion. As of 2008, that figure stood at 14.8 abortions per 1,000 women.

While the latest call to limit oral contraception has yet to spark demonstrations, many believe it will eventually ignite the tensions that have been simmering for years now.

Ayse Dunkan, journalist and activist, believes the outcry will pick up momentum, with more people rebelling against the “conservative concept (that) women (must) stay home and raise children.”

Such ideals, she told IPS, have resulted in Turkey having the world’s second highest population growth rate after China.

Selime Buyukgoze, a volunteer at Mor Cati, an Istanbul-based network for battered women, called the proposal “problematic” since the morning-after pill must be taken within 72 hours of having unprotected sex and few women will be able to reach their doctors that soon.

Like most others, though, her biggest fear is that doctors will break a woman’s confidence by reporting her lifestyle to the family.

Ahmet Kaya, a family doctor who sees almost 150 patients a week, rebukes that claim. “If your patient doesn’t want you to inform her family, you can’t make that call,” he told IPS.

At the moment, pharmacies are continuing to sell the pill without asking for a prescription

It remains to be seen whether or not the government will push ahead with the law, or whether it will respond to the will of more than 1.5 million female protesters.

By Joan Erakit
UNITED NATIONS, Jul 11 2013 (IPS)

On Thursday, the international community recognises World Population Day, a time of assessment, discussion and projections for the future that necessarily gives great weight to the rights of women and girls and particularly their sexual and reproductive health.

Dr. Babatunde Osotimehin. Credit: UNFPA

This past week, the Netherlands has been host to the International Conference on Population and Development (ICPD) where equality and the rights of every person have been highlighted.

“Women’s rights are human rights,” the executive director of the United Nations Population Fund (UNFPA), Dr. Babatunde Osotimehin, told IPS. “I would hate an institution where we are now discriminating in terms of which rights are now for women and which rights are for men.”

According to Population Action International, a non-profit organisation geared towards making contraceptives accessible to all women all over the world, some 215 million women currently lack access to family planning.

This leads to unwanted pregnancies, unsafe abortions, medical complications during birth and even death, not to mention the economic setbacks and educational detours that may accompany the raising of a child.

As the framework for the post-2015 development agenda is being prepared, it has become clear that human rights and sexual reproductive health are intertwined with economic growth and sustainable development.

IPS correspondent Joan Erakit spoke with Dr. Osotimehin about the challenges and opportunities facing women and girls when it comes to voluntary family planning, and protecting human rights in order to sustain the post-2015 Development Agenda.

Excerpts from the interview follow:

Q: What is the relationship between sexual and reproductive health and human rights?

A: The best way to capture it is to come back to the ability of girls and women to exercise their basic human right of choice, and freedom to access education, to access services, to access opportunity. It also ensures that they can develop their full potential, and finally to make choices about how many children they want to have – if they want to have them – what’s the gap between the children they would like have, and do so without coercion from anybody.

Q: What happens to a woman when she is given the opportunity to decide when she wants to have kids?

A: What tends to happen from the experience and the research we have is that they tend to have as many children as they can afford to look after. And they also tend to have the children, given the interval, so that they can be healthy. And that has implications for contraception; so they must be able to access contraception to enable them to exercise that right to its fullest.

Q: Because economic growth and development are greatly connected to voluntary family planning, how do we show this kind of information to local communities and governments so that they can invest in family planning?

A: There are two approaches to it. The first approach is a short-term approach, which is to actually demonstrate that, from a service perspective, when you invest in family planning there is always a return on investment. For every dollar that you invest, there’s a minimum of three to six dollars return on the investment.

The long term is that the woman or the girl would be able to freely develop herself, access quality education, access skill development, be able to get a job, or start a business. Do something for herself that makes her economically viable and contribute to community in terms of development.

When a woman has access to contraception and she is able to develop her potential and she is able to have the number of children she can afford to have, the children tend to do better than the women who don’t have that access. We know for a fact that when you look at the metrics of it, girls who don’t go to school, when they have kids, the kids don’t do well. So, there is a cycle of poverty.

Once they go to school and they are older than 18, their children do better. What you are doing is ensuring that you have generations that are actually having access to several things, and in that sense building human capacity that drives economic growth.

Q: What are you looking to add to the post-2015 development framework in regards to the rights of women and girls?

A: The post-2015 development framework is one where we must assert the issues of reproductive human rights, and the fact that women and girls must be the centre of human development. If you don’t have human development and human capital development, it’s going to be difficult for you to have sustainable development.

Excerpt:

Every three years since 2007, a global advocacy organisation called Women Deliver has convened an international conference to talk about issues relating to the health and well-being of girls and women.

UNFPA, the United Nations Population Fund, has been privileged to participate in these conferences, and looks forward to joining multilateral organisations, NGOs and global leaders for the third Women Deliver conference in Kuala Lumpur this weekend.

Dr. Babatunde Osotimehin. Credit: UNFPA

Our focus this year will be on two issues that affect not just women and girls, but development in general, because research shows that voluntary family planning and maternal health are two key vectors for lifting developing nations out of poverty.

We will unveil new initiatives for each and seek to galvanise the world community for both programmatic and financial support. UNFPA has promoted voluntary family planning since it began operations in 1969, and if we have learned anything in the decades since, it is that the ability of women to plan when and at what intervals they will have children is essential to national progress in everything from education to health to economic prosperity.

Equally important, we have learned that family planning is about more than just condoms and other family planning commodities. It’s about human rights, information and education.

At the Women Deliver conference, UNFPA will launch a new partnership with the International Planned Parenthood Federation (IPPF) to increase access to family planning in some of the world’s most hard-to-reach areas. In cooperation with IPPF, we will seek to galvanise political commitments from 13 nations with statistically low contraceptive prevalence rates in order to increase support for programmes to educate women and men about the benefits of family planning.

UNFPA’s second major initiative will actually take place in the days leading up to Women Deliver, when we will co-host a symposium on the crucial, frontline role midwives play in lowering maternal deaths, reducing disabilities related to childbirth, and improving overall national health indicators.

More than 230 midwives will be joined by leading U.N. agencies, civil society representatives, policy makers and officials from donor nations to discuss ways to increase the numbers and improve the skills of midwives in developing countries.

At the symposium, UNFPA, alongside its partners from Intel, the World Health Organization and Jhpiego, the NGO affiliated with Johns Hopkins University, will roll out a new online training module for frontline maternal health workers to help train them to deal with issues such as pre-eclampsia, excessive post-birth bleeding and prolonged and obstructed labour. These medical complications can be matters of life and death for women giving birth in the developing world, so this is a critically important initiative.

But it is clear that these family planning and maternal health initiatives will succeed only if they are embraced by government leaders in a position to fund and support them. And there are often obstacles to that embrace.

The first obstacle, of course, is money. Governments struggling to meet the basic needs of their citizens face severe competition for scarce resources. But family planning and maternal health are so critically important to long-term development that they should be among the top spending priorities for developing nations’ governments.

And because helping underdeveloped nations rise out of poverty is so vital to international security and the global economy, voluntary family planning and maternal health should be investment priorities for developed nations as well.

The second obstacle standing in the way of family planning initiatives, in particular, are some cultural practices. The sad fact is that some societies still deny the human rights of half of their populations in the name of cultural traditions that do physical, social and psychological damage to women and girls.

As UNFPA sees it, the time has long passed when men can or should be allowed to dictate the reproductive rights of women. Young girls should not be forced into marriage. Sex should always be un-coerced. And every woman should have the means to enjoy her human right and freedom to choose if or when she will have children, and how many she will have.

We will be raising these issues at Women Deliver in Kuala Lumpur, and I hope all who attend will come away from the conference with a re-energised commitment to the central role these issues play in humanity’s future and to address the challenges of family planning and maternal health forthrightly.

*Dr. Babatunde Osotimehin is a United Nations Under-Secretary-General and Executive Director of UNFPA, the United Nations Population Fund.

Young women on a Damascus street. Credit: Rebecca Murray/IPS

By Thalif Deen
UNITED NATIONS, May 21 2013 (IPS)

When thousands of participants from around the world gather in the Malaysian capital of Kuala Lumpur next week, the primary focus will be on health and empowerment of girls and women.

The meeting, scheduled for May 26-30 under a banner titled Women Deliver, will zero in on a longstanding unanswered question: how does the international community meet the massive unmet needs for contraception by over 222 million women in the developing world?”

The U.N. Population Fund (UNFPA) points out that increased contraceptive use and reduced unmet needs for contraception are central to achieving three of the U.N.’s Millennium Development Goals (MDGs) – improving maternal health, reducing child mortality and combating HIV/AIDS – heading towards the 2015 deadline.

Sivananthi Thanenthiran, executive director at the Malaysia-based Asian-Pacific Resource & Research Centre for Women (ARROW), told IPS the ability to decide the number, timing, and spacing of their children is one of the most fundamental rights individuals and couples can have.

Currently, she said, it is estimated 222 million women have an unmet need for family planning, and in many countries most women still continue to have more children then they desired.

“Investing in reproductive health and reproductive rights requires investment in a number of interventions by U.N. agencies, governments and donors,” she added.

Since UNFPA began operations back in 1969, the average global fertility has been cut in half. UNFPA says it has been a “critical catalyst” in this success by responding to requests by developing countries.

Asked how best the contraceptive needs could be met, Dr. Purnima Mane, president and chief executive officer of Pathfinder International, told IPS the United Nations and the international community need to continue advocating for increased funding – domestic and international – for access to contraception and for the integration of family planning into universal health coverage in all possible forums and through broader partnerships across sectors.

While it is true that investments in women’s education are essential to this effort, she said, much more needs to happen to change the situation of women.

Community-oriented work to change social norms around gender and enabling social and economic policies are essential to prevent early marriage, to keep girls in school, and to help women to space their births and give birth safely, when they want to bear children, said Dr. Mane, who heads an organisation described as the global leader in sexual and reproductive rights.

She argued that based on historical evidence, political will is, and will be, the most critical element of success for strong family planning programmes.

“However, we need to be vigilant about the voluntary nature of such programmes and the quality of the care provided,” Mane added.

At this time, she said, the most critical priority is for the global community to come together to address the contraceptive and sexual and reproductive health information and service needs of the growing youth population of over three billion under the age of 25.

“There is no easy fix and we all know that. What we need is to address the multiple factors that impact on this issue rather than focus on any one aspect alone,” she said.

The Kuala Lumpur meeting, the third Women Deliver conference launched originally in 2007, is touted as the largest global event of the decade – primarily of government leaders, policymakers, healthcare professionals, representatives of non-governmental organisations (NGOs), corporate leaders, and global media outlets.

The event will include a Youth Pre-Conference, a Minister’s Forum and a Parliamentarians Forum.

Asked about investments in reproductive health, Thanenthiran told IPS these include interventions around delaying the age of marriage and the age of first pregnancies, which include investments in girls’ education especially at the secondary and tertiary levels.

Interventions such as making available a range of contraceptive methods and ensuring women receive the right information so that they can make informed choices about the method that best suits them, and that health service providers treat women with kindness and provide quality care and service are essential in increasing trust towards family planning programmes, she added.

Naturally this requires funding and political commitment, but the health of women and girls is well worth safeguarding, Thanenthiran added.

Asked how the U.N.’s post-2015 economic agenda could underline reproductive health, Dr. Mane told IPS human rights principles of the International Conference on Population and Development (which took place in Cairo in 1994) can be embedded constructively in a variety of ways in the new set of development goals, but given that the relevant MDGs are especially lagging, “more explicit attention to the unfinished agenda is needed as we go forward.”

Population dynamics are also often left out of important discussions about future needs and development scenarios. For example, population growth may be mentioned but not in relation to access to contraception as a solution, she added.

She said universal health care is a start, if coverage of the broadest range of sexual and reproductive health care is explicitly included to move the unfinished agenda forward.

“Only then will we achieve sustainable development,” she said.

“My organisation, Pathfinder International, stands behind confronting inequality by advocating with other civil society partners for better governance which not only addresses inequality but holds policymakers accountable for failing to address preventable deaths among women and children,” Dr. Mane declared.

Thanenthiran said it is essential that access to comprehensive, quality sexual and reproductive health services, as promised to women and committed to by governments in the Cairo ICPD Programme of Action, is prioritised in the post-2015 development framework.

The ICPD Programme of Action (PoA) is going to be 20 years in 2014, and women are yet to enjoy in full the promises made to them during that time, she pointed out.

In the MDGs, some attention was given to the agenda under MDG 5 (on improving maternal health), and those working in the field of sexual and reproductive health and rights are hoping to see a more comprehensive approach with more reproductive health issues and indicators being covered in the new goal on reproductive and maternal health.

This would be the best way to go about to ensure government commitments to the ICPD are fulfilled, and initial investments made during the MDGs are continued and fully realised in the new development framework, she declared.

By Sabine Clappaert
BRUSSELS, Jan 20 2013 (IPS)

Despite staggering advances in medical science and technology over the years, women around the world continue to suffer gravely as a result of inadequate access to basic reproductive health services.

Marleen Temmerman, head of the Department of Reproductive Health and Research at the World Health Organisation (WHO). Credit: World Health Organisation.

Roughly 134 million women are “missing” worldwide as a result of sex-selective abortions and neglect of newborn girls. Complications in childbirth are responsible for the deaths of over 350,000 women annually, 99 percent of them from developing countries.

Against this backdrop, the appointment this past October of fifty-nine-year-old Marleen Temmerman – known as ‘Mama Daktari’ in Kenya, where she worked as a gynaecologist for many years – as head of the Department of Reproductive Health and Research at the World Health Organisation (WHO), is a promising move in the right direction.

IPS correspondent Sabine Clappaert spoke to Temmerman, an illustrious Belgian physician, about her plans to weave the reproductive health agenda tightly into the WHO’s mission.

Excerpts from the interview follow:

Q: Why did you decide to leave your career as head of the Obstetrics and Gynaecology Department and member of the board of directors at the Ghent University Hospital to join the WHO?

A: Throughout my career, my goal has always been to improve the reproductive and sexual health and rights of women and girls across the world. While I wasn’t actively looking for a new job I realised that this opportunity at the WHO presented a very powerful lever to help me achieve these goals.

Q: What budget are you working with and what are your goals?

A: I have a working budget of approximately 40 million dollars, which is less that what it has been in previous years. The (global financial) crisis is clearly also impacting the budgets allocated to sexual and reproductive health. At the time of my appointment, for example, I was promised a significant contribution by the Belgian government. Sadly, it never materialised.

I do fear that the difficult economic climate will mean that sexual and reproductive health are seen as less of a priority, yet nothing is further from the truth. If we want the next generations of women to be healthy and empowered, we need to give them access to facilities and programmes that keep them alive and well during pregnancy and childbirth or give them access to family planning services so they can plan their own future.

Family planning is key not only to women and children’s health, but also to slowing unsustainable population growth and sustaining the economy and ecology.

An estimated 222 million women do not have access to family planning: women who would like to delay or stop childbearing but who are not using any method of contraception. In China, for example, only married women have access to family planning clinics. If we could change policy to also give single women access to family planning, we could help make a real difference.

In my new role, I will be looking at why this problem persists and how we can reduce it from various perspectives: by looking at contraceptive solutions in the R&D (research and development) pipeline, through implementation research that aims to identify possible barriers – cultural and religious beliefs or the availability and cost of family planning, as well as what educational initiatives need to be taken to correct misconceptions at the community and individual level.

Adolescent sexual and reproductive health is also enormously important if you consider the fact that abortions and complications during childbirth remain the number one cause of death among 15 to 19 year-old girls.

Q: In 1994 you founded the International Centre for Reproductive Health (ICRH), which today is active in many countries across the world including Kenya, Mozambique, China and Guatemala. What lessons did you learn that you take with you into your new role at the WHO?

A: One of the most important lessons I’ve learnt is that collaboration is key to the success of projects in the sexual and reproductive health realm. At the moment we’re working on a project in Kenya that aims to support girls and women who are victims of sexual violence. We’re training medical staff to make sure they follow correct procedures and do all the right medical checks. We also ensure that girls are given psychological support and that they have access to legal advice.

Secondly, I’ve learnt that sexual and reproductive health remains a sensitive topic; that changing attitudes, behaviours as well as political vision and policies is a long, slow process. We have to remain committed to the importance of improving women’s sexual and reproductive rights. One of my biggest concerns is that, due to the crisis, budgets allocated to sexual and reproductive health will “disappear” into general health budgets. If this happened, it would take away the focus and attention that we must keep on this topic to help drive real change.

There is still so much to be done to end female genital mutilation (FGM), to lower mortality rates during childbirth or to make sure that every girl and woman has access to sexual and reproductive health facilities. There is a saying that says ‘If you want to go fast, go alone; if you want to go far, go together’. I think we must go fast and far. And we can only do this together.”

Q: What is the developed world’s role in assuring reproductive health and justice in the global South?

“I think the developed world has a fundamental responsibility toward developing countries. The traditional North-South view is clearly out-dated, but on the other hand, women’s rights and gender equality are much more advanced in the developed than in developing world. It is our responsibility to support women in the South, to ensure that programmes of sexual and reproductive health don’t “disappear” into global health initiatives, that we continue to commit sufficient resources and budgets to advancing women’s access to sexual and reproductive health facilities.

Q: What has been the hardest lesson for you while undertaking your work in Africa?

There is no doubt about it: the young women and new-born babies that have died in my arms simply because they were in a part of the world where I did not have access to medical technologies that I would have access to in Europe or another developed part of the world. There is nothing worse than the powerless feeling of holding a dying young woman in your arms and thinking: “If we were in another part of the world now, she would have lived.”

I am also always shocked by the ease with which our societies brush over topics such as sexual violence, as if it is normal. So often I am told “but it is part of our culture”. This has to change. The way we bring up boys and girls, and the gender roles we instil in our children, must change.

(END)

Excerpt: