A mother and her child from West Point, a low-income neighbourhood of Monrovia, Liberia (file photo). It is estimated that 20,000 girls under the age of 18 give birth everyday in developing countries — amounting to 7.3 million births a year. Research shows that the media is the main source of information for the youth but this did not provide enough information on SHR or family planning. Credit: Travis Lupick/IPS

By Samira Sadeque
UNITED NATIONS, Feb 4 2021 (IPS)

With the COVID-19 pandemic negatively affecting access to Adolescent and Youth Sexual and Reproductive Health (AYSRH) services, it’s imperative governments employ community-based initiatives and peer educators to ensure these services are still available to them.

This is according to Dr. Simon Binezero Mambo, co-founder and team leader of the Youth Alliance for Reproductive Health in the Democratic Republic of the Congo. Mambo was speaking to IPS following a two-day forum “Not Without FP”, which was organised by the International Conference on Family Planning and was attended by more than 7,000 people.

The virtual forum was organised to discuss the role of family planning in shaping universal health coverage schemes and explore how the COVID-19 pandemic has impacted this discourse around the world.

The forum included a number of high-level speakers: Dr. Natalia Kanem, the United Nations Under-Secretary-General and Executive Director of UN Population Fund (UNFPA); Anutin Charnvirakul, Thailand’s Deputy Prime Minister and Minister of Public Health; Beth Schlachter, Executive Director of Family Planning 2020; and Dr. Laura Lindberg, Principal Research Scientist from the Guttmacher Institute.

During a session focused on the youth, Mambo spoke alongside Christine Power, a policy advisor at the Population Reference Bureau (PRB), Sophia Sadinsky from the Guttmacher Institute, and Erika Dupuis, the Canada country coordinator at the International Youth Alliance for Family Planning (IYAFP).

Power explained to IPS why it’s crucial to focus on the sexual and reproductive health and rights (SRHR) of the youth.

“They face stigma when they try to gather accurate and comprehensive information about their sexual and reproductive health and rights; they face barriers when they try to seek out quality care; and, if faced with an unintended pregnancy, they often face limited options and judgment,” Power told IPS.

According to UNFPA statistics, it is estimated that 20,000 girls under the age of 18 give birth everyday in developing countries — amounting to 7.3 million births a year. Complications from pregnancy and childbirth remain the leading cause of death among adolescent girls.

Speaking during the panel session, Mastewal Zenebe Bekele from IYAFP, Ethiopia, said research showed that a prominent barrier to youth accessing these services was that they did not have access to correct information.

In 2018, Empowering Evidence-Driven Advocacy (EEDA), a project implemented by PRB and IYAFP in five African countries, including Ethiopia, conducted research into the experiences of youth accessing SRH services. It showed that media remained the main source of information for the youth but did not provide enough information on SRHR or contraceptives, Bekele explained.     

Speaking during the panel session, Sadinsky said the coronavirus lockdowns meant that the youth now had limited options to access SRHR services since schools are closed.

“Governments should identify ways to institutionalise service delivery methods that have gained traction during the pandemic — such as mobile clinic outreach, and patient call centres,” she said.

Sarah Ashraf, Director of Maternal, Newborn and Reproductive Health in Emergencies at Save the Children, told IPS there should also be focus on preparedness.

“There should be an emergency response system and pre-positioned resources as part of a health system that can be initiated or activated when an emergency happens,” she said, adding that this could include mobile outreach services or employing trained community healthcare providers.

“Empowering local organisations through localisation efforts can also work on bringing services closer to people during times of emergencies,” Ashraf added.

However, with the digital divide growing even wider under the lockdown, suggested services that require technology might be challenging for many communities. 

“For countries with no technology, the first thing to do is make AYSRH essential and include them in the pandemic plan response by training community-based distributers with services,” Mambo suggested.

“Second, work with young people as peer educators who can reach their fellow youth with messages of COVID-19 prevention coupled with SRH and this will yield more results for young people to adhere to the standard operational procedures,” he added.

There are also policy gaps as pointed out by Power from PRB.

“Gaps between policy commitments made by governments and stigma and barriers young people still face must be addressed,” she told IPS.  “Youth are the most effective change agents when it comes to strengthening youth SRH policies and therefore they must be meaningfully engaged in policy change.”

She said one mechanism of doing that would be to equip them with research, evidence, and the skills for them to educate others. PRB is working to set up such options with the Youth FP Policy Scorecard and activities to strengthen their communications and outreach.

Meanwhile, Dupuis highlighted the importance of including voices in the conversation that are often marginalised.

“We need Black, Indigenous, and radicalised youth leading the way,” Dupuis told IPS.

“We need to move beyond creating youth advisories for agencies or organisations that do not implement suggested findings or action items created by young people,” they added. “We need young people to sit at the table, but we also need a systemic overhaul.”

In 2019, the youth were a prominent focus of the International Conference on Population and Development (ICPD25) which aimed to accelerate progress towards universal SRHR, and women’s and  girls’ empowerment and gender equality.

During the conference, Dr Osamu Kusumoto from the Asian Population and Development Association, told IPS that the capacity of countries to accelerate and achieve ICPD25 commitments was dependent on the extent to which countries invested in their youth.

“Unplanned pregnancies are a big problem in developing countries. When you have a large population of young people pregnant while they should be in school, this is a problem for the economy too,” Kusumoto had said.

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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.”

Babatunde Osotimehin, Executive Director of the United Nations Population Fund (UNFPA). Credit: UN Photo/Paulo Filgueiras

By Dr. Babatunde Osotimehin
UNITED NATIONS, May 20 2015 (IPS)

Seventy years ago, with the founding of the United Nations, all nations reaffirmed their faith in fundamental human rights, in the dignity and worth of the human person, and in the equal rights of men and women and of nations large and small.

The commitment to fundamental human rights that was enshrined in the United Nations Charter and later in the Universal Declaration of Human Rights lives on today in many other treaties and agreements, including the Programme of Action of the 1994 International Conference on Population and Development.There is a wealth of indisputable evidence that when sexual and reproductive health is integrated into broader economic and social development initiatives, it can have a positive multiplier effect on sustainable development and the well-being of entire nations.

The Programme of Action (PoA) , endorsed by 179 governments, articulated a bold new vision about the relationships between population, development and individual well-being.

And it was remarkable in its recognition that reproductive health and rights, as well as women’s empowerment and gender equality, are the foundation for economic and social development.

The PoA is also rooted in principles of human rights and respect for national sovereignty and various religious and cultural backgrounds. It is also based on the human right of individuals and couples to freely determine the number of their children and to have the information and means to do so.

Since it began operations 46 years ago, and guided by the PoA since 1994, the United Nations Population Fund has promoted dignity and individual rights, including reproductive rights.

Reproductive rights encompass freedoms and entitlements involving civil, political, economic, social and cultural rights.

The right to decide the number and spacing of children is integral to reproductive rights and to other basic human rights, including the right to health, particularly sexual and reproductive health, the right to privacy, the right to equality and non-discrimination and the right to liberty and the security of person.

Reproductive rights rest not only on the recognition of the right of couples and individuals to plan their families, but also on the right to attain the highest standard of sexual and reproductive health.

The impact of the PoA has been nothing short of revolutionary for the hundreds of millions of women who have over the past 21 years gained the power and the means to avoid or delay a pregnancy.

The results of the rights-based approach to sexual and reproductive health, including voluntary family planning, have been extraordinary. Millions more women have become empowered to have fewer children and to start their families later in life, giving them the opportunity to complete their schooling, earn a better living and rise out of poverty.

And now there is a wealth of indisputable evidence that when sexual and reproductive health is integrated into broader economic and social development initiatives, it can have a positive multiplier effect on sustainable development and the well-being of entire nations.

Recent research shows that investments in the human capital of young people, partly by ensuring their right to health, including sexual and reproductive health, can help nations with large youth populations realize a demographic dividend.

The dividend can help lift millions of people out of poverty and bolster economic growth and national development. If sub-Saharan Africa realized a demographic dividend on a scale realized by East Asia in the 1980s and 1990s, the region could experience an economic miracle of its own.

The principles of equality, inalienable rights, and dignity embodied in the United Nations Charter, the Universal Declaration of Human Rights and the Programme of Action are relevant today, as the international community prepares to launch a 15-year global sustainable development initiative that builds on and advances the objectives of the Millennium Development Goals, which come to a close later this year.

The new Post-2015 Global Sustainable Development Agenda is founded on principles of equality, rights and dignity.

Upholding these principles and achieving each of the proposed 17 new Sustainable Development Goals require upholding reproductive rights and the right to health, including sexual and reproductive health.

Achieving the proposed goal to ensure healthy lives and promoting well-being for all at all ages, for example, depends in part on whether individuals have the power and the means to prevent unintended pregnancy or a sexually transmitted infection, including HIV.

Human rights have guided the United Nations along the path to sustainability since the Organisation’s inception in 1945. Rights, including reproductive rights, have guided UNFPA along that same path for decades.

As we observe the 70th anniversary of the United Nations and look forward to the post-2015 development agenda, we must prioritise the promotion and protection of human rights and dignity for every person, for current and future generations, to create the future we want.

Edited by Kitty Stapp

Excerpt:

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:

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

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

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

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

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

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

Excerpts from the interview follow.

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

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

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

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

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

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

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

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

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

A: We are already doing it!

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

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

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

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

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

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

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

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

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

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

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

Edited by Kanya D’Almeida

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:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

*Names have been changed

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

Edited by Kanya D’Almeida

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:

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

By Thalif Deen
UNITED NATIONS, Jul 10 2014 (IPS)

As the United Nations continues negotiations on a new set of Sustainable Development Goals (SDGs) for its post-2015 development agenda, population experts are hoping reproductive health will be given significant recognition in the final line-up of the goals later this year.

At the same time, an upcoming Special Session of the General Assembly in mid-September may further strengthen reproductive rights and the right to universal family planning."Advocates are rallying to ensure that SRHR remains as central to the next set of goals as it is to women's lives." -- Gina Sarfaty

Gina Sarfaty of the Washington-based Population Action International (PAI) told IPS, “We are at a critical juncture for sexual and reproductive health and rights (SRHR).”

As the conversation around the next set of SDGs begins to heat up, she said, “Advocates are rallying to ensure that SRHR remains as central to the next set of goals as it is to women’s lives.

“The stakes are high, and the need for action is paramount,” cautioned Sarfaty, a Geographic Information Systems (GIS) specialist and research associate at PAI.

World population, currently at over 7.2 billion, is projected to increase by 3.7 billion people by 2100. Much of this growth will occur in developing countries, with 64 percent concentrated in just 10 countries, according to PAI.

In eight of these nations – Nigeria, Tanzania, Democratic Republic of Congo, Niger, Uganda, Ethiopia, Kenya and Zambia – an important driver of population growth is persistently high fertility.

The remaining two countries accounting for the world’s increase – India and the United States – are those with already large populations and high net migration.

The ongoing negotiations for SDGs take place against the run-up to the upcoming special session of the General Assembly commemorating the 20th anniversary of the 1994 landmark International Conference on Population and Development (ICPD) in Cairo.

The special session, to be attended by several heads of state, is scheduled to take place Sep. 22 during the 69th session of the General Assembly.

Dr. Babatunde Osotimehin, under-secretary-general and executive director of the U.N. Population Fund (UNFPA), told IPS the principles set at the ICPD in 1994 are as relevant today as they were 20 years ago.

“But we need to act strong and fast to realise the Cairo vision and achieve universal access to sexual and reproductive health and reproductive rights, including family planning,” he added.

The special session presents the perfect opportunity for governments, at the highest level, to recommit to its success and to renew their political support for actions required to fully achieve the goals and objectives of its Programme of Action and achieve sustainable development, he said.

This will also place the Cairo principles firmly in the post-2015 development agenda, said Dr. Osotimehin, a former Nigerian minister of health.

Purnima Mane, president and chief executive officer of Pathfinder International, told IPS the September meeting represents an opportunity for world leaders to assess progress made over the past 20 years against the goals and strategies developed in 1994, identify any remaining gaps in performance that require increased attention and investment, and realign their efforts moving forward.

“This is a very important session for all of us working on sexual and reproductive health since it provides a critical forum for reaffirming and unifying international commitment to ICPD goals and for making an added push to do more on areas and in countries where we are lagging,” she said.

Asked why there wasn’t a follow-up international conference, perhaps an ICPD+20 on the lines of the Rio+20 environment conference in 2012, Mane said the Cairo Programme of Action developed a very forward-looking agenda and set the bar high for the international community 20 years ago.

She said its goals are still relevant and actionable, and the agenda is unfortunately not yet finished.

“My sense is that having a follow-up conference in such an environment was seen as neither strategic nor a good use of resources,” Mane said.

The upcoming special session “is intended to heighten focus on the goals established in the 1994 Programme of Action, stimulate discussion around what we will do to complete the unfinished agenda, re-engage on commitments already made and also push for more.

“I would hope the upcoming U.N. session will highlight the need to include sexual and reproductive health and rights upfront as a core component of the Sustainable Development Goals as the Open Working Group continues to develop its proposal,” said Mane, who oversees sexual and reproductive health programmes in more than 20 developing nations on an annual budget of over 100 million dollars.

Asked about the current status of world population growth, PAI’s Sarfaty told IPS that despite the fact that mortality has declined substantially, women in sub-Saharan Africa currently have more than five children on average, representing a modest decrease from the average of 6.5 children they had in the 1950s.

Compared to Latin America and Asia, she said, a slower pace of fertility decline has characterised sub-Saharan Africa, with stalls and even reversals along the way.

Of 22 countries where recent survey data is available, 10 are transitioning towards lower childbearing while 12 are currently experiencing fertility stalls.

“Therefore, the expectation that fertility will steadily decline in Africa, as the U.N. projects, will not hold without concerted policy and programme effort,” she warned.

The polar opposite fertility scenario is happening in the high income countries with low levels of fertility.

It is estimated that 48 percent of the world’s population lives in countries where women have fewer than 2.1 children on average in their lifetimes, she pointed out.

While fertility rates in these countries may be below replacement level, their need for family planning does not disappear, she declared.

Sarfaty said family planning use continued in Iran, for example, after the government discontinued its funding of family planning programmes in an attempt to encourage higher birth rates.

In addition to being ineffective, restricting access to family planning also restricts the right of a woman to determine her family size, she added.

Meanwhile, in a report released Thursday, the United Nations said the world’s population is increasingly urban, with more than half living in urban areas today and another 2.5 billion expected by 2050.

With nearly 38 million people, Tokyo tops U.N.’s ranking of most populous cities followed by Delhi, Shanghai, Mexico City, Sao Paulo and Mumbai.

The largest urban growth will take place in India, China and Nigeria: three countries accounting for 37 per cent of the projected growth of the world’s urban population between 2014 and 2050.

By 2050, India is projected to add 404 million urban dwellers, China 292 million and Nigeria 212 million.

Excerpt:

Huama farmers harvest their crop. Half the population lived as subsistence peasants in the year 2012, according to the World Bank. Credit: Milagros Salazar/IPS

By Kanya D'Almeida
CHATTANOOGA, Tennessee, U.S., Oct 5 2013 (IPS)

What does gorilla conservation have in common with the provision of contraceptives to women? How does rural-urban migration contribute to global warming? What does city planning in Kenya have to do with coastal erosion in the Philippines?

Such are the topics of conversation at the 23rd annual conference of the Society of Environmental Journalists (SEJ), running from Oct. 2-6 in what was, until 1960, referred to as “the dirtiest city in America”: Chattanooga, Tennessee.

Besides exploring an urban centre that has made the impressive about-turn from a highly polluted landscape into a model of sustainability, the nearly 300 journalists convened here are looking past their many differences to answer some fundamental questions about the profession.

What is the role of the media in an era of rapid climate change? How do we tell the interconnected stories of population, development and environmental crisis? And, more, importantly, is anyone listening?

Speaking at a pre-conference workshop entitled ‘From Chattanooga to Chennai: reporting on population and sustainability in an urbanising world’, Meaghan Parker, of the Woodrow Wilson Centre and associate board member of SEJ, pointed out that the global urban population is expected to nearly double from its 2009 total of 3.4 billion people to 6.4 billion by 2050.

Citing World Bank statistics, she added that in the decade between 1995 and 2005, cities in developing countries welcomed 165,000 newcomers every single day. By the middle of the century, seven out of 10 people will live in an urban area.

These numbers have long had population experts on red alert but seldom made it into dinner table conversations, let alone onto front-page headlines.

But as the planet gets hotter – with the U.N.’s latest comprehensive climate change report predicting an “ice-free” Arctic by 2050, much sooner than previously anticipated –more voices are sounding the alarm that densely-packed cities are disasters waiting to happen.

Others are finding ways to link rural flight with erratic temperatures, a combination that is altering the basic composition of the earth’s human population, 50 percent of which lived as subsistence peasants in the year 2012, according to the World Bank.

Yet at every turn, journalists attempting to thread together the umpteen strands of this crisis say they are thwarted by a global media industry reluctant to accept stories that fail to fit into established paradigms.

“If we pitch a story on how climate change and natural disasters affect women from poor communities in the U.S., we’re told it’s a ‘human interest story’. If we pitch on the weather hazards of the construction industry, we’re told it’s a ‘labour story’,” a reporter from a prominent U.S. news outlet told IPS under condition of anonymity.

“If we talk about climate refugees lacking access to health services, we’re told it’s a ‘human rights’ piece – it’s almost impossible to connect the science of climate change with the human impacts of those changes.”

Forced to think outside the box, journalists are stretching the narrow limits of the profession by working closely with researchers and grassroots activists for whom the links between environmental justice and population are inseparable.

In southwestern Uganda, a small NGO known as Conservation Through Public Health (CTPH) has teamed up with communities on the fringes of the secluded Bwindi Impenetrable National Park (BINP) to achieve the twin goals of gorilla conservation and improved access to family planning.

With a wild population of just 880, mountain gorillas are one of the most critically endangered species on earth, according to Gladys Kalema-Zikusoka, founder and CEO of CTPH.

Nearly half of those gorillas live in BINP, whose outlying areas are among the most densely populated in all of Africa, housing some 200 people per square kilometre.

This is partly a result of Uganda’s massive population boom – which took the country from 6.5 million people in 1959 to 28.5 million in 2008 – and a high-fertility rate in the region: the average family size is 10 people in Bwindi, well above the already high national average of seven.

Speaking at a panel at the Chattanooga Convention Centre Friday, Kalema-Zikusoka said the gorillas enter human settlements where people live in squalid conditions, 20 miles from the nearest health centre. In such close quarters, gorillas frequently lay waste to farmers’ crops, and pick up and transmit diseases like scabies and tuberculosis (TB).

With one of the top 22 TB infection rates in the world, Uganda is already in the middle of a veritable health crisis, lacking the resources to reach remote communities and stop the outbreak, which is exacerbated by the country’s high HIV/AIDS rate.

Inspired by the emerging field of “conservation medicine”, Kalema-Zikusoka launched CTPH in 2003. Today the initiative reaches some 40,000 people, teaching them how to prevent the spread of diseases from ape to human and vice versa, and recruiting them into conservation efforts that double up as economic opportunities.

In addition, the programme deploys ‘couple peer educators’ to deliver information about family planning services to combat the region’s high infant and maternal morbidity, and reduce overpopulation.

“Now, 60 percent of women in the two parishes where the programme was piloted use some form of contraception and we’ve seen an 11-percent increase in TB suspect referrals,” said Kalema-Zikusoka, adding that scientists are also recording fewer signs of sickness among gorillas.

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:

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

By Stella Paul
KUALA LUMPUR, May 29 2013 (IPS)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

A mother and her child from West Point, a low-income neighbourhood of Monrovia, Liberia. The 10-worst countries to be a mother in are all in sub-Saharan Africa. Credit: Travis Lupick/IPS

By Agnes Odhiambo and Gauri Van Gulik
NAIROBI , May 19 2013 (IPS)

Victoria J. married in 2009 at age 14, and became pregnant shortly after. “I started labour in the morning on a Friday …. The nurse kept checking and saying I would deliver safely. On Monday she said I was weak.

“The doctor decided to operate on me. (During the) operation they found the baby was dead. The doctor said the baby had died due to the long labour. After that, I found out that urine was coming out all the time,” she said.

Women and girls like Victoria in Kenya, South Africa and South Sudan also spoke to us about pregnancy and childbirth. Sadly, too many of their stories were not about the joy of having a child, but about abuse, neglect and pain.

In interviews and reporting across Africa, Human Rights Watch heard from girls who knew too little about sexuality and family planning when they were forced into marriage and pregnancy.

We spoke to girls who were married and conceived when their bodies were not mature enough to go safely through pregnancy and delivery. Women and girls also told of health centres that were poorly staffed and ill-equipped to handle obstetric complications.

They described not having enough money for transportation to government health facilities or to pay the high cost of giving birth there. Women described the shortage of ambulances to transport them when they needed specialised care, abuse and negligence by health workers, and the absence of a complaints process to notify the facilities of mistreatment and other problems.

Sadly, we spoke with the families of those women and girls who did not survive pregnancy and could not tell their own stories.

Significant global and regional progress has been made to reduce the number of preventable maternal deaths: data released in 2012 by the United Nations shows that the number of women worldwide dying of pregnancy and childbirth-related complications has almost halved in the last 20 years.

Human Rights Watch researcher Agnes Odhiambo. Courtesy: Human Rights Watch.

The report, “Trends in Maternal Mortality: 1990 to 2010”, shows that sub-Saharan Africa saw a 41 percent reduction in maternal death. Despite these promising results — in a region that bears a disproportionate burden of maternal mortality — the progress is still too slow and uneven.

The 10-worst countries to be a mother in, according to Plan International’s “State of the world’s mothers report”, are all in sub-Saharan Africa. In addition to the unacceptably high numbers of women who die, African women also suffer disproportionately from childbirth injuries.

One of the most devastating is the obstetric fistula that Victoria suffered from, which leads to constant leakage of urine and stool. Fistula can be prevented or treated and hardly exists in the developed world.

As the African Union (AU) celebrates 50 years of existence on May 25, it should put a spotlight on the human rights of African women and girls.

The AU adopted the Maputo Protocol in 2003. Of the 54 AU member countries, 36 have ratified it. The protocol is unique in that it focuses on issues that affect women in Africa the most and covers topics that are not included in international treaties, including CEDAW (Committee on the Elimination of Discrimination against Women), the women’s rights convention.

It is in the area of reproductive rights that the protocol is most ground-breaking. Article 14 calls on governments to provide adequate, affordable and accessible health services and to establish and strengthen existing health and nutritional services for women during pregnancy and while they are breast-feeding.

Importantly, it calls on governments to protect the reproductive rights of women by authorising medical abortion in cases of sexual assault, rape, incest, and where there is a risk to the health or life of the mother or the foetus.

There are many other commitments and declarations, at least on paper, promoting maternal health in Africa. In 2008, the AU passed a resolution on maternal mortality in Africa, well before the U.N. Human Rights Council did so, that recognised that preventable maternal mortality is a violation of women’s right to life, health and dignity. It included recommendations to improve health financing and accountability.

The AU’s campaign on Accelerated Reduction of Maternal Mortality in Africa features the theme “Africa Cares: No Woman Should Die While Giving Life,” to mobilise political commitment and resources to help reduce maternal deaths.

The campaign includes a focus on improving monitoring of health systems. Since its launch in 2009, 37 countries have joined the campaign and signed on to its pledge.

While these commitments are important, it is time African governments be held accountable for failing to meet them.

To date, accountability has not been one of the AU’s strong points — but that can change. While the AU recognises that member states have not done enough to reduce maternal deaths, there is no effective monitoring and reporting mechanism at the regional level on what countries are doing to fulfil their promises, and where they are lacking. Establishing such a mechanism could enable countries to identify failings and needs, and to learn from each other’s best practices.

It is time for the governments and leaders of Africa to honour their commitments to women. It is time for Africa and the AU to ensure that no woman should die while giving life.

* Agnes Odhiambo and Gauri Van Gulik are researchers with the Women’s Rights Division at Human Rights Watch.

Only 12 percent of women in Senegal use contraceptives, which has led to a “baby boom” in the country. Credit: karah24 /CC-BY-ND-2.0

By Issa Sikiti da Silva
DAKAR, Jan 21 2013 (IPS)

A 25-year-old mother of five hailing from Senegal’s eastern Tambacounda province believes that contraceptives damage the womb and cause health problems in the long term, such as a rise in blood pressure and chronic headaches.

“This is what I heard some women saying in the bus I boarded to go to town,” the woman, now living in the capital city of Dakar after her tragic divorce, tells IPS.

She was only 16 when she was forced to marry her 35-year-old cousin. When she tried to discuss contraception with her former husband, “he beat me up and swore that he would kill me if I ever mentioned it again. So we kept having babies.”

As a result of misconceptions about children and family planning, religious dogma and a lack of reproductive health services, thousands of women across Senegal share her plight.

Breaking the stereotypes

Children are a symbol of wealth in this West African country of 12 million people, a perception that has led to a “baby boom”, experts here say.

“This ancient belief implies that more boys mean more manpower (for) a farm, or that you stand a chance of seeing (your son) become a rich man or even the president of the republic or a minister, while many girls bring their parents more money or livestock for dowry when they get married, ” marriage counsellor Fatoumata Sow tells IPS in Dakar.

“The moment (women) get married, they start making children as if a high-speed train has taken off late at a station, and is flying to catch up.

“And though I’m using Senegal as a case study, the trend is almost the same all over West Africa,” according to Sow, the mother of nine children.

She says family planning is taboo in many parts of West Africa, especially in rural communities where illiteracy is rife and awareness about family planning services – let alone access to contraception and birth control – is non-existent.

“Lack of effective family planning policies and (this perception) of children being a symbol of wealth has seriously damaged the social fabric of Senegal,” a doctor at one of the country’s public hospitals, who was afraid to give his real name for fear of persecution by the authorities, tells IPS.

“I always ask every pregnant woman who stands before me for consultation if she has ever used contraceptives, and the response I get every day is no.”

Only 12 percent of Senegalese women use contraceptives, Senegal’s Health and Social Action Minister Professor Awa Marie Coll Seck told a family planning conference in London last year.

Government intervention

Coll-Seck, who confessed that the country’s current contraceptive prevalence rate is one of the lowest in the world, says her government’s vision is to move the needle from 12 to 27 percent by 2015.

This will mean reaching five percent of users per year. “It is possible,” an optimistic Coll-Seck told the press in Dakar.

In a bid to create awareness and break down the stereotypes surrounding contraception, the government launched a national day of family planning action late last year.

The plan comes not a minute too soon: according to Coll-Seck, one woman out of two has expressed the desire to space births but does not have access to family planning products and services.

The national action day will also be used to sensitise men about the importance of spacing births, because family planning is a matter for the couple, not just for the woman.

The Senegalese government says it has set a target of reaching 350,000 women in the next three years.

In order to effectively reach its goals, the campaign has been divided into three phases, according to Dr Bocar Mamadou Daff, national director for reproductive health and child survival.

First of all, creating awareness through mass communication, which includes sending specific messages to selected targets and embarking on an advocacy campaign to get leaders to support family planning values.

The second phase involves a community-based distribution system to improve access to short-term contraceptives. Private actors will also be involved, Daff says, to help expand the supply of contraceptives.

The third and final phase is to ensure that contraceptives are readily available for those who need them.

According to Sow, better family planning could also help the government tackle two related problems that it has struggled for many years to address: malnutrition and homelessness.

This past December, the United Nations Children’s Fund (UNICEF) said it had distributed life-saving treatment to more than 850,000 severely malnourished children in the Sahel region, who were starving to death in 2012.

Senegal has one of the highest rates of acute malnutrition in the world; in the northern province of Matam the rate is as high as 19 percent, according to the World Food Progamme.

“When there are too many kids to feed, the head of the household must have plenty of (money) to take care of them, otherwise they will either get sick from hunger and die, or move to the streets to beg,” says Sow.

But not everyone is supportive of the new government initiative. Religious leaders like Al-Hajj Ibrahima Dieng (61) believes such practices “are anti-Islamic”.

“Allah is the one who gives (us) children and he’s in charge of providing everything for them, to enable them to grow healthy and strong,” an incensed Dieng, father of 15 children, tells IPS.

“And you want to stop that from happening? I swear by Allah that I will never be part of such nonsense. It’s haram.”

Though such opinions are widespread among the country’s conservative religious majority, not all religious leaders share Dieng’s anti-contraception sentiments.

Cheick Mouhamadou Mbara Segnane, a highly respected leader of the Tidjiane community in Senegal, is extremely concerned about the baby boom.

He told the press last year that the government needed to step in to eradicate the problem. The imam even suggested that the government impose a limit on the number of children per family.

Some experts like Sow believe change will only come slowly.

“I think as a society, we are not yet ready for such an evolution,” she tells IPS. “Traditions and cultural beliefs have affected our minds so much and brainwashed us so totally that we have become blind. But there is room for hope.”

(END)

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:

A team from Kawempe Home Care visits Barbara Namirimu, one of their patients, at her home in Kampala, Uganda. Credit: Andrew Green/IPS

By Carey L. Biron
WASHINGTON, Nov 29 2012 (IPS)

At perhaps a critical turning point in the global fight against HIV/AIDS, the U.S. government, the single largest funder in that fight, on Thursday unveiled a major new strategy for pushing towards achieving an “AIDS-free generation”, the stated U.S. goal.

The far-reaching new blueprint for what’s known as the President’s Emergency Plan for AIDS Relief (PEPFAR) is being widely lauded, yet little attention has been given to a document, published in October, that stipulates how new PEPFAR funding can be used. According to that guidance, “PEPFAR funds may not be used to purchase family planning commodities.”

While this would include a broad set of contraception, under PEPFAR definition, condoms – a central component in comprehensive AIDS-prevention strategies around the world – are not considered “family planning”, and thus the ban does not apply to condom procurement.

Still, such a line was not included in a similar directive offered last year, and some now say that it indicates President Barack Obama’s capitulation to conservative forces in the United States – with potentially negative ramifications on the ground.

“The language in the guidance was put there to make clear what exactly (PEPFAR) could and couldn’t pay for – that’s problematic,” Mary Beth Hastings, with the Center for Health and Gender Equity, a Washington advocacy group, told IPS.

“We believe strongly that funding for family planning is critical, especially in countries where there is no funding from USAID (the United States’ foreign aid department) for family planning or where there are very few services for family planning.”

A PEPFAR spokesperson told IPS that “There’s no gap in need” for family planning, and that “there are other entities, particularly USAID, that meet that need. We’re very interested in integrating our services.”

But Hastings notes that many countries in Africa and Latin America, for instance, lack any state funding for family planning, and may or may not receive related assistance from USAID. However, nearly all do receive financial support from PEPFAR.

Following the October publication of the new guidance, Hastings’s colleague, Serra Sippel, wrote, “The U.S. government just voluntarily stopped short of potentially saving a great number of lives … women’s lives are yet again being treated like expendable assets.”

Conservative suspicion

It’s important to note that the family planning issue is only a small aspect of PEPFAR’s overall vision. The new blueprint has received widespread praise from the most important players in anti-AIDS medicine and advocacy, though many caution that, as always, success will depend on implementation.

Of particular note is an aggressive new focus on a spectrum of touchy subjects, including sex workers, men who have sex with men, and users of injectable drugs, as well as a central prioritisation on the traditional discrimination against these groups.

“When discrimination, stigma, and other factors drive these groups into the shadows, the epidemic becomes that much harder to fight,” U.S. Secretary of State Hillary Clinton said Thursday morning, unveiling the blueprint. “That’s why we are supporting country-led plans to expand services for key populations, and bolstering the efforts of civil society groups to reach out to them.”

Yet while this renewed willingness on the part of the U.S. government to advocate for progressive social change in other countries is potentially critical in the fight against AIDS, the problematic issue of family planning underlines a discrepancy in the political will to mould opinion at home.

By far the largest single part of the United States’ global health budget, PEPFAR, created in 2003 by former president George W. Bush, has had an authorised budget of some 63 billion dollars over the past decade. And while political support for PEPFAR has always been notably bipartisan, it still represents a problematic issue for some conservatives in the U.S. government.

“There’s always been pressure from conservatives on the U.S. government to consider family planning as akin to abortion,” Hastings says. “In turn, the Obama administration is sensitive to Congress’s desire not to spend this money on anything other than HIV. If they were to specifically come out and say that they were planning on funding contraception, there would be a reaction.”

During the 2008 re-authorisation of the PEPFAR budget, for instance, conservative members of the U.S. Congress dubbed the legislation the “abortion bill” and succeeded in getting family planning dropped from the final version. Importantly, PEPFAR’s current budget will run out in 2013, requiring another round of re-authorisation from Congress.

Reinforcing the problem

The 2008 tussle was actually a continuation of the intense backroom negotiations that took place following President Bush’s initial 2003 proposal.

According to Jon O’Brien, president of Catholics for Choice, a Washington advocacy group, the conservative President Bush was at the time under tremendous pressure for having put forth such a bold initiative. Eventually, a lobby group spearheaded by the U.S. Conference of Catholic Bishops said it would work to sink the proposal unless family planning was taken out of PEPFAR’s mandate.

“Even the AIDS advocates weren’t willing to stand strong because of the huge ramifications of PEPFAR,” O’Brien told IPS. “The idea was to go back one day and change this, but what’s happened since is deafening silence from President Obama on family planning.”

O’Brien notes that while these initial agreements were put in place under Republican control, President Obama has been well aware of the “damaging shortfalls” of not fixing the family planning clauses.

“Now, not only did they not fix it, but the Obama administration has put the ban on family planning in concrete,” he says. “Any smart prevention strategy is tailored to meet the needs on the ground, not the distressingly common desire to placate one or another conservative group.”

In fact, the new PEPFAR blueprint does lay out a far more progressive stance on family planning, noting in part that the programme will “Provide voluntary family planning and safer pregnancy counseling for HIV-positive or discordant couples who desire pregnancy.”

Indeed, the October guidance itself notes a “significant unmet need for voluntary family planning … worldwide” and cautions, “Among women infected by HIV, there is strong evidence to suggest that they have less access to family planning.”

Yet O’Brien says that “the rhetoric doesn’t match the reality.” He continues: “It’s not enough to say we mean to change it – at the end of day, if you’re a woman in a rural area and you need family planning, such rhetoric is not enough. The administration needs to walk the walk.”

View outside a U.N.-supported family clinic in Khovd aimag, Mongolia, providing immunisation and child care. Credit: UN Photo/Eskinder Debebe

By Thalif Deen
UNITED NATIONS, Nov 14 2012 (IPS)

Since the 1966 International Covenant on Economic, Social and Cultural Rights, the United Nations has consistently maintained that family planning is a basic human right to be exercised by all – not just the wealthy and otherwise privileged.

The right of individuals to decide on the number of children they bear has been enshrined in at least seven other key treaties and U.N. declarations: the proclamation of the international human rights conference in 1968, the 1969 General Assembly resolution on Social Progress and Development and the 1979 Convention on Women’s Rights (CEDAW).

And over the last three decades, family planning has also been reaffirmed in the Children’s Rights Convention of 1989, the Vienna Programme of Action on Human Rights in 1993, the Programme of Action of the 1994 International Conference on Population and Development (ICPD) and the Beijing Platform of Action in 1995.

Dr. Babatunde Osotimehin, executive director of the New York-based U.N. Population Fund (UNFPA), is unequivocal in his strong advocacy of family planning.

“Family planning is not a privilege, but a right,” he told IPS. “Yet, too many women and men are denied this human right.”

The latest 2012 UNFPA report released Wednesday says the huge unmet need for family planning persists, “despite international agreements and human rights treaties that promote individuals’ rights to make their own decisions about when and how often to have children”.

An estimated 222 million women lack access to reliable, high-quality family planning services, information and supplies, putting them at risk of unintended pregnancies.

The report notes that even in developed countries, there are high levels of unintended pregnancies, especially among adolescents, the poor and ethnic minorities.

Dr. Osotimehin points out that family planning has a positive multiplier effect on development.

“Not only does the ability for a couple to choose when and how many children to have help lift nations out of poverty, but it is also one of the most effective means of empowering women,” he told IPS.

He argues that women who use contraception are generally healthier, better educated, more empowered in their households and communities and more economically productive.

And women’s increased labour-force participation boosts nation’s economies, he adds.

Titled, “The State of World Population 2012: By Choice, Not By Chance: Family Planning, Human Rights and Development”, the report says voluntary family planning should be available to all – because it is a universal human right.

Shortages of contraceptives are only one reason why millions of people are still unable to exercise their right to family planning.

Access to family planning may also be restricted by other factors, including
poverty, negative social pressures, gender inequality and discrimination.

Still, the report finds that financial resources for family planning have declined and contraceptive use has remained mostly steady.

In 2010, there was a shortfall of about 500 million dollars in expected contributions from donor countries to sexual and reproductive health services in developing countries.

Contraceptive prevalence has increased globally by just 0.1 percent per year over the last few years.

At the London Summit on Family Planning last July, donor countries and Foundations together pledged about 2.6 billion dollars to make family planning available to 120 million women in developing countries with unmet needs by 2020.

Developing countries themselves pledged two billion dollars.

But still, an additional 4.1 billion dollars is necessary each year to meet the unmet needs for family planning of all 222 million women who would use family planning but currently lack access to it, according to the UNFPA report.

“This investment would save lives by preventing unintended pregnancies and unsafe abortions,” it says.

However, money is just one part of the solution, the report points out.

Failing to meet the sexual and reproductive health needs of adolescents and young people in Malawi, for example, contributed to high rates of unintended pregnancy and HIV, the report said.

In the United States, the report showed that teenage motherhood reduces a girl’s chances of obtaining a high school diploma by up to 10 percent.

To ensure that every person’s right to family planning is realised, the report calls on governments and leaders to take or reinforce a rights-based approach to family planning; secure an emphasis on family planning in the global sustainable development agenda that will follow the Millennium Development Goals in 2015; ensure equality by focusing on specific excluded groups; and raise funds to invest fully in family planning.

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

By Zofeen Ebrahim
KARACHI, Nov 14 2012 (IPS)

Thirty-year-old Shahida Saleem, who was not educated past the tenth grade, is a mother of two, living with her family in Karachi. Six months ago she suffered a miscarriage and her doctor, concerned about her anaemic condition, advised her to space out her next pregnancy by taking contraceptives.

“I don’t want to have any more children; it’s difficult to bring up two in these times of rising food prices,” Saleem told IPS.

Still, she is not planning to use any modern method of birth control.

“I tried pills after my first child but I developed a cyst in my ovary, which the doctor said was due to the contraceptive,” she said, explaining why she discontinued that particular method.

Neither she nor her husband has initiated the use of condoms.

Saleem is among the estimated 222 million women who, according to the ‘State of the World Population 2012’ report, released Wednesday by the United Nations Population Fund (UNFPA), “lack access to reliable, high-quality family planning services, information and supplies, putting them at risk of unintended pregnancy”.

According to the Islamabad-based Research and Development Solutions (RADS), six million Pakistani couples need contraception annually.

Overseen by the Department of Health and the Ministry of Population Welfare, the public health sector covers just 33 percent of these couples’ needs. Fifteen percent go to the private sector or non-governmental organisations for family planning services.

This leaves over 1.5 million people at the mercy of market-distributed family planning, which is often cost-prohibitive.

Changing a conservative mindset

But as the UNFPA’s research shows, “Shortages of contraceptives are only one reason why millions of people are still unable to exercise their right to family planning. Access to family planning may also be restricted by forces including poverty, negative social pressures, gender inequality and discrimination.”

A highly conservative mindset still dominates huge swathes of Pakistani society. The latest Pakistan Demographic and Health Survey (PDHS), tracking data from 2006 to 2007, states, “Many Pakistani women and men regard continuing contraceptive practices more threatening to their health than an occasional induced abortion.”

“We keep talking about unmet need; but having worked with women for many years, I have come to the conclusion that a lot has got to do with the mindset. No amount of contraception supplies in population welfare centres will help if the women are not convinced to use them,” Dr. Arjumand Rabbani of the Midwifery Association of Pakistan, told IPS.

Dr. Talat Rizvi, a leading medical practitioner, stressed that maternal health indicators will only improve if female education and economic empowerment are given due attention.

Pakistan lagging on MDGs

Zulfikar Bhutta, head of women and child health at the Aga Khan University in Karachi, is sceptical about Pakistan’s ability to achieve the fourth and fifth Millennium Development Goals (MDGs) of improving child health and reducing maternal mortality.

“Pakistan has failed to make substantive progress towards (achieving) the MDGs for health and has fallen way behind most countries in the region including Nepal and Bangladesh,” Bhutta, who is part of the seven-member independent Expert Review Group (iERG) for maternal and child health for the U.N. Secretary General, told IPS.

“Even northern Afghanistan seems to have made more rapid progress in recent years. The reasons for this lack of progress are manifold, including lack of political will to address maternal and child health, unbridled population growth, poor governance and accountability.

“Social determinants of health such as female education and empowerment, poverty alleviation and under-nutrition have received scant attention,” he lamented.

The situation is complicated by the population boom in the country.

On average, Pakistani women have four children. With almost 84 percent of women not using any form of modern birth control, keeping Pakistan’s population at a manageable level is a massive task.

If current trends continue, by the year 2020 the country’s population will reach 200 million.

“Any delay in addressing the issue of millions of uneducated and unemployed youth will lead to a disaster of unprecedented proportions in the near future,” Dr. Farid Midhet, a demographer and founder of the Safe Motherhood Alliance in Pakistan, told IPS.

Local efforts offer hope

Health experts are now turning their attention back to the Lady Health Workers (LHW) programme, whose army of 90,000 community health workers is perhaps Pakistan’s best bet to providing comprehensive reproductive healthcare and family planning.

The programme began in 1994, when government-trained medical professionals went door-to-door delivering temporary supplies of condoms, injections and birth-control pills, as well as other basic health needs.

If the programme hopes to reach the entire population of 180 million, 60 percent of which lives in rural areas, the country needs to double the number of workers to 180,000, health experts say.

“The health sector has failed to implement even one programme properly, with the exception of the LHW programme,” Bhutta said.

But in recent years, the programme has been undergoing a shift, with lady health workers increasingly tasked with managing other campaigns for tuberculosis, malaria and polio, which have eaten up much of their time and energy.

“I think if LHWs revert back to their original job description, they can do wonders with regards to both family planning and prenatal care,” Midhet said.

“They are discrete, known to the women, easily accessible and (able to provide) advice and support when women first start using a pill or injection,” he pointed out.

However, he hastened to add that other factors must improve simultaneously, such as salaries. The women must be “allowed the space to work independently of all political interference.”

(END)

Lack of family planning has led to a surge in unsafe abortions in Eastern Europe. Credit: William Murphy/CC-BY-SA-2.0

By IPS Correspondents
PRAGUE/WARSAW, Nov 14 2012 (IPS)

Pressure from the Catholic Church, social stigma, a lack of information about sexuality and reproductive health and limited access to reproductive healthcare services are putting the lives of hundreds of thousands of women across Eastern Europe at risk.

According to the World Health Organisation (WHO), “Women are over four times as likely to die in childbirth in the newly independent states of the former USSR as in the European Union.

“In some countries unsafe abortions cause over 20 percent of all registered maternal deaths, and Eastern Europe has the highest abortion rate in the world.”

In the ‘State of World Population 2012’ report, released Wednesday, the United Nations Population Fund (UNFPA) urges all developed and developing countries to “increase financial support and political commitment” to reproductive health and “promote family planning as a right” to ensure women’s health and safety.

But far from heeding the calls of the international community, Eastern Europe appears to be sliding further away from these goals.

“The reproductive health situation in Eastern Europe and Central Asia is quite dire. The contraceptive prevalence rate in some countries is as low as (the rate) in least developed countries,” Werner Haug, director of the UNFPA’s Eastern Europe and Central Asia regional office, told IPS.

While governments drag their feet on implementing national reproductive health policies, women are left at the mercy of a conservative society that offers very little space or support for family planning.

The last few years have seen a push, in many cases driven by the Church, to reinforce or tighten abortion legislation and deter access to or discussion of contraception.

This and other factors such as poverty, say women’s rights groups, have already led to a thriving underground abortion industry riddled with health risks and, in some countries, a growing practice of do-it-yourself terminations that are dangerous at best, but often fatal.

Poland: a laboratory of unsafe practices

Poland has some of Europe’s tightest restrictions on abortions, only allowing termination of pregnancy in the case of rape, incest or if the mother or baby’s health is at serious risk.

Yet even when those conditions are met, doctors in this staunchly Catholic society often refuse to carry out abortions for their own moral reasons, says Dr. Dorota Pudzinowska, a lawyer at the Helsinki Foundation for Human Rights in Poland.

“In principle, the law states that abortions should be allowed in certain circumstances,” she told IPS. “But the law also protects doctors’ rights to refuse certain procedures,” which means women are often forced to seek illegal abortions or go abroad to terminate their pregnancies.

“Approximately every third private gynaecologist provides abortion services illegally, which cost between 400 and 700 euros, but women have no control over the conditions in which these termination are provided” nor can they determine the skill level of the so-called doctors who carry out these operations, according to Aleksandra Szymczyk, an activist belonging to a prominent women’s rights group in Poland that organises an annual demonstration on Mar. 8 to demand reproductive justice.

Under the constant threat of being caught and potentially jailed for assisting women to terminate their pregnancies, doctors generally carry out these procedures hastily, in unsterile conditions, away from the gaze of the medical establishment or law enforcement officials.

Several women in Poland unable to receive any kind of operation at all have taken their cases to the European Court of Human Rights.

One was the case of a 14-year-old rape victim from the southeast Polish town of Lublin, known only as ‘P’, who was turned away from a number of clinics where she sought a termination. Church leaders would wait at the clinics to try to persuade her not to terminate the pregnancy.

The Court condemned the Polish state for the inhumane and degrading treatment of the girl, and ordered it to pay compensation.

That case, say campaigners, was just an extreme example of a climate around reproductive health in Poland that puts moral strictures laid down by the church ahead of women’s well-being.

“A major issue is that nobody knows how many abortions are conducted every year and in what conditions. Official data indicates just over 600 legal terminations annually, but it is common knowledge that many more abortions happen every year – women’s groups estimate that the number could be anything between 100,000 to 200,000 annually,” Elżbieta Korolczuk, another activist from the ‘March 8’ group, told IPS.

“Most abortions are carried out at home without any medical assistance, and judging from the content of Internet forums, many of the women do not use abortion pills but drugs that cause abortion as a side-effect,” she said.

“As a result, they expose themselves to a number of other side-effects and health problems, which they often don’t report afterwards out of fear and shame.”

Family planning is an issue that desperately needs to be discussed in Poland, said Karolina Wieckiewicz, a lawyer at the Polish Federation for Women and Family Planning.

“There is no counselling, no family planning advice available as part of primary health services,” she told IPS. “Even if a woman knows about the possibilities of avoiding pregnancy, she often does not have access to contraception.”

Contraceptives are available on prescription, but not every doctor will prescribe them. “And often pharmacists will refuse to hand over contraceptives because they say it is against their conscience,” Wieckiewicz said.

The problem is not limited to Poland, but is widespread throughout the region.

Reports in the former Soviet state of Armenia last month stated that there was evidence suggesting that the last few years have seen an upsurge in dangerous home abortions using freely available pharmaceuticals for the treatment of ulcers.

The pills have a contraindication of causing bleeding and miscarriages, and women have been using them to terminate unwanted pregnancies.

But doctors have reported that this method often results in severe bleeding and incomplete abortions, with many women being admitted to hospital needing emergency surgery.

Surgical abortions at a hospital cost up to 50 euros while these over-the-counter pills cost closer to 50 cents. The average monthly wage in Armenia is around 400 euros, effectively making professional surgical abortions cost-prohibitive.

No official record of mortality rates or serious health problems resulting from these illegal abortions can ever be obtained because of their clandestine nature.

However, the WHO has stated that even today up to 30 percent of maternal deaths are still caused by unsafe abortions in some countries of Eastern Europe and Central Asia.

*Pavol Stracancsky contributed to this report from Prague and Claudia Ciobanu and Chloe Arnold from Warsaw.

By Zofeen Ebrahim
KARACHI, Pakistan, Aug 3 2012 (IPS)

“This is just a trailer of the horror that awaits us,” says noted demographer Farid Midhet, referring to Pakistan’s bulging population and the possibly corresponding  link to rising crime, including murders, robberies, rioting and extremist activity.

According to the independent Human Rights Commission of Pakistan, at least 1,257 people, including 64 children, have been murdered in different parts of Karachi alone, since the beginning of the year.

Karachi, Pakistan’s financial capital and the world’s fifth largest city, has an estimated population of 20 million, which is increasing at the rate of six percent per year.

Regarded also as one of the world’s most dangerous cities, 40 percent of Karachi’s  population livies in squalid shanty towns.

Data maintained by the Citizens Police Liaison Committee suggest that an average of 82 persons were kidnapped in Karachi per year between 2008 and 2010. Between 1997 and 2007, the average was 27 cases per year.

By the year 2020, Pakistan’s population is projected to reach 200 million and by 2050, in a business as usual scenario, the country will have 309 million people.

“If we start making efforts today, we may be able to apply brakes to the population in the next 30 to 40 years,” said Midhet, founder of Safe Motherhood Alliance. “The threat is the biggest ever in the history of mankind.”

“If population growth is slowed down to replacement level and concomitant investment made in the social sector, we could deal with this youth bomb,” says Zulfiqar Bhutta, member of the independent expert review group for maternal and child health for the United Nations Secretary-General.

Bhutta, co-chair of ‘Countdown to 2015’, a global scientific and advocacy group tracking progress towards the U.N. Millennium Development Goal Five pertaining to maternal health, told IPS that the fact that population growth would inevitably outstrip resources for education, employment and development, was always well recognised.

“It is just that the mismatch has become became apparent over time,” Bhutta told IPS. “Our current resources and investments cannot deal with a fresh birth cohort of 4.5 million every year and the proportion of people who are uneducated, unemployable and uncared for continues to grow,” he said.

Midhet said the plethora of donor-driven and country-cultivated family planning (FP) programmes had failed to significantly increase the use of modern methods of contraception.

But if the facts and problems are known; solutions seem obvious and resources available and there is an infrastructure on the ground, why cannot couples limit family size? “We (Pakistan) are doing a lot of things, but we are probably not doing them right,” Midhet explains.

Between 2005 and 2010, many South Asian countries, including Sri Lanka, Bhutan, the Maldives, Bangladesh, India and Nepal, brought their total fertility rates,  or the average number of children a woman bears in her lifetime, from 3.2 to 1.5, but Pakistan remained stuck at four.

As contraceptive prevalence picked up to 74 percent in adjacent Iran between 2005 and 2010, it stayed stuck at a dismal 30 percent in Pakistan during the same period.

Only half of Pakistan’s couples are using a modern temporary method (condom, pill or intrauterine device), while 7.7 percent couples are still opting for the traditional FP methods, which are far less effective than the modern methods.

“If in the last five decades we had implemented the FP programmes sincerely and efficiently, made education compulsory and provided technical skills, today we would have been ahead of South Korea, Thailand, Indonesia and even India, due to our demographic dividend,” said Midhet.

The main problem seems to be lack of political will says Bhutta. “None of the political parties backed it ever.”

A ‘lady health workers programme’ launched in 1994 held out the promise of delivering both FP and basic healthcare at the doorstep, but quickly fell into the doldrums because of overstretched staff.

Dr. Ayesha Khan, who heads Research and Development Solutions, a non-governmental organisation that focuses on public health issues, told IPS that the programme ended up providing a rushed four minutes to every woman client. “The workers’ time and energy is expended on other programmes, including campaigns on TB, malaria and polio,” she said.

The only way out of the present stagnation in FP is for the ministries of population and health to completely merge their field operations and give the programme the primary task of providing modern contraceptives to couples, says Midhet.

“Pakistan could have achieved less than one percent population growth and today the population would have been less than 100 million had Pakistan invested in FP and education of its population,” says Midhet.

“In addition, the secondary school education rate could have reached 100 percent and the higher education rate could have surpassed 50 percent among youth and young adults,” he added.

Of Pakistan’s 180 million, 20.6 percent are between the ages of 15 and 24. Of these, 32 percent are uneducated with no vocational and life skills. Pakistan’s youth bulge consists of disgruntled and unhappy young people.

At a seminar organised by the National Vocational and Technical Training Centre (NVTTC) and United Nations Educational, Scientific and Cultural Organisation in June, to find ways to get youth into technical education, NVTTC chairman Mumtaz Akhtar Kahloon termed the youth bulge “a window of opportunity.”

“But, if we are  to turn this youth bulge into a demographic dividend, they must be equipped with marketable skills,” Kahloon added.

“If youth are not put to productive use, they pose a threat to peace,” Bhutta said at the seminar. “Small wonder that some see employment options in these (extremist) outfits.”

Each year, 16 million girls aged 15-19 give birth. 50,000 of them die from complications related to pregnancy and childbirth. And 95 percent of those births occur in developing countries.

Latin America and Sub-Saharan Africa lead the world in this department, with 80 and 120 births, respectively, per 1,000 adolescent females in 2009. But young girls’ bodies are not ready for childbirth, and getting pregnant before the age of 18 is a risk to both mother and child, as a UNICEF report, “Progress for children”, has shown. In fact, childbirth is the leading killer of adolescent girls in Africa.

Better access to and more effective use of contraceptives would help prevent 272,000 maternal deaths worldwide each year, according to a recent Johns Hopkins Bloomberg School of Public Health study. But in ensuring that girls can access and know how to use contraception, education is key, despite various cultural challenges that educating girls often faces.

Studies have shown that keeping girls in school improves their sexual and reproductive health. A recent released report by Save the Children shows that the higher a mother’s level of education, the lower children’s under-five mortality rate.

Laura Laski, chief of the sexual and reproductive health technical division at the United Nations Population Fund (UNFPA), told IPS that some families “believe that more education will not contribute to what (young girls) would…become later in life”.

Cultural barriers

Winifride Mwebesa, senior director of family planning and reproductive health at Save the Children, told IPS about cultural barriers in Sub-Saharan Africa. “Very often, poor families find themselves obliged to marry their children. The tradition has been that as soon as the girl menstruates she needs to get married because you don’t want the shame of having a pregnancy in the house before she is married.”

According to the World Health Organisation (WHO), in the developing world 90 percent of adolescent pregnancies are those of married girls.

Early marriage is a problem in Sub-Saharan Africa because it’s rooted deeply in the traditional values of the community. “Over 30 percent of girls in developing countries marry before 18 years of age; around 14 percent do so before the age of 15,” said Laski. Then, community expectations that girls soon have children prevents them from going to school.

In Latin America, early marriage is not as big a problem as in Sub-Saharan Africa. The report “Jóvenes y derechos” by Family Care International shows that in Latin America, factors related to a higher rate of teenage births have more to do with poverty, sexual abuse, absence of parents, culture and education levels.

María Faget, regional consultant in Latin America and the Caribbean for Family Care International, told IPS that “sexual context is still something not in the open”. Talking about the topic with parents or friends is difficult, and there is a reigning culture mandating that “young people do not need or should not be looking for contraception”, Faget explained.

Efforts in this region focus on providing “friendly services” and a welcoming environment for young people because sometimes, confidentiality is a problem. “These services are open and many times they are opened within hospitals and so young people do not go because they are afraid they are going to meet people, people they know,” said Faget.

In Sub-Saharan Africa, “friendly services” are also trying to be implemented. They include the training of  health personnel to provide accurate information to young people without interfering with their own values.

Education as the foundation

In both Sub-Saharan Africa and Latin America, the solution is strongly linked to the improvement of girls’ education.

Mali is a clear example. The percentage of female attendance in primary school between 2005-2010 (latest data) was 55 percent. But this number falls to 24 percent in secondary school, according to UNICEF data.

The number of girls in school is very low and the teenage pregnancy rate is extremely high – 190 births per 1,000 women – as the “Countdown to 2015 report” shows. The number is even higher than  the Sub-Saharan Africa average of 120 births per 1,000 women.

Often, families won’t take their girls to school because they are so far away . But Save the Children is working to build community schools there, as well as to create a girls-friendly environment –  also important in a family’s decision to let girls go to schools. “We build community schools that are friendly to girls, that have separate latrines,” Mwebesa told IPS.

Family Care International was part of a plan called Plan Andino para la Prevención del Embarazo en Adolescents (Plan Andino to Prevent Pregnancies Among Adolescents) that worked in six countries: Bolivia, Chile, Ecuador, Perú, Venezuela and Colombia.

Of those countries, Colombia has seen major improvement. “Colombia has made enormous effort in  friendly health programs,” explained Faget. In 2010, it launched an important communication campaign, “Por el derecho a una sexualidad con sentido,” that had a strong rights component.

Organisations agree that in these reproductive health and sexual education programmes, including young people’s voices is critical. After all, youth are the bridge between health and education systems and what is really needed.

Save the Children relies on youth participation to help develop materials related to sexual education. “We may have an idea of the content that needs to be in, but the format has to be decided by young people,” said Mwebesa.

Family Care International also believes in the importance of youth involvement, because youth can shift attitudes and they can have a big impact in changing culture, explained Faget.

In addition to keeping girls in school, young people need to have access to family planning and receive age-appropriate sex education, which Laski descrbied as “comprehensive sexuality education (where) girls and boys are educated about not only about their sexuality but (also) about…relationships and how to protect and promote human rights”.

Girls’ and women’s access to contraceptives is both a right and a transformational health and development priority. Credit: Patrick Burnett/IPS

By Julio Godoy
PARIS, Jul 18 2012 (IPS)

Improving family planning to avoid unwanted pregnancies in developing countries, as well as assuring girls’ access to education, and women’s participation in the economy, are essential components of a sound development policy, according to Western experts and African activists.

During a summit on family planning in London last week numerous economic development experts, government delegates from industrialised and developing countries, and private donors agreed to raise some 4.3 billion dollars by 2020 to allow 120 million women and girls in the world’s poorest countries, particularly in the continent of Africa, to access contraceptives and other family planning materials.

The summit underscored the importance of girls’ and women’s access to contraceptives as both a right and a transformational health and development priority.

Simultaneously, gender activists attending the second African Women’s Economic Summit, which concluded on Jul. 14 in Lagos, Nigeria, urged policy makers, corporate organisations and political leaders to step up measures to promote women’s empowerment and remove barriers impeding their economic development.

“I don’t want my daughters … in the coming years discussing these same issues (of women’s education and economic empowerment),” Cecilia Akintomide, vice president of the African Development Bank (AfDB), co-organiser of the African summit, told the audience in Lagos. “I want to see a change in my lifetime.”

During the meeting in Lagos, Nigeria’s finance minister, Ngozi Okonjo-Iweala, emphasised that women’s economic empowerment is no longer simply an option “because investing in women, who constitute half of the continent’s population, is the only way to sustain the growth” recently recorded across the African continent.

“Women are the third largest emerging market in the globe.  Women are the third largest source of growth. One of the fastest ways to sustain current growth is to invest in women,” Okonjo-Iweala said.

Participants at the London summit echoed these views, with an emphasis on the health risks associated with unwanted pregnancies.

“Enabling an additional 120 million women in the world’s poorest countries to access and use contraception, something women in the developed world take for granted, will save millions of lives and enable girls and women to determine their own futures,” said Andrew Mitchell, British secretary of state for international development.

Mitchell called the commitments of the summit a “breakthrough for the world’s poorest girls and women, which will transform lives now and for generations to come.”

By 2020, the collective efforts announced in London will allegedly result in 200,000 fewer women dying during pregnancy and childbirth, more than 110 million fewer unintended pregnancies, over 50 million fewer abortions, and nearly three million fewer babies dying in their first year of life.

Avoiding unwanted pregnancies also allows girls and women pursue their own education and improve their professional opportunities.

Numerous studies show that the investment of a single dollar in family planning leads to savings of up to six dollars in health, housing, water, and other public services.

Contraceptive use also leads to more education and greater opportunities for girls, helping to end the cycles of poverty that millions of women and their families are trapped in. Up to a quarter of girls in sub-Saharan Africa drop out of school due to unintended pregnancies.

Based on such evidence, the United Nations Millennium Development Goals (MDGs) call for gender equality, universal education, and improving maternal and child health, setting specific objectives to be met by 2015.

According to the U.N. 2012 MDG report, released Jul. 2, meeting these goals by 2015, while challenging, is possible, “but only if governments do not waiver from their commitments made over a decade ago.”

In the foreword of the report, U.N. secretary-general Ban Ki-moon, warned that the current economic crises battering much of the developed world “must not be allowed to decelerate or reverse the progress that has been made.”

“Let us build on the successes we have achieved so far, and let us not relent until all the MDGs have been attained,” he urged.

The U.N. report points out that the world has achieved parity in primary education between girls and boys. Driven by national and international efforts, many more of the world’s children are enrolled in school at the primary level, especially since 2000.

Girls have benefited the most. There were 97 girls enrolled per 100 boys in 2010 – up from 91 girls per 100 boys in 1999.

Such improvements, as well as improving maternal health and reducing unwanted pregnancies, coincide with women’s demands across the world.

Melinda Gates, co-chair of the Bill & Melinda Gates Foundation, told participants at the London summit that women she meets on her travels tell her that “access to contraceptives can often be the difference between life and death”.

“Today is about listening to their voices, about meeting their aspirations, and giving them the power to create a better life for themselves and their families,” Gates added.

In Lagos, in a video message addressed to the Second African Women’s Economic Summit, AfDB President, Donald Kaberuka said that women have always played a pivotal role in the socio-economic development of Africa.

As farmers, entrepreneurs, traders and innovators, they are key economic actors in the continent, he added. “I believe, strongly believe, investing in women…is essential to revitalising our economies,” Kaberuka pointed out.

(END)

A number of people line up at the Kanungu Health Center IV, Uganda to access family planning facilities. Courtesy: Tadej Znidarcic/UNFPA

By Mantoe Phakathi
Kanungu, UGANDA , Jun 29 2012 (IPS)

It is midmorning at the Kanungu Health Centre IV and the queue of patients grows as more people start to arrive for treatment at this rural facility more than 400 kilometres outside the Ugandan capital of Kampala.

Most are here to access family planning services, while some are waiting for cancer screening.

Generally about 100 patients a day visit the health centre. But today there will be four times as many.

“We see an average of 400 people a day when the doctor from Kampala visits once a month,” says nursing sister Kwesiga Muteisa.

There are mostly women in the queue here, although some are accompanied by their partners.

“Those who come with their husbands are served first to encourage male involvement in family planning,” says acting district health officer sister Rwabahima Florence.

She explains that it also serves as an opportunity for men to undergo HIV counselling and testing, and to learn about other methods of family planning not commonly practiced among Ugandans, like having a vasectomy.

The increased number of patients who visit the health centre are a testament to the success of the voluntary health team (VHT). Three years ago, the United Nations Population Fund (UNFPA), in collaboration with the Ugandan Ministry of Health and the Kanungu District Local Government, created the teams. UNFPA funds 95 percent of family planning services in this East African nation, while the government provides the remainder.

VHTs consist of volunteer members from the community who are trained in family planning in order to encourage the practice in their areas.

They conduct home visits and educate people about family planning, distribute condoms and refer patients to health facilities for more information and services. Each VHT is assigned to 25 households.

Voluntary health team member and pensioner Babwicwa Mark beams from ear to ear, satisfied with the number of couples who have now embraced family planning in the Kanungu district.

While the country’s 2011 Demographic and Health Survey (DHS) states that the contraceptive prevalence rate at national level is 26 percent, it is 41 percent in Kanungu.

“I motivated some of the people to come to the facility for family planning services,” says Mark. “Most people in my area did not believe in contraceptives, but after a lot of education they realised they’ve got nothing to fear.”

Making Ugandans aware of the need for family planning is vital in a country with the world’s third-highest population growth rate: 3.2 percent.

“People in the communities listen better to the VHTs than the health workers, because at least they know them better than us,” explains Saturday Nason, a nursing officer and VHT trainer at the Kihihi Health Centre in the Kanungu District.

Ugandan women give birth to an average of six children, according to the DHS, a 0.5 decrease from the 2006 average of seven. Nason attributes this decrease to family planning awareness.

Although 26 percent of the Ugandan productive population of 15 to 49-year-olds use modern family planning methods according to the DHS, myths and cultural beliefs still stand in the way.

Women are often subjected to pressure from men to produce more children. “The biggest challenge is that while many women want to adopt family planning and have fewer children, their spouses insist on more,” says VHT member Nyakato Peace, a mother of three.

While the majority of women IPS interviewed at Kanungu Health Centre IV want an average of four children, the majority of men want seven or more. Twesigye Chrisente and her husband, Niwagaba Savio, are an example.

The mother of four is satisfied with the number children she now has, but Savio wants seven and is threatening to marry a second wife if she insists on refusing to have more.
“I only have a brother and sister and we’re not respected in the community because our family is small,” says Savio.

“I don’t want this to happen to my children.”

Chrisente, on the other hand, argues that their income is barely enough to provide for the needs of the children they already have. Both husband and wife are subsistence farmers with no steady income.

The couple had to undergo counselling at the Kinaaba Health Centre II in Kanungu District before Savio agreed that his wife could get a contraceptive implant. It will prevent her from falling pregnant for three years while Savio ponders whether or not to have more children.

While Chrisente is assured of not having any more children within the next three years, the situation is not so easy for other women on different types of contraceptives. Peace says that once women experience the slightest side effects from contraceptives they tend to discontinue them, and this inevitably leads to unplanned pregnancies.

“When it comes to side effects people prefer to discuss their problems with fellow women instead of returning to the health centre to seek advice,” says Florence. “That’s why we need people in the community who can give advice.”

The DHS reported that the use of modern contraceptives increased from eight percent in 1995 to 26 percent in 2011, showing increased demand for family planning services. However, there is a serious shortage of services in the area.

The VHTs complain that pills and female condoms are not available in Kanungu.

UNFPA assistant representative Dr. Wilfred Ochan says that there is a 41 percent unmet need for family planning in Uganda. He attributes this to inadequate funds and poorly skilled health workers.

“However, we’ve made progress because it’s the first time we’re seeing a decrease in the fertility rate in this country,” says Ochan.

Family planning in the LDCs is crucial to lowering birth rates, reducing poverty and protecting vulnerable populations against climate change. Credit: SERP/IPS

By Julio Godoy
PARIS, May 30 2012 (IPS)

The reproductive rights agenda, from improving women’s access to education to systematic family planning to reducing birth rates and combating poverty, has become a cornerstone of most industrialised nations’ development policies toward the least developed countries (LDCs), comprised primarily of sub-Saharan African states.

This sharpening of focus comes just in time for the Rio+ 20 summit on sustainable development, slated to run from Jun. 20-22 in Brazil, where the question of climate change will be discussed alongside the development agenda.

It is no surprise that LDCs with the lowest gross national income per capita, weakest human resources and highest economic vulnerability are also the most affected by climate change.

This double challenge, of mitigating climate change and combating crushing poverty, makes improving reproductive rights and promoting gender equality goals that can no longer be delayed, according to several recent reports and agreements.

During a meeting of the United Nations Entity for Gender Equality and the Empowerment of Women – U.N. Women – with the Organisation Internationale de la Francophonie (OIF), which took place in Paris this week, delegates agreed to put the empowerment of women and reproductive rights at the centre of their joint action.

The agreement, signed by Michelle Bachelet, executive director of U.N. Women, and Abdou Diouf, secretary general of the OIF, aims at tackling gender inequality in the 75 OIF member states, most of which are also LDCs.

Gender inequality, typified by violence and discrimination against women, also leads to higher birth rates and poverty, according to experts.

The agreement between U.N. Women and the OIF is but one of several other covenants launched in recent weeks, in the hopes of improving women’s access to education and promoting reproductive rights and family planning.

Last April, U.N. Women set up another agreement with the European Union to strengthen cooperation between the two organisations in their work on gender equality.

Simultaneously, the Royal Society of London (RS) released its new People and the Planet report, which focuses on reproductive rights and social justice as cornerstones of global economic sustainability.

The report called attention to LDCs’ urgent need to “improve women’s access to education and family planning if they are to achieve sustainable development”.

The report recalled that even though global population growth is slowing, rates in LDCs — particularly in sub-Saharan African countries — are expected to remain high for the rest of the century, hampering efforts to reduce poverty.

On the other hand, the report deplored disproportionately high consumption levels in industrialised countries, the root cause of global warming and climate change.

British biologist John Sulston, co-author of the report, said that “population growth and high consumption must be considered together” while searching for solutions to climate change.

Sulston, who headed a working group at the RS while preparing the newest People and the Planet report, said that family planning is indispensable in countries with the highest fertility rate, mostly LDCs.

He also pointed out that populations in industrialised countries, which consume resources at a rate that the planet cannot afford, must realise that their way of life is not sustainable.

The report is extremely timely, coming just ahead of the Rio + 20 summit, which is poised to deal with sustainable development and the planet’s future.

The report stressed the world must meet the challenge of lifting “the 1.3 billion people living on less than 1.25 dollars per day” out of absolute poverty.

To fulfil this objective, international inequality must be eliminated, a process that “will require focused efforts in key policy areas including economic development, education, family planning and health.”

The report also emphasised that “the most developed and the emerging economies must stabilise and then reduce material consumption levels through … improvements in resource-use efficiency, including reducing waste; investment in sustainable resources, technologies and infrastructures; and systematically decoupling economic activity from environmental impact.”

Sulston told IPS, “An enormous injustice affects the human world, as expressed by extremely high consumption in some areas, a consumption of food for instance, that is unhealthy for the very people consuming (the foodstuffs), while other people (in LDCs) consume too little, and suffer malnutrition, diseases and even death due to poverty.”

Sulston lamented, “Humanity is the victim of a system of global economics based on an (inadequate) measurement of gross domestic product (GDP), which drives consumption, and pushes people to compete against each other.”

“The one thing that governments all over the world say is: we must grow, we must grow, more than the others,” Sulston said.

To actually measure human development, “We must add the cost of the Earth, the price of its resources, into our economic models, in order to have a more stable socio-economic structure, not only for the present, but also for the wellbeing of humans in the future,” he said.

Sulston added that climate change is making clear that humanity “is running out of space.” Evidence of climate change and of social injustice fuels the crucial need “to put all these issues – population growth, human consumption and environment – on top of the agenda of the forthcoming Rio + 20 summit.”

Eliya Msiyaphazi Zulu, executive director of the African Institute for Development Policy and president of the Union for African Population Studies, recalled that there is a well-established link between low education levels and high birthrates.

Education delays the onset of childbirth, but also empowers women, “because once you’re more educated, you can have more autonomy, more say in decision making processes in your marriage,” Zulu said.

The report notes that educated women are also more likely to seek out healthcare for their children and get jobs, thereby contributing to their economies. Consequently, instead of waiting for development to slow population growth, Zulu said, countries should focus on reducing fertility rates to promote development.

(END)