A Cuban family walks down a street in the neighborhood of Vedado, in the Plaza de La Revolución municipality, in Havana, Cuba, where just 49 per cent of children grow up in households with both parents. Credit: Jorge Luis Baños/IPS

By Ivet González
HAVANA, Mar 6 2017 (IPS)

A new set of regulations to strengthen the maternity rights of working women and encourage people to have children in Cuba were seen as a positive step but not enough, because they do not include measures to encourage more active participation in child-rearing by men.

“These legislative changes promote responsible maternity and paternity,” sociologist Magela Romero, who is about to become a mother, told IPS. “There are still aspects to review to achieve a legal text which reflects from beginning to end its spirit of promoting a culture of equality between parents.”

Against a backdrop of a record low fertility rate and accelerated aging of the population, the authorities published on Feb. 10 two new decree-laws and four statutes that modify the 2003 Law for Working Mothers, which was reformed previously in 2011.

The theme this year of International Women’s Day, celebrated Mar. 8, is “Women in the Changing World of Work: Planet 50-50 by 2030”, because improving the participation of women in the labour market is seen as essential to achieving equality.

Romero, who is currently studying the father figure in Cuba’s labour legislation, proposed revising even “the most subtle aspects, such as the title of the law itself, which doesn’t mention the working father, and therefore could conceal them as possible beneficiaries.”

In 2003, Cuba placed itself in the forefront in Latin America, passing a law that ensured working fathers one year of parental leave in case they became widowers or were abandoned by the mother.

But in what is seen as a sign of the prevailing sexism in Cuban society, few men have availed themselves of this benefit. The latest figures show that only 125 fathers requested parental leave between 2006 and 2013, in this Caribbean island nation of 11.2 million people.

In response to the low level of involvement by fathers and to address the fact that many children are mainly cared for by their grandmothers, the new regulations also allow working maternal or paternal grandparents to request leave to take care of newborns.

According to the latest population and housing census, from 2012, just 49 per cent of children in Cuba lived with both parents, 38 per cent only lived with their mother (the majority) or their father, while 13 per cent were at the time being cared for by other relatives.

Cuba is the country with the lowest number of children per woman in Latin America – 1.72 in 2015, according to official figures – in a country which since 1978 has had a fertility rate below the replacement level of one daughter per woman, a situation that the region as a whole will not reach until 2050.

Two grandmothers sit with their granddaughters, whom they take care of while their mothers work, on a street in the historic centre of Old Havana, Cuba. Working grandmothers and grandfathers are included in the benefits established by the new regulations to encourage people to have children. Credit: Jorge Luis Baños/IPS

Romero said the new laws acknowledge new developments that have arisen in light of the current economic reforms, such as women having more than one job, and those that make up the growing private sector, who constitute 32 per cent of the 507,342 registered self-employed workers.

For this reason, women who work in the private sector and have two or more children under 17 will pay only 50 percent of the monthly taxes they would otherwise owe. And people with a permit to offer services of childcare, or caring for sick, disabled or elderly people, will also pay half of the monthly tax.

Moreover, women who go back to their public sector jobs before the end of the year of maternity leave continue to draw the monthly stipend of 60 per cent of their salary. And those with two jobs receive maternity payments for each job.

In addition, families with more than two children pay reduced fees, or are even exempt from paying, for public daycare and school meals.

Hundreds of comments on local news websites have urged the authorities to take measures in that direction and have assessed them as positive, for seeking to ease the heavy economic burden that a baby implies in a country in the grip of a virtually chronic economic crisis since 1991, and which is now suffering a new economic downturn.

Having a baby in Cuba “can be economically a tremendously stressful challenge,” said Mayra García, who is expecting at any moment the birth of her first child. It is even hard for her and her husband, who waited to get pregnant until they had their own house, were economically independent and had stable jobs in their professions.

“And few couples our age are able to achieve such economic independence,” the 30-year-old editor, who hopes to have at least two children, told IPS.

She said it was a good thing that new mothers who return to their jobs before the year is up continue to draw their maternity leave stipend. And she called for the expansion and improvement of public childcare services, to help families reconcile family life and work.

“Currently, public childcare centres are unable to keep up with demand,” she said.

A father settles his son on his horse, as he picks him up from school in a rural community in the central province of Villa Clara, Cuba. The new legislation to stimulate maternity in the country doesn’t pay any attention to fathers, according to experts. Credit: Jorge Luis Baños/IPS

In public daycare centres, monthly fees per child average 40 cuban pesos (1.6 dollars) and vary depending on the family’s income. With differences per region, a private daycare costs about 100 cuban pesos (four dollars) and some exclusive childcare centres in the capital even cost much more and in dollars.

Marybexy Calcerrada and Aida Torralbas, psychologists and gender experts who live in the city of Holguín, 689 km east of Havana, propose creating support mechanisms in the workplace for more specific cases.

“A quota for subsidised purchases of a variety of products to meet the basic needs of infants and adolescents could be considered,” Calcerrada told IPS, urging “continued encouragement of the involvement of men in their role as fathers.”

She believes that “parents should be given quotas of hours for justified absence from work to take care of children in the face of health problems and school needs.”

Studies show that working women in Cuba earn less than men, despite earning equal wages, because they are absent more often from their jobs, to take care of their children and sick and elderly people in their care.

For Torralbas, the new reforms in the legislation “could have been a good opportunity to give fathers a short period of leave after their baby’s birth. In other countries, the father has two weeks of parental leave when his child is born,” she said as an example.

“In Cuba, women and men think it over carefully before having children,” said Frank Alejandro Velázquez. “They are not the same mothers and fathers as 60 years ago. They have been taught to think about minimally adequate, fair social conditions, infused with gender equality, before having a child.”

This young expert of the Christian Centre for Reflection and Dialogue- Cuba, in the city of Cárdenas, 150 km east of Havana, also brought up other issues, such as the “social uncertainty” that exists in this country where the government began to reform its socialist system in 2008.

“These measures are just a step forward with respect to previous legislation,” he told IPS.

Excerpt:

Zimbabwe struggles to contain maternity deaths. Here in this southern African nation, the number of women dying in childbirth continues to rise. Credit: Jeffrey Moyo/ IPS

By Jeffrey Moyo
HARARE, Jan 30 2015 (IPS)

For 47-year-old Albert Mangwendere from Mutoko, a district 143 kilometres east of Harare, the Zimbabwean capital, transporting his three pregnant wives using a wheelbarrow to a local clinic has become routine, with his wives delivering babies one after the other.

But these routines have not always been a source of joy for Mangwendere.

“Over the past twenty years, I have been ferrying my pregnant wives to a local clinic using a wheelbarrow because I have no (full size) scotch cart and we have lost 12 babies in total while traveling to the clinic,” Mangwendere told IPS.

Mangwendere’s case typifies the deepening maternity crisis in this Southern African nation.An estimated 3,000 women die every year in Zimbabwe during childbirth and at least 1.23 percent of gross domestic product (GDP) is lost annually due to maternal complications – United Nations issue paper on 'Maternal Mortality in Zimbabwe', 2013

An estimated 3,000 women die every year in Zimbabwe during childbirth and at least 1.23 percent of gross domestic product (GDP) is lost annually due to maternal complications, according to Maternal Mortality in Zimbabwe, a United Nations issue paper released in 2013.

In fact, the United Nations found that maternal mortality worsened by 28 percent between 1990 and 2010. The major causes were bacterial infection, uterine rupture (scar from a previous caesarean section tearing during an attempt at birth), renal and cardiac failure, as well as hyperemesis gravidarum (condition characterised by severe nausea, vomiting and weight loss during pregnancy).

This year, the government has allocated 301 million dollars to the health sector for a country of 13.5 million, according to the local NewsDay publication, which concluded: “This is to say that the government intends to spend on average just over 22 dollars on an individual this year. Compare this with 650 dollars for South Africa, 90 dollars for Botswana, 390 dollars for Botswana and 200 dollars for Angola.”

On top of a barely adequate public transportation system, user fees for delivering pregnant women that are charged in healthcare centres are also at fault, say civil society activists.

“In 2012, the government crafted and adopted a policy that saw user fees for maternity services being scrapped,” Catherine Mukwapati, director of the Youth Dialogue Action Network, a grassroots organisation, told IPS.

“But despite this policy, some facilities still charge indirect service fees, which is scaring away many pregnant women from hospitals and clinics, leaving them in the hands of less skilled midwives.”

Zimbabwe’s local authority clinics say they have resisted scrapping maternity fees despite the official directive, claiming that they are not reimbursed as promised by the government.

28-year-old Chipo Shumba pictured here holds her only child after she lost six others while giving birth over the past few years, a crisis health experts in Zimbabwe say is on the rise. Credit: Jeffrey Moyo/IPS

“Council clinics have no choice but to charge the council-subsidised 25 dollars for maternity since they haven’t received money from government,” Harare city director of health services, Stanley Mungofa, told IPS.

The actual cost of providing maternity services in council clinics has been pegged at 152 dollars, Mungofa said. At public hospitals like Parirenyatwa in Harare, the cost of a normal delivery is 150 dollars while a caesarean section costs as much as 450 dollars.

In a bid to lower the high maternity fees of public hospitals and council clinics, a group of donors pledged 435 million dollars for the nation’s health system for the period 2011-2015. The fund – the so-called Health Transition Fund – was led by the health ministry and managed by the U.N. Children’s Fund (UNICEF).

Importantly, the Health Transition Fund is helping to retain skilled workers by raising low wages. Underpaid doctors make up a large part of the country’s “brain drain” and there are now just 1.6 doctors for every 10,000 people.

Maternal fees may not apply in Zimbabwe’s countryside, where many like Mangwendere and his wives live, but other obstacles present an equally insurmountable barrier to obtaining care. Clinics and referral hospitals are often far away from people needing help, a major cause of maternity deaths there.

Finally, the tentacles of systemic corruption have reached into the health care systems. According to Transparency International, one local hospital was found to be charging mothers-to-be five dollars every time they screamed while giving birth.

A staggering 62 percent of Zimbabweans reported having paid a bribe in the previous year, the group stated in its 2013 report on global corruption.

Zimbabwe’s health sector was one of the best in sub-Saharan Africa in the 1980s, but it nearly collapsed when an economic crisis caused hyper-inflation of more than 230 million percent in 2008. Over the following years, chronic under-investment made a bad situation worse.

The increase in maternal mortality is being witnessed despite the U.N. Millennium Development Goal (MDG) for maternal health, under which countries should reduce the maternal mortality ratio by three-quarters between 1990 and 2015.

A 2012 status report on the MDGs asserted that Zimbabwe was unlikely to meet its mandate of reducing the maternal mortality ratio to 174 per 100,000 live births.

In research conducted in 2013 to address causes of maternal death, Zimbabwe’s Ministry of Health and Child Care blamed excessive bleeding after childbirth and unsafe abortion as the major causes of death, although no information was provided to back the claim.

“Statistics on maternal deaths often leave out sad realities of these similar deaths in unreachable remote areas where pregnant women and infants die daily without these cases being recorded anywhere,” said Helen Watungwa, a midwife at a council clinic in Gweru, the capital of the Midlands province, 222 kilometres outside the capital.

“But in any case, with the limited resources we have as nurses, we are doing all we can to save lives both of delivering mothers and infants,” Watungwa told IPS.

“It is truly a miracle that we continue to survive a series of pregnancies while battling to give birth often on the way to the clinic, bleeding heavily without any skilled persons to attend to us, with only our husband tottering with each one of us to the village healthcare centre using a wheelbarrow,” 28-year-old Mavis Handa, one of Mangwendere’s wives, told IPS.

Edited by Lisa Vives/Phil Harris    

A young mother approaches a healthcare facility inside the Domiz refugee camp in Iraqi Kurdistan, mid-September 2014. Credit: Shelly Kittleson/IPS

By Shelly Kittleson
DOHUK, Iraq, Sep 19 2014 (IPS)

At the largest refugee camp in Iraqi Kurdistan, young Syrian mothers and pregnant women are considered relatively lucky.

The number of registered Syrian refugees surpassed 3 million in late August, with the highest concentrations in Lebanon (over 1.1 million), Turkey (over 800,000), and Jordan (over 600,000). In all of the above, serious concerns have been expressed about the availability of healthcare services for expectant mothers.

In Lebanon, for example – which hosts the largest number of Syrian refugees, 76 percent of whom are women and children – the U.N. refugee agency (UNHCR) last year had to reduce its coverage of delivery costs for mothers to 75 percent instead of 100 percent, due to funding shortfalls.Though some in the Domiz camp live in tents on the edges of the camp with little access to basic sanitation facilities, others reside in small container-like facilities interspersed with wedding apparel shops and small groceries, and enjoy the right to public healthcare

The Domiz camp in the northern Dohuk province houses over 100,000 mostly Syrian Kurds, but is in a geographical area with a 189 percent coverage rate of humanitarian aid funding requests in 2014. The Syria Humanitarian Response Plan (SHARP) has received only 33 percent of the same.

Though some in the Domiz camp live in tents on the edges of the camp with little access to basic sanitation facilities, others reside in small container-like facilities interspersed with wedding apparel shops and small groceries, and enjoy the right to public healthcare.

This does not necessarily equate with quality healthcare, however. Halat Yousef, a young mother that IPS spoke to in Domiz, said that she had been told after a previous birth in Syria that she would need a caesarean section for any subsequent births.

On her arrival at the Dohuk public hospital, she was instead refused a bed, told to come back in a week and that she would have to give birth normally. They also told her she had hepatitis.

Fortunately, she said, her husband realised the seriousness of the situation and took her to the capital, where they immediately performed a C-section and found that she was instead negative for hepatitis. IPS met her as she was leaving healthcare facilities set up in the camp, holding her healthy 10-day-old infant.

Until recently, many mothers would also simply give birth in their tents. On August 4, Médicins San Frontiéres (MSF) opened a maternity unit in the camp that offers ante-natal check-ups, birthing services headed by MSF-trained midwives and post-natal vaccinations provided by staff who are also refugees.

Information on breastfeeding and family planning advice is also provided, according to MSF’s medical team leader in the camp, Dr Adrian Guadarrama.

MSF estimates that 2,100 infants are born in the camp every year, and others to refugees living outside of it.

The United Nations Population Fund (UNFPA) has long been providing safe delivery kits to healthcare providers. It also works to prevent unwanted pregnancies and provides contraceptives to those requesting them, thereby ensuring that pregnancies are planned, wanted and safer.

The clean delivery kits contain a bar of soap, a clear plastic sheet for the woman to lie on, a razor blade for cutting the umbilical cord, a sterilised umbilical cord tie, a cloth (to keep the mother and baby warm) and latex gloves.

UNFPA humanitarian coordinator Wael Hatahet told IPS that so far the programmes in Iraqi Kurdistan for Syrian refugees had received enough funding to cover the necessary services, and this was why ‘’the situation is no longer an emergency one for Syrians here’’.

Hatahet said that he gives a good deal of credit to the Kurdistan Regional Government (KRG), which – despite having seen a major cut in public funds from the central government as part of a prolonged tug-of-war between the two – continues to support Syrian refugees coming primarily from the fellow Kurdish regions across the border.

Many residents expressed dissatisfaction to IPS about what they considered ‘’privileged treatment’’ given to Syrian refugees while the massive influx of internally displaced persons (IDPs) that have arrived in the region over the past few months – after the Islamic State (IS) extremist group took over vast swathes of Iraqi territory in June – are seen to be suffering a great deal more.

Even Hatahet, who is of Syrian origins himself, noted that he had seen ‘’Iraqi IDPs wearing the same set of clothes for the past 15 days’’.

‘’We obviously try to support with garments and dignity kits,’’ he said, ‘’but it’s really, really sad.’’

However, he also noted that ‘’almost all the IDP operations are supported by the Saudi Fund [for Development]’’ totalling some 500 million dollars and announced in summer, ‘’which was strictly for IDPs and not refugees.’’

Hatahet expressed concerns that a broader shift in focus to Iraqi IDPs might result in a loss of the gains made in this geographical area of the Syrian refugee crisis, urging the international community to remember that ‘’we have 100,000 refugees scattered within the host community’’ and not just in the camps.

The Turkish office of UNFPA told IPS that, in its area of operations, ‘’it is estimated that about 1.3 million Syrian refugees have entered Turkey, of which only one-fifth of them are staying in camps due to limited space. 75 percent of the refugees are women and children under 18 years old.’’

It pointed out that ‘’women and girls of reproductive age under conditions of war and displacement are especially vulnerable to gender-based violence, including sexual violence, early and forced marriage, high-risk pregnancies, unsafe abortions, risky deliveries, lack of family planning services and commodities and sexually transmitted diseases.’’

(Edited by Phil Harris)