Two of the six Russian women who were detained by the Argentine immigration authorities when they reached the country on Feb. 8 and 9 sleep in the Buenos Aires airport. A federal judge ruled that they were placed in a situation of vulnerability and ordered that they be allowed to enter the country. CREDIT: TV Capture

By Daniel Gutman
BUENOS AIRES , Feb 16 2023 (IPS)

They began to arrive en masse in Argentina in the second half of 2022, a few months after the Russian invasion of Ukraine. They are pregnant Russian women who land in the capital to give birth, with the hope of gaining an Argentine passport, given the fact that so many countries refuse to let in people with Russian passports today.

Authorities are investigating whether they are the victims of scams by organizations holding out false promises.

“Of the 985 deliveries we attended in 2022, 85 were to Russian women and 37 of them were in December. This trend continued in January and so far in February,” Liliana Voto, Head of the Maternal and Child Youth Department at the Fernández Hospital, one of the most renowned public health centers in the Argentine capital, located in the Palermo neighborhood, told IPS.“One thing are human trafficking networks, which make false promises in exchange for large sums of money, and another thing is the rights of women to enter Argentina and have their children here. They are victims.” -- Christian Rubilar

“Some come with an interpreter and others use a translation app on their phones. We do not ask them how they got to Argentina, but it is clear that there is an organization behind this,” added Voto.

In this South American country, public health centers treat patients free of charge, whether or not they have Argentine documents.

The issue exploded into the headlines on Feb. 8-9, when the immigration authorities detained six pregnant Russian women who had just landed at the Ezeiza international airport, on charges of not actually being tourists as they claimed.

The six women filed for habeas corpus and on Feb. 10 a federal judge ordered that they be allowed to enter the country, after some of them spent more than 48 hours on airport seats.

The ruling handed down by Judge Luis Armella stated that the authorities’ decision not to let them into the country put the women in a vulnerable situation that affected their rights “to proper medical care, food, hygiene and rest,” and said he was allowing them into the country to also protect the rights of their unborn children.

In addition, the judge ordered a criminal investigation into whether there is an organization behind the influx of pregnant Russian women that is scamming them or has committed other crimes. The results of the investigation are sealed.

On Feb. 10, shortly after the court ruling was handed down, 33 Russian women who were between 32 and 34 weeks pregnant arrived in Buenos Aires on an Ethiopian Airlines flight from Addis Ababa. (There are no direct flights between Russia and Argentina.)

As reported by the national director of the migration service, Florencia Carignano, in 2022, 10,500 people of Russian nationality entered Argentina and 5,819 of them were pregnant women.

The immigration authorities carried out an investigation in which it interviewed 350 pregnant Russian women in Argentina. They discovered that there is an organization that “offers them, in exchange for a large sum of money, a ‘birth tourism’ package, and gaining an Argentine passport is the main reason for the trip,” Carignano tweeted.

The Fernández Hospital, in the Palermo neighborhood of Buenos Aires, is one of the most prestigious public health centers in Argentina. In December 2022, 37 Russian women gave birth there. CREDIT: Daniel Gutman/IPS

“Argentina’s history and legislation embrace immigrants who choose to live in this country in search of a better future. This does not mean we endorse mafia organizations that profit by offering scams to obtain our passport, to people who do not want to live here,” she added.

Under Argentine law, foreign nationals who have a child born in Argentina are immediately given permanent residency status, in a process that takes a few months. To obtain citizenship, they have to prove two years of uninterrupted residence here, in a federal court.

“Becoming a citizen is a difficult process that takes many years. If the organizations promise Russian women a passport in a few months, they are lying or there is corruption behind this,” Lourdes Rivadeneyra, head of the Migrant and Refugee Program at the National Institute against Discrimination (INADI), told IPS.

Rights in Argentina

“One thing are human trafficking networks, which make false promises in exchange for large sums of money, and another thing is the rights of women to enter Argentina and have their children here. They are victims,” Christian Rubilar, a lawyer for three of the six women who were held in the Ezeiza airport, told IPS.

Rubilar pointed out that the constitution guarantees essential rights “for all people in the world who want to live in Argentina.” He added that the country’s laws do not mention “false tourists”, and that therefore the immigration office exceeded its authority by denying them access to the country.

Argentina received different waves of European migration from the end of the 19th century until the middle of the 20th century. This created a culture of respect for the rights of immigrants among citizens and in the country’s legislation, which see Argentina as a land that welcomes foreigners in trouble, such as Venezuelans who have arrived in large numbers in the past few years.

Since Russian President Vladimir Putin invaded Ukraine on Feb. 24, 2022, hundreds of thousands of people have fled Russia, in what has been described by some as a third historic exodus, after the ones that followed the Russian Revolution in 1917 and the fall of the Soviet Union in 1989.

Although there are no official figures, recently the English newspaper The Guardian estimated that between 500,000 and one million people have left Russia since the beginning of the war. Many leave out of fear of being sent to the front lines, or because they are in conflict with the government or due to the consequences of international economic sanctions on the country.

The RuArgentina website offers a package of services including a hospital birth for pregnant woman in Buenos Aires and the promise of obtaining Argentine passports for the parents, which gives them entrance without a visa to most countries around the world. CREDIT: Online ad

As can be quickly verified in an Internet search, there are organizations operating in Argentina that promise Russian women who give birth in this country that they and their husbands can quickly obtain citizenship here.

“Give birth in Argentina. We help you move to Argentina, obtain permanent residence and a passport, which gives you visa-free entry to 170 countries around the world,” announces the RuArgentina website, which offers a package that includes accommodation in Buenos Aires, medical assistance, the help of a translator and aid in applying for documents, among other services for pregnant women.

The founder of RuArgentina is a Russian living in Argentina, Kirill Makoveev, who said in an interview on TV that “there are a variety of reasons why our clients come to Argentina: some want a passport because the Russian passport is toxic now. So we explain that the constitution and immigration laws here allow you to obtain a passport without breaking the law.”

The Russian Embassy in Buenos Aires did not respond to IPS’s request for comments, but the pregnant women have not been defended by the Russian community in Argentina.

“They are not coming to Argentina as immigrants, to work and seek a better future, as many Russians did in different waves of immigration. They are coming in order to use Argentina as a springboard to go to Western European countries or the United States,” Silvana Yarmolyuk, director of the Coordinating Council of Organizations of Russian Compatriots in Argentina, which brings together 23 community associations from all over the country, told IPS. .

Yarmolyuk, who was born in Argentina and is the daughter of a Ukrainian father and a Russian mother, said that the Russians who are coming to Argentina now are people of certain means who are taking advantage of Argentina’s flexible immigration policies.

“Just the ticket from Russia to Argentina costs about 3,000 dollars,” she said. “The danger is that this exacerbates the spread of Russophobia, which hurts all of us.”

Two Mexican teenage girls at their school. Investing in education for teenage girls in Latin America is regarded as the way forward for them to become future drivers of sustainable develpment in their societies. Credit: UNFPA LAC

By Estrella Gutiérrez
CARACAS, Jul 11 2016 (IPS)

Latin America’s teenage girls are a crucial force for change and for promoting sustainable development, if the region invests in their rights and the correction of unequal opportunities, according to Luiza Carvalho, the regional head of UN Women.

“An empowered adolescent will know her rights and will stand up for them; she has tools for success and is a driving froce for positive change in her community,” Carvalho told IPS in an interview from the regional headquarters of UN Women in Panama City.

Adolescent girls and boys will have a leading role in their societies when the Agenda 2030 for Sustainable Development has been completed, she said. One of the Sustainable Development Goals (SDG) is gender equality. Investing in today’s girls will have “a great transformative impact in future,” she said. “Investing in education and protection against violence are important tools for fulfilling the potential of teenage girls and young women,as wellas for promoting gender equality” -- Luiza Carvalho.

The world today has a higher proportion of its population aged between 10 and 24 years old than ever before, with 1.8 billion young people out of a  total population of 7.3 billion. Roughly 20 percent of this age group live in LatinAmerica and the Caribbean, Carvalho said.

According to data given to IPS by the regional office of the United Nations Population Fund (UNFPA), 57million of the region’s 634 million people are girls aged between 10 and 19, living mainly in cities.

The theme for this year’s World Population Day, celebrated July 11, is “Investing in Teenage Girls”, on the premise that transforming their present situation to guarantee their right to equality will not only eliminate barriers to their individual potential but will also be decisive for the sustainable development of their countries.

Women Deliver, an international organisation, has calculated the benefits of this investment in financial terms. For every additional 10 percent of girls in school, national GDP rises by an average of three percent; for every extra year of primary schooling a girl has completed, her expected salary as an adult grows by between 10 and 20 percent.

This is fundamental because, as Carvalho pointed out, “lack of economic empowerment, together with generalised gender discrimination and the reinforcemet of traditional stereotypes, negatively affects the capability of women in Latin America and the Caribbean to participate on an equal footing in all aspects of public and private life.”

Luiza Carvalho, regional director of UN Women for Latin America and the Caribbean. Credit: UN Women LAC

That is why “investing in education and protection against violence are important tools for fulfilling the potential of teenage girls and young women,as well as for promoting gender equality,” she said.

Teenage women, she said, “are an especially vulnerable group who face special social, economic and political barriers.” Their empowerment in the region may come up against difficulties such as unwanted pregnancy, forced early marriage or union, gender violence and limited access to education and reproductive health services.”

As an example of these obstacles, the regional director of UN Women said that a Pan-American Health Organisation (PAHO) study of women aged 15-49 years in 12 countries of the region “reported that for a substantial proportion of these women, their first sexual encounter had been unwanted or coerced.”

Carvalho stressed that “early marriage or union imposed on girls is a major concern in the region, and it significantly affects the exercise of adolescent girls’ rights developing their full potential.”

“It is a form of violence that denies them their childhood, interrupts their education, limits their social development, curtails their opportunities, exposes them to the risk of premature pregnancy at too young an age, or unwanted pregnancy and its possible complications, and increases their risk of contracting sexually transmitted infections, including HIV (human immuno-deficiency virus),” she said.

It also increases the girls’ exposure to “becoming victims of violence and abuse,” Carvalho said.

In Carvalho’s view it is very positive that all the countries inthe region have established minimum ages for marriage in their laws, but on the other hand, the laws fix different minimum ages for boys and for girls, and in certain cases such as pregnancy or motherhood, girls may legally marry before they reach the minimum age.

In Latin America, far from diminishing, teenage pregnancies have increased in recent years, due to cultural acceptance of early sexual initiation. As a result, the region ranks second in the world for adolescent birth rates, with an average of 76 live births per 1,000 women aged 15-19 years, second only to sub-Saharan Africa.

Furthermore, 30 percent of Latin American teenage girls do not have access to the contraceptive care services they need, according to UNFPA. Sexual and reproductive health face especially high barriers in this region because of patriarchal,culture, the weight of conservative sectors and the dominance of the Roman Catholic Church.

In Latin America, indigenous teenage girls, together with their rural counterparts, are the group most discriminated against in terms of opportunities and access to education. Credit: Rajesh Krishnan/UN Women

In contrast, the region has a good record on education. Over 90 percent of its countries have policies to promote equal access by teenagers to education. Ninety percent of teenage girls have finished their primary school education, although only 78 percent go on to secondary school, according to UNFPA.

The greatest educational access barriers are faced by rural and indigenous teenage girls, who have difficulties for physical access to some education centres. In the case of indigenous and Afro-descendant girls, this is added to inappropriate curricula or the absence of educational materials in their native languages (mother tongues). 

Carvalho highlighted as a positive element that education laws, especially those that have been reformed recently, “have begun to recognise the importance of establishing legal provisions that promote and disseminate human rights, peaceful coexistence and sex education.”

However, she regretted that “direct connections with prevention of violence against women and girls are still incipient.”

In her view, the school curriculum plays an essential role. Including contents and materials “related to human rights and the rights of women and girls, non-violent conflict resolution, co-responsibility and basic education about sexual and reproductive health,” will potentiate more non-violent societies, inside and outside of the classroom, she said.

Carvalho quoted a 2015 study carried out in 13 Latin American countries by UN Women and the United Nations Children’s Fund (UNICEF), which concluded that education systems are failing to prevent violence against girls.

“This is something that must be improved, because it is in the first few years of early childhood that egalitarian role modelling between girls and boys can occur and lay the foundations of the prevention of violence, discrimination, and inequality in all its forms,” she emphasised.

Carvalho said changes should start with something as simple as it is frequently forgotten: “Girls, teenagers and women are rights-holders and entitled to their rights.”

If girls are given “equal access to education, health care, sexual and reproductive education, decent jobs, and representation in political and economic decision-making processes, sustainable economies would be promoted and societies, and humanity as a whole, would benefit,” she concluded. 

Edited by Verónica Firme. Translated by Valerie Dee.

A teenage mother and her toddler in Bonpland, a rural municipality in the northern province of Misiones in Argentina. Latin America has the second highest regional rate of early pregnancies in the world, after sub-Saharan Africa. Credit: Fabiana Frayssinet/IPS

By Fabiana Frayssinet
BUENOS AIRES, Jul 8 2016 (IPS)

In plain and simple language, an Argentine video aimed at teenagers explains how to get sexual pleasure while being careful. Its freedom from taboos is very necessary in Latin American countries where one in five girls becomes a mother by the time she is 19 years old.

“For good sex to happen, both partners have to want it and this is as much about being sure they want it, as about being in the mood or ‘hot’ with desire,” said psychologist Cecilia Saia who made the video “Let’s talk About Sex” (Hablemos de sexo), aimed at adolescents and preadolescents and posted on social networks.

The video was produced by Fundación para Estudio e Investigación de la Mujer (FEIM – Foundation for Women’s Studies and Research) as part of a Take the Non-Pregnancy Test campaign. It was also distributed to teenagers so they “would be able to take free and informed decisions about becoming mothers and fathers.” “Keeping children in the education system or bringing them back into it would be effective interventions to prevent teenage pregnancy. In the same way, creating conditions within the education system to ensure that pregnant teenagers or adolescent mothers can continue their education, would be another intervention with a positive impact” - Alma Virginia Camacho-Hübner.

During the campaign, teenagers of both sexes were given boxes similar in appearance to pregnancy test kits, containing information about teenage pregnancy and the myths surrounding how it is caused, as well as condoms and instructions on how to use them, Mabel Bianco, the president of FEIM, told IPS.

The campaign was broadcast on YouTube and other social networks, with candid messages in the language used by adolescents. “This meant we could reach a large numbers of 14-to-18-year-olds, an age group that such campaigns usually find hard to reach,” she said.

According to FEIM, in Argentina 300 babies a day, or 15 percent of the total, are born to mothers aged under 19.

“This percentage has shown a sustained increase over the last 10 to 15 years, and the proportion of births to girls under 15 years of age has also risen,” Bianco said.

Argentina exemplifies what is happening in the rest of Latin America, which is the world region with the second highest teenage fertility rate, after sub-Saharan Africa. The national rate in Argentina is 76 live births per 1,000 women aged 15-19 years, according to United Nations’ demographic statistics.

In order to call attention to this problem and to the general need to promote the equal development of women, Investing in Teenage Girls is the theme of this year’s World Population Day, to be celebrated July 11.

The United Nations Population Fund (UNFPA) states that one in five women in the Southern Cone of South America (Argentina, Brazil, Chile, Paraguay and Uruguay) will become a teenage mother, in an area where over 1.2 million babies a year are born to adolescents.

“Early pregnancy and motherhood can bring about health complications for mother and baby, as well as negative impacts over the course of the lives of adolescents,” says a UNFPA report about fertility and teenage motherhood in the Southern Cone.

The report says that “when pregnancy is unplanned, it is a clear indication of the infringement of teenagers’ sexual and reproductive rights and hence of their human rights.”

Alma Virginia Camacho-Hübner, UNFPA sexual and reproductive health adviser for Latin America and the Caribbean, told IPS that teenage pregnancy has implications for individual patients, such as maternal morbidity and mortality associated with the risks involved with unsafe abortions, among other factors.

Prematurity rates and low birthweights are also several-fold higher, especially among mothers younger than 15.

For health services, the costs of prenatal care, childbirth, postnatal care and care of the newborn are far higher than the cost of interventions to prevent pregnancy and promote health education.

“For society as a whole, from a strictly economic point of view, in countries that enjoy a demographic dividend, early motherhood represents an accelerated loss of that demographic dividend,” Camacho-Hübner said from the UNFPA regional headquarters in Panama City.

This is because “instead of increasing economic productivity by having a larger economically active proportion of the population, a rise in early motherhood causes a rapid rise in the dependency ratio, that is the proportion of the population that is not economically active and requires support from family or society,”she said.

The Southern Cone study found that dropping out of school usually preceded getting pregnant.

“Therefore, keeping children in the education system or bringing them back into it would be effective interventions to prevent teenage pregnancy. In the same way, creating conditions within the education system to ensure that pregnant teenagers or adolescent mothers can continue their education, would be another intervention with a positive impact,” Camacho-Hübner said.

In her view, teen pregnancy and motherhood are an issue of inequality which mainly affects women in lower socio-economic strata.

“It is teenagers from the poorest families and with the least education, living in underprivileged geographical regions, that are most prone to becoming adolescent mothers,” she said.

“Becoming mothers at an early age reinforces conditioning and the inequalities in the process by which teenagers who are, and who are not, mothers, effect the transition into adulthood,” she said.

“The main consequence of pregnancy is the interruption of schooling, although in many cases they have already dropped out by the time they become pregnant. But they do not go back to school afterwards because they have to look after the baby,” Bianco said.

“This makes for a poorer future, as these girls will have access to lower-paid jobs and will be able to contribute less to the country’s development. On the personal level, they will have to postpone their adolescence, they cannot go out with friends, go dancing and other typical teen activities,” she said.

Federico Tobar, another UNFPA regional adviser, said that “in addition to strengthening health, education and social services, there must be investment to promote demand, with interventions to motivate young people to build a sustained life project.”

“This involves incorporating economic incentives as well as symbolic remuneration, and also concrete childcare support for teenage mothers so that they can finish school and avoid repeated childbearing, which is frequently seen in these countries,” he told IPS.

Among other positive experiences, Tobar mentioned the Uruguayan initiative “Jóvenes en red” (Young People’s Network) which includes returning to school and work, and promotion of sexual and reproductive health.

“I believe it is important to invest in the education of teenage women, including comprehensive sex education and the capacity to decide whether or not they wish to have children. It is not a question of eliminating all pregnancy in adolescence, but of making it a conscious choice rather than an accident,” Bianco said. 

Edited by Estrella Gutiérrez. Translated by Valerie Dee.

Karam and Adam, twin Palestinian babies born after their mother underwent IFV treatment using sperm smuggled out of the Israeli prison where their father has been held for the last 11 years. Credit: Silvia Boarini/IPS

By Silvia Boarini
GAZA CITY, Jul 31 2015 (IPS)

Thirteen-year-old Hula Khadoura sits on a large sofa in her grandfather’s home in the neighbourhood of Tuffah, Gaza City, her one-year-old twin brothers Karam and Adam on her lap. “I am so happy they arrived,” she beams, holding the babies’ feeding bottles in her hands.

There is an aura of mystery and something of the miraculous around the  twins’ births – their father, Saleh Khadoura, has spent the past 11 years in an Israeli prison and has had no physical contact with Hula’s mother, Bushra, since then.

Hula hears people refer to her brothers as ‘special babies’ but does not fully grasp what the fuss is about. She is completely unaware of the unusual obstacles her father’s sperm had to overcome to reach her mother’s eggs.“After the suffering I am put through with each visit [to her husband in an Israeli prison], with the searches and the humiliation, with this pregnancy, with Karam and Adam, I wanted to show that rules can be broken” – Bushra Abu Saafi

Freedom ambassadors

Bushra Abu Saafi, is one of around 30 Palestinian women who have conceived babies since 2013 with sperm smuggled out of the Israeli prisons in which their husbands are being held. She was only the second woman in Gaza to do this. Before her, two had tried but only one succeeded.

According to the Palestinian Prisoners’ NGO Addameer, there are currently some 5,750 Palestinian political prisoners being held in Israel. Of these, roughly 5,550 are adult males.

Women whose husbands are serving decades-long sentences do not want to see their dream of starting a family, or increasing its size, taken away by the very same authorities that took away their husbands.

Until recently, the Israeli Prison Service (IPS) was highly sceptical that sperm smuggling could be happening at all. Spokesperson Sivan Weizman told the press that tight security made it very unlikely. Recently, though, they have acknowledged that it may be an issue.

The Palestinian National Authority and Hamas, on the other hand, have never shown any doubt and have financially supported women wishing to try this very unconventional method of conceiving.

In May in Gaza, the Palestinian Ministry of Prisoners even organised a collective birthday party for the little ‘ambassadors of freedom’, as babies born this way are often called.

Families apart

“It was my husband who suggested we try ‘in vitro fertilisation’ (IVF) treatment with his smuggled sperm,” Bushra Abu Saafi told IPS from her father’s apartment, where she lives with her five children.

The majority of Palestinian households have at least one relative in an Israeli prison. For a people under occupation, political prisoners become part of the collective identity, they are adopted by Palestinians as long lost brothers, sisters, mothers or fathers and are celebrated at Prisoners’ Day marches and recurring demonstrations.

In the private sphere, the prisoners continue to be individuals and occupy prominent places in the home. Their handicrafts are displayed with pride, their photos adorn each room and the vacuum they have left is still palpable.

A flowery picture frame with a photo of her smiling husband Saleh in his twenties sits on a side table in Bushra’s living room. He was arrested at the age of 23, accused of being part of the Islamic Jihad. They had been married for five years and only two of their children have had the privilege of spending some time with him as a family.

When Saleh was imprisoned, Bushra was pregnant with Ahmed. “It hasn’t been easy these past 11 years,” she told IPS.  “We miss him terribly, my son Ahmad especially. He doesn’t know the meaning of the word ‘father’. He tells me ‘when I grow up I want to be like grandad’.”

Smuggling new life out of jail

Entering a fourth pregnancy was something Bushra did not take lightly and her father worried about the extra pressure. “When Saleh proposed this to me from prison, I was sceptical,” she confessed. “My family and I worried about what people would say. Imagine, pregnant with a husband in jail!”

She need not have worried. The advice she was given, like other women undergoing IVF in this way, was to tell everyone in her family and village that her husband’s sperm had been brought out and would be used for insemination. Since then, local media stations have helped spread the story and both Palestinian society and local religious authorities have been highly supportive.

“In the end, my father saw that it was my desire to try for another baby and eventually supported my choice,” Bushra said. It took two months and many tests before she could be ready for the operation.

Although the women do not wish to discuss how the sperm is smuggled past Israeli security and out of prison, it is acknowledged that it may be slipped into the clothes of  unaware children.

While wives talk to imprisoned husbands through glass and over a phone, children are the only ones allowed physical contact at the end of a visit. The clinics performing the operation,  both in Gaza and in the West Bank, report that sperm has arrived in a variety of improvised containers, from sweet wrappers to eye drop bottles.

“The preparation, the waiting, it was all very tough,” said Bushra. “But when the news came that I was pregnant, the pressure was off and we finally celebrated.” The double surprise came later, when she was told that twins were expected.

She describes the steps leading to this pregnancy as being about resistance and overcoming challenges. “After the suffering I am put through with each visit, with the searches and the humiliation, with this pregnancy, with Karam and Adam, I wanted to show that rules can be broken.”

Fertility and non-violent resistance

According to Liv Hansson, a Danish public health specialist who has researched fertility in Palestine, the practice of sperm smuggling only makes associations between fertility and resistance easier to draw.

“In a context such as Palestine, where women are well educated and child mortality is low, a lower fertility rate would be expected according to classic demography,” Hansson told IPS. The fertility rate of 4.1 registered in Palestine between 2011 and 2013, then, must be seen in the light of Israel’s ongoing occupation.

Indeed, fertility has long been considered by Palestinians as part of resistance efforts against Israel’s military occupation. For its part, Israel views high fertility rates in the West Bank and Gaza, and in majority Palestinian areas inside Israel, as a very real threat. Talk of the ‘demographic time-bomb’ – the time when Palestinians will outnumber Jewish Israelis – is very common.

“Former Palestinian president Yasser Arafat famously stated that ‘the wombs of Palestinian women are the greatest weapon of Palestine’,” Hansson told IPS. “Fertility is seen as something of interest not only to the family but to the community, society at large and to politicians too.”

The wait

Bushra and her five children will have to wait three more years to be reunited as a family with Saleh. Since 2012, following the release of kidnapped Israeli soldier Shalit, Israel’s Prison Service has been slowly reinstating visiting rights for family and prisoners from Gaza.

Ahmed saw his father two years ago for the first time, Hula six months ago and for the twins, the only meeting so far has been through the photograph on the side table, portraying Saleh as a young man eager to live life.

Edited by Phil Harris    

So extreme are gender inequalities in South Sudan that a young girl is three times more likely to die in pregnancy or childbirth than to reach the eighth grade – the last grade before high school – according to Plan International, one of the oldest and largest children’s development organisations in the world.

A vast majority of South Sudanese girls will have been victims of at least one form of gender-based violence in their young lives, but those living in Eastern Equatoria State face a particularly abhorrent practice which is a tradition among at least five of the state’s 12 tribes – being given away as ‘blood money’.

Dina Disan Olweny, Executive Director of the non-governmental Coalition of State Women’s and Youth Organisations, is one of the rights activists pushing for an end to harmful traditions and injustices facing young girls in South Sudan. Credit: Miriam Gathigah/IPS

“When a person kills another person, the bereaved family expects to be given ‘blood money’ as compensation,” Dina Disan Olweny, Executive Director of the non-governmental Coalition of State Women’s and Youth Organisations, told IPS.

Most tribes demand compensation when a life has been taken in one of the regular conflicts over cattle and pasture, revenge killings and other inter-village conflicts, and although 20 to 30 goats is what many tribes demand in form of compensation, Olweny explained that “most families can either not afford or are unwilling to pay so much, and prefer to give away one of their girls as compensation.”

According to child protection specialist, Shanti Risal Kaphle, “a young girl is taken as a commodity that can be given in lieu of someone’s lost life, or as ‘blood money’, to keep the family and community in peace.”

Kaphle explained that the girl’s life is negotiated “without her information and consent and is subject to violence, abuse and exploitation.”

The practice of girl child compensation has not escaped the eye of the government, which set an estimated 500 dollars as the amount for compensation for a life, but tribe people still prefer to be given a girl, saying that the figure set by the government is too little.“A young girl is taken as a commodity that can be given in lieu of someone’s lost life, or as ‘blood money’, to keep the family and community in peace” – child protection specialist Shanti Risal Kaphle

Experts say that a girl is also preferred as compensation by a bereaved family because she can either be married to one of their own without having to pay a bride price, or she can be married off when she turns 12 and attract a herd of goats.

Many of the girls handed over as compensation are often as young as five years. They are expected to forget their birth families and start afresh, severing all contacts with their natural families once the exchange has been concluded.

At this point their lives can take a dramatic turn for the worse through multiple abuse. These girls may be “subjected to child labour, and to sexual, physical and emotional abuse – to escape this hell, more of them now prefer to commit suicide,” said Olweny.

Residents here say that customary laws which perpetuate and rubber stamp these forms of abuse are seen to play a vital role in conflict resolution because they are considered cheap, accessible and the decisions are made on the basis of customs they are familiar with.

Kaphle said that customary laws and decisions are also perceived as more amicable and less time-consuming.

However, girl child compensation is just one of a multitude of abuses that the girl child in South Sudan faces.

The state of Western Bahr El Ghazal, for example, has a notorious tradition of widow compensation which has seen many young girls denied an opportunity to go to school because they are forced into early marriages.

Linda Ferdinand Hussein, Executive Director of the non-governmental organization Women’s Organisation for Training and Promotion, explained how this tradition works.

“When a man’s wife dies for whatever reasons, the man can demand to be given back the bride price that he had paid.” This price varies from one family to the next “but most families are unwilling to pay back the bride price so they give the man one of the deceased wife’s younger sisters as compensation.”

Four years after South Sudan won its independence and became the world’s youngest nation, child protection specialists like Hussein are raising the alarm. “Gender-based violence against young girls continues to be perpetrated in a variety of ways in both peacetime and during conflict,” she said.

A report released Jun. 30 by the United Nations Mission in the Republic of South Sudan (UNMISS) revealed that the Sudan People’s Liberation Army (SPLA) and associated armed groups recently carried out a campaign of violence against the population of South Sudan, which was marked by a “new brutality and intensity” and included the raping and then burning alive of girls inside their homes.

A report released last year by leading humanitarian organisation CARE, titled ‘The Girl Has No Rights’: Gender-Based Violence in South Sudan, highlighted the extreme injustices faced by young girls in the country.

These injustices continue to serve as obstacles towards accessing education and later exploiting the opportunities that life presents for those who have gone through school.

According to Plan International, 7.3 percent of girls are married before they reach the age of 15 years and another 42.2 percent will have been married between the ages of 15 and 18. And, although 37 percent of girls enrol in primary school, only around seven percent complete the curriculum and only two percent of them proceed to secondary school.

Edited by Phil Harris

She is just 14, but Janida avoids eye contact with others, preferring to look down at the ground and nodding her head if someone tries to engage her in conversation.

Janida (not her real name) was once a sociable and playful child, but that was before she was sexually abused by her stepfather and giving birth to a baby who is now four months old.

Her days marked by trauma and depression, Janida is just one of many girl children in Kenya who have been abused and robbed of their childhood, leaving them emotionally scarred.

“The little girl [Janida] underwent both physical and mental torture,” Teresa Omondi, Deputy Executive Director and Head of Programmes at the Federation of Women Lawyers (FIDA) Kenya, told IPS. ”Her best option was to terminate the pregnancy rather than suffer the mental and physical torture, but she could not afford the cost of a safe abortion.”Many of the induced abortions taking place continue to be unsafe and complications are common” – Teresa Omondi, Federation of Women Lawyers (FIDA) Kenya

Under Article 26 (4) of the Kenyan constitution, “abortion is not permitted unless, in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law.”

In September 2010, Kenya’s Ministry of Health released national guidelines on the medical management of rape or sexual violence – guidelines that allow for termination of pregnancy as an option in the case of conception, but require psychiatric evaluation and recommendation.

Then, in September 2012, the health ministry released standards and guidelines on the prevention and management of unsafe abortions to the extent allowed by Kenyan law, only to withdraw them three months later under unclear circumstances.

According to Omondi, “the law has not yet been fully put into operation and many providers have not been trained to provide safe abortion, meaning many of the induced abortions taking place continue to be unsafe and complications are common.”

The health ministry is responsible for doctors and nurses not being permitted to be trained on providing safe abortion, said Omondi, so “it is ridiculous that while Kenya’s Ministry of Health accepts that post-abortion care is a public health issue regarding numbers, practitioners have their hands tied.”

The issue of unsafe abortions in Kenya hit the headlines in September last year, when Jackson Namunya Tali, a 41-year-old nurse, was sentenced to death by the high court in Nairobi for murder, after the death of both Christine Atieno and her unborn baby in a botched illegal abortion.

Various inter-African meetings attended by Kenya have been held on reducing maternal mortality rates by providing safe abortions, with health ministers agreeing that statistics show that countries that do provide safe abortions have reduced their maternal mortality rates.

In a recent analysis, Saoyo Tabitha Griffith, Reproductive Health Rights Officer at FIDA and an advocate at the High Court of Kenya, said that despite Kenya having adopted a Constitution that affirms among others, women’s rights to reproductive health and access to safe abortion, Kenyan women continue to die from unsafe abortion – a preventable cause of maternal mortality.

For Dr Ong’ech John, a health specialist in Nairobi, perforated uteruses and intestines, heart and kidney failures, anaemia requiring blood transfusion as well as renal problems are just a few of the health complications arising from an abortion that goes wrong.

“Unsafe abortion complications are not just about removal of the products of conception that were not completely removed. One can evacuate but the perforated uterus has to be repaired, or you remove the uterus and it is rotten,” Dr Ong’ech told IPS.

“When the health ministry issued a directive in February this year instructing all health workers, whether from public, private or faith-based organisations, not to participate in any training on safe abortion practices and the use of the medication abortion, many questions were left unanswered,” said Omondi.

A highly respected Kenyan doctor, Dr John Nyamu, spent one year in prison in 2004 after his clinic was raided following the discovery of 15 foetuses on major roads together with planted documents from a hospital he had worked for but had since closed.

Speaking of his ordeal with Mary Fjerstand, a senior clinical advisor at Ipas, a global non-governmental organisation dedicated to ending preventable deaths and disabilities from unsafe abortion, Nyamu said that the publicity surrounding his imprisonment helped people to “realise the magnitude and consequences of unsafe abortion in Kenya; women were dying in great numbers. Before that, abortion was never spoken of in public.”

He went on to say that Kenya wants to achieve the Millennium Development Goal of a 75 percent reduction in maternal mortality, but that “it can’t be achieved if safe abortion is not available.”

A May 2014 World Health Organisation (WHO) updated fact sheet indicates that every day, approximately 800 women die worldwide from preventable causes related to pregnancy and childbirth, with 99 percent of all maternal deaths occurring in developing countries.

Edited by Phil Harris   

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 billboard in Freetown, Sierra Leone, urging people to go to hospital to be tested for HIV. Ebola has stopped people from doing that. Credit: Lansana Fofana/IPS

By Lansana Fofana
FREETOWN, Dec 1 2014 (IPS)

The outbreak of the deadly Ebola epidemic in Sierra Leone has dwarfed the campaign against HIV/AIDS, to the extent that patients no longer go to hospitals and treatment centres out of fear of contracting the Ebola virus.

“It is a big challenge for us. HIV/AIDS patients now fear going to hospitals for treatment and our workers, who are also government health officials, are also afraid of contacting patients for fear of being infected,” Abubakar Koroma, Director of Communications at the National AIDS Secretariat, told IPS.“HIV/AIDS patients now fear going to hospitals for treatment and our workers, who are also government health officials, are also afraid of contacting patients for fear of being infected” – Abubakar Koroma, Director of Communications, Sierra Leone’s National AIDS Secretariat

Sierra Leone records one of the lowest HIV/AIDS prevalence rates in the West African region. For over five years, the country has managed to stabilise the figures at 1.5 percent, out of a population of 6 million, mainly because of massive countrywide awareness raising. The authorities also offer free medicines and treatment to people living with HIV/AIDS.

But all this may be reversed if the Ebola crisis is not contained soon.

Before the outbreak of the Ebola crisis in Sierra Leone in April, one key area of success in the fight against HIV/AIDS had been in curtailing mother-to-child transmission. Today, however, there are concerns that it may surge again because pregnant women are now reluctant to go to hospitals for treatment.

In 2004, the prevalence rate among pregnant women was 4.9 percent but, just before the Ebola in April this year, the figure had dropped to 3.2 percent.

According to Koroma, “between January and now, that service [for pregnant women] has dropped by 80 percent. We are worried that the Ebola crisis may worsen the situation.” From the point of view of those already living with HIV/AIDS, this is already happening.

Idrissa Songo, Executive Director of the Network of HIV Positives in Sierra Leone (NETHIPS) advocacy group, says that its members fear going to hospitals for care and treatment and that they are constrained by what he described as a cut in the support they were receiving from donors and humanitarian organisations before the outbreak of Ebola.

“Donors and other philanthropists have turned their attention away from the fight against HIV/AIDS,” he said. “Now it’s all about Ebola. Most organisations have diverted their funding to the fight against Ebola and this is badly affecting our activities.”

Songo added that the core activities of NETHIPS, which include community awareness raising and training of members in care and prevention, have all come to a standstill because of the government’s ban on all public gatherings following the Ebola outbreak.

Given the current crisis, the National Aids Secretariat and the Ministry of Health have set up telephone hotlines to connect with people suffering from HIV/AIDS. The aim is to be able to trace and locate them and then get treatment to them. At the same time, HIV/AIDS patients are now receiving a quarterly supply of the drugs they need, compared with the monthly dosage they were receiving before Ebola struck.

According to Songo, these measures are working because “that way, our members, who fear going to hospitals and treatment centres, can stay at home and take their medication. We know it is risky to go to treatment centres nowadays because of the possibility of contracting Ebola, another killer disease,” Songo told IPS.

Notwithstanding the Ebola crisis, Ministry of Health officials say that they have not lost sight of the fight against HIV/AIDS.

Jonathan Abass Kamara, Public Relations Officer at the Ministry of Health, told IPS that attention is still focused on the fight against HIV/AIDS. “Even though Ebola has taken centre-stage, the Ministry is still very much focused on the fight against HIV/AIDS. We supply drugs to patients regularly and we try our best to give care and attention to them,” Kamara told IPS.

However, while Sierra Leone has made tremendous progress in the fight against HIV/AIDS and its success in this fight surpasses that of almost all countries in the West Africa region, it may well find it difficult to maintain its achievements in this sector if the Ebola epidemic is not brought under control.

(Edited by Phil Harris)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(Edited by Phil Harris)

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)

Doctors Without Borders (MSF) says Afghanistan is “one of the riskiest places to be a pregnant woman or a young child”. Credit: DVIDSHUB/CC-BY-2.0

By Karlos Zurutuza
KABUL, Sep 16 2014 (IPS)

Nasrin Mohamadi, a mother of four, has promised herself never to set foot in an Afghan public hospital again. After her first experience in a maternity ward, she has lost all faith in the state’s healthcare system.

“The doctors said that I had not fully dilated yet so they told me to wait in the corridor. I had to sit on the floor with some others as there wasn’t a single chair,” Mohamadi tells IPS, recalling her experience at Mazar-e Sharif hospital, 425 km northwest of Kabul.

“They finally took me into the room where three other women were waiting with their legs wide open while people came in and out. They kept me like that for an hour until I delivered without [an] anaesthetic, and not even a single towel to clean my baby or myself,” adds the 32-year-old.

“Immediately afterwards the doctors told me to leave as there were more women queuing in the corridor.”

“Many rural health clinics are dysfunctional, as qualified health staff have left the insecure areas, and the supply of reliable drugs and medical materials is irregular or non-existent." -- Doctors Without Borders (MSF)
Even after she left the hospital, Mohamadi’s ordeal was far from over. The doctors told her not to wash herself for ten days after the delivery, and as a result her stitches got infected.

“I paid between 600 and 800 dollars to give birth to my other three children after that; it was money well invested,” she says.

This is a steep price to pay in a country where the average daily income is under three dollars, and 75 percent of the population live in rural areas without easy access to health facilities.

Many women have no other option than to rely on public services, and the result speaks volumes about Afghanistan’s commitment to maternal health: some 460 deaths per 100,000 live births give the country one of the four worst maternal mortality ratios (MMR) in the world outside of sub-Saharan Africa.

While this represents a significant decline from a peak of 1,600 deaths per 100,000 births in 2002, far too many women are still dying during pregnancy and childbirth, according to the United Nations.

In 2013 alone, 4,200 Afghan women lost their lives while giving birth.

The lack of specialised medical attention during pregnancy or delivery for a great bulk of Afghan women is partly responsible. Few have access to health centres because these are only reachable in urban areas. The lack of both security and proper roads forces many women to deliver at home.

This does not bode well for the 6.5 million women of reproductive age around the country, particularly since Afghanistan only has 3,500 midwives, according to the U.N. Population Fund (UNFPA)’s latest State of the World’s Midwifery report.

This means that the existing workforce of midwives meets only 23 percent of women’s needs. The situation is poised to worsen: UNFPA estimates that midwifery services in the country “will need to respond to 1.6 million pregnancies per annum by 2030, 73 percent of these in rural settings.”

Even women with access to top-level urban facilities, such as the Kabul-based Malalai Maternity Hospital, are not guaranteed safety and comfort.

For instance, Sultani*, a mother of four, tells IPS she is far from satisfied with her experience.

“I gave birth through caesarean section to my four children in this hospital but the doctors who attended to me were unskilled,” she remarks bluntly. “A majority of them had only completed three years of medical [school].

“On a scale of one to 10, I can only give Malalai a four,” she concludes.

Sultani’s opinion may be specific to her own experience, but it finds echo in various reports and studies of the country’s health system. A 2013 activity report by Doctors Without Borders (MSF) labeled Afghanistan “one of the riskiest places to be a pregnant woman or a young child” due to a lack of skilled female medical staff.

“Private clinics are unaffordable for most Afghans and many public hospitals are understaffed and overburdened,” reports the organisation, which runs four hospitals across the country.

“Many rural health clinics are dysfunctional, as qualified health staff have left the insecure areas, and the supply of reliable drugs and medical materials is irregular or non-existent,” continues the report.

This is a sobering analysis of a country that will need to configure its health system to cover “at least 117.8 million antenatal visits, 20.3 million births and 81.3 million post-partum/postnatal visits between 2012 and 2030”, according to UNFPA.

Given that contraceptive use is still scarce, reaching only 22 percent of reproductive-age women, large families continue to be the norm. Afghan women give birth to an average of six children, a practice fuelled by a cultural obsession with bearing at least one son, who will in turn care for his parents in their old age.

A lack of information about birth spacing means mothers seldom have time to fully recover between deliveries, causing a range of health issues for the mother and a lack of milk for the newborn child.

Findings from a 2013 survey conducted by the Afghan Ministry of Public Health indicate that only 58 percent of children below six months were exclusively breastfed.

Still, this is an improvement from a decade ago and represents small but hopeful changes in the arena of women and children’s health. The same government survey found, for instance, that “stunting among children has decreased by nearly 20 percent from 60.5 percent in 2004 to 40.9 percent in 2013.”

Dr. Nilofar Sultani, who practices at the Malalai Maternity Hospital, tells IPS that medical assistance in Afghanistan has improved “significantly” over the last ten years.

“There are more health centres, and [they are] far better equipped. The number of skilled doctors has also grown,” explains Sultani, a gynaecologist.

But the most important change, she says, has been in women’s attitude towards medical care. “Before, very few women would come to the hospitals but today, the majority of women come forward on their own. They’re slowly losing their fear [of] doctors,” notes Sultani, adding that health centres are among the very few places where Afghan women can feel at ease without the presence of a man.

Edited by Kanya D’Almeida

Fatema,15, sits on the bed at her home in Khulna, Bangladesh, in April 2014. Fatema was saved from being married a few weeks earlier. Local child protection committee members stopped the marriage with the help of law enforcement agencies. Credit: UNICEF

By A. D. McKenzie
LONDON, Jul 23 2014 (IPS)

Heightening their campaign to eradicate violence against women and girls, United Nations agencies and civil groups have called for increased action to end child marriage and female genital mutilation.

At the first Girl Summit in London Wednesday, hosted by the U.K. government and UNICEF, delegates said they wanted to send a strong message that there should be “zero tolerance” for these practices.

“Millions of young girls around the world are in danger of female genital mutilation and child marriage – and of losing their childhoods forever to these harmful practices,” Susan Bissell, UNICEF’s Chief of Child Protection, told IPS.“Millions of young girls around the world are in danger of female genital mutilation and child marriage – and of losing their childhoods forever to these harmful practices” – Susan Bissell, UNICEF's Chief of Child Protection

“FGM is an excruciatingly painful and terrifying ordeal for young girls. The physical effects can last a lifetime, resulting in horrific infections, difficulty passing urine, infertility and even death.”

Bissell said that when a young girl is married “it tends to mark the end of her education and she’s more likely to have children when she’s still a child herself – with a much higher risk of dying during pregnancy or childbirth”.

“Without firm and accelerated action now, hundreds of millions more girls will suffer permanent damage,” she added in an e-mail interview.

At the summit, the United Kingdom announced an FGM prevention programme, launched by the government’s Department of Health and the National Health Service (NHS) England. Backed by 1.4 million pounds, the programme is designed to improve the way in which the NHS tackles female genital mutilation and “clarify the role of health professionals which is to ‘care, protect, prevent’,” the government said.

According to British Prime Minister David Cameron, some 130,000 people are affected by FGM in the United Kingdom, with “60,000 girls under the age of 15 potentially at risk”, even though the practice is outlawed in the country.

The prevention programme will now make it mandatory for all “acute hospitals” to report the number of patients with FGM to the Department of Health on a monthly basis, as of September of this year.

U.N. officials said that the Girl Summit was a significant development because it marked the importance of the issues addressed.

“International leaders came together in one place and said enough is enough,” Bissell said.

While it is difficult to measure the impact of intensified campaigns on the reductions in child marriage and female genital mutilation/cutting over the past few years, the United Nations and other organisations have noted that the numbers of girls affected are in fact decreasing.

In the Middle East and North Africa, the percentage of women married before age 18 has dropped by about half, from 34 percent to 18 percent over the last three decades, UNICEF says.

In South Asia, the decline has been especially marked for marriages involving girls under age 15, dropping from 32 percent to 17 percent.

“The marriage of girls under age 18, however, is still commonplace,” Bissell told IPS.

“In Indonesia and Morocco, the risk of marrying before age 18 is less than half of what it was three decades ago. In Ethiopia, women aged 20 to 24 are marrying about three years later than their counterparts three decades ago,” she added.

Regarding female genital mutilation/cutting, Kenya and Tanzania have seen rates drop to one-third of their levels three decades ago through a combination of community activism and legislation, while in the Central African Republic, Iraq, Liberia and Nigeria, prevalence of FGM has dropped by as much as half, Bissell said.

However, officials stressed that with population growth, it is possible that progress in reducing child marriage will remain flat unless the commitments made at the Girl Summit are acted upon. Flat progress “isn’t good enough”, Bissell told IPS.

Recently released U.N. figures show that, despite the declines, child marriage is widespread, with more than 700 million women alive today who were married as children. UNICEF says that some 250 million women were married before the age of 15.

The highest percentage of these women can be found in South Asia, followed by East Asia and the Pacific which is home to 25 percent of girls and women married before the age of 18, UNICEF says.

Statistics also indicate that girls who marry before they turn 18 are less likely to remain in school and more likely to experience domestic violence. In addition, teenage mothers are more at risk from complications in pregnancy and childbirth than women in their 20s; some 70,000 adolescent girls die every year because of such complications, according to the United Nations.

The statistics on female genital mutilation are also cause for international concern, with the United Nations Population Fund (UNFPA) saying that about 125 million girls and women have been subjected to the practice, which can lead to haemorrhage, infection, physical dysfunction, obstructed labour and death.

According to UNFPA, female genital mutilation/cutting and child marriage are human rights violations that both help to perpetuate girls’ low status by impairing their health and long-term development.

UNFPA Executive Director Dr. Babatunde Osotimehin told IPS that a number of states have adopted legislation against female genital mutilation/cutting but that some perpetrators are still operating with “impunity”.

Participating in the London summit, Osotimehin said that certain governments were facing challenges within their own countries because of long-held cultural beliefs, but like Bissell, he said that the picture is not completely bleak, because civil society and grassroots organisations are amplifying their campaigns.

“Our message for girls who are affected by these practices is that they have support – moral, psychological, physical and emotional support,” he told IPS. “We also want to send a message that those who are affected should advocate to try and stop these practices.”

Meanwhile, U.N. officials said it was significant that the summit saw commitment from the African Union and the deputy prime Minister of Ethiopia, as well as from the United States Agency for International Development (USAID) and the U.K. Department for International Development (DfID). The Government of Canada and several other financial supporters also made commitments.

For the executive director of UN Women, Phumzile Mlambo-Ngcuka, the pledges show support for the message of “zero tolerance” of child marriage and FGM that her organisation wishes to send. They are also a strong signal that the practices can be ended in a generation, she told IPS.

When Phumzile Khoza* came to the central Johannesburg antenatal clinic on a chilly day in August 2013, she was feeling on edge. Not about the medical procedures – she already had two children – but about talking to the nurse.

One in four South African women experience intimate partner violence during pregnancy. Credit: Alisa Hatfield

This was her third pregnancy living with HIV, but the first with a new partner from whom she had been hiding her status for the past two years.

This pregnancy had been rocky from the start. Khoza had been trying to convince her partner to join her for HIV testing, but he refused. Without couples’ counseling, Khoza was afraid to disclose, and it was becoming harder to take and hide her daily medication of antiretrovirals (ARV).

Khoza’s partner was now regularly slapping her, punching her stomach, and kicking her during arguments.  Khoza feared it would get worse if he learned she was HIV-positive.

Although she wanted help, Khoza imagined the nurses would not have time to talk through her complex situation. Plus, she had seen how angry the nurses became with women who defaulted on ARV treatment.

Looking back on that antenatal visit, Khoza reflected: “I was stressing about the way I lived my life, stressing about my past, stressing about my pregnancy. And I had no one.”

Shocking figures

Khoza’s story is increasingly common. An estimated one in four South African women experience intimate partner violence in the 12 months leading up to childbirth.

Violence in pregnancy is associated with pregnancy loss, miscarriage and neonatal death, higher rates of postpartum depression and poor health gains for infants.

In a systematic review of the literature, Dr Simukai Shamu, a Medical Research Council expert on violence, found that prevalence of violence among pregnant women in Africa is among the highest reported globally, and that a major risk factor for violence is HIV infection.

“Because most studies are cross-sectional, it’s difficult to tell whether violence was a result of demands or changes in life due to pregnancy, or if the pregnancy was the outcome of violence,” Shamu told IPS.

Since early 2013, a team from Wits Reproductive Health and HIV Institute (Wits RHI) has been interviewing women living with violence in Johannesburg.

Lead researcher Nataly Woollett said that many women described pregnancy as a time of greater violence.

“Partly because they had to disclose their HIV status and partly because men use the woman’s antenatal visit –where testing is virtually mandatory – as a proxy for their own HIV status, so they are curious about the results,” she told IPS.

At the same clinic, IPS met Martha Ramphele*, who described the rapid escalation of violence that landed her in hospital while six-months pregnant: “He started telling me that I’m a fool and stupid. And then he strangled me and let his cousin beat me up.”

Ramphele reported the incident to the police, but later withdrew the charges to protect her safety and financial security. She suspected her HIV disclosure led to physical abuse, but she couldn’t be sure.

No one can say precisely what triggers violence, but often the blend of stress associated with pregnancy, the shifting power and control dynamics, coupled with a new HIV diagnosis, are enough to heighten conflict.

The nurses’ response

Violence in pregnancy impacts negatively on the health of HIV positive women.

Sister Marieta Booysen, a senior nurse with the Aurum Institute, a research organisation in Johannesburg, explained that pregnant women in violent relationships are the most likely to quit treatment: “When you tell a patient she is HIV-positive but she is scared to disclose to her partner, it is that very same patient who will default on her medication later.”

The Wits RHI team found that most antenatal nurses interviewed recognised that violence hurts adherence to ARV treatment but few know how to deal with the issue.

The poor health care response can partly be attributed to the lack of training but it may also reflect the fact that many nurses suffer violence at home and are afraid to respond.

Dr Nicola Christofides, an expert on both violence and HIV based at Wits University, explained that “nurses who experience violence in their own lives […] are either very sensitive to the issue of violence in their patients’ lives and very receptive, or the opposite, where they are actually in denial and shut down.”

Antenatal nurses want training to respond to violence, the WITS RHI project found.

IPS talked to Khoza at the antenatal clinic five months after she had first met a Wits RHI nurse of the Safe & Sound project, which identifies violence in pregnancy and provides one-on-one counseling and referrals in three antenatal clinics in Johannesburg.

The nurse referred Khoza to the nearest hospital offering psychological care and counseling.  “It is nice to talk about the difficult things if you have someone who understands the situation and gives you clues,” Khoza said.

Khoza had never spoken about the violence in her life until the antenatal visits. A few months later, she separated from the abusive partner and is finding ways to support her children.

“I still have stress but I don’t put that in my heart. I just tell myself everything is going to work out all right even though it is difficult,” Khoza said.

* Name changed to protect her safety.

Midwives assume the role of the doctor and replaces the more clinical hospital setting with holistic and homeopathic methods. Credit: Bigstock

By Lorraine Farquharson
NEW YORK, Jan 27 2014 (IPS)

It was a long and hard 10 hours of labour.

“Don’t give up,” Carolina Pinheiro recalls her doula urging, as she provided both physical and emotional support.“If you feel safer in a hospital then do that, but there should not be an assumption that hospitals are safer than home. " -- Carolina Pinheiro

Pinheiro says she chose at-home birthing with midwife assistance because she wanted a safe environment, plus the gentle care the method provides, which included exercise stretches, a foot massage and aromatherapy.

Since Pinheiro could not sit up to eat during the 10 hours, yet still needed strength to push, the doula squeezed “fresh green [kale and fruit] juice” for her and constantly brought jugs of water.

“A doula is recommended if a mother chooses the at-home [birth], because she comes to your house and guides you through until the time is right for the midwife to come,” Pinheiro tells IPS.

Pinheiro’s baby was positioned feet-down, and it took three hours to turn him around. “Usually, pushing should last two to three hours,” she says.

“If I was in a hospital they would not allow me to push so long and suggest a C-section. I didn’t want that,” she adds. “My doula and I agreed to invite the midwife over only when the time felt right.”

In Pinheiro’s view, the midwife assumes the role of the doctor and replaces the more clinical hospital setting with holistic and homeopathic methods. “So there is no medication during pushing. She just guided me holistically in the positions that I could try,” Pinheiro says.

Even as women in the United States spend 98 billion dollars a year on hospitalisation for pregnancy and childbirth, the country’s maternal mortality rate has doubled in the past 25 years, to around 15 deaths per 100,000 births. Currently, the U.S. ranks 50th in the world in terms of maternal mortality, among the bottom of the most developed countries.

“My midwife took care of me through my entire pregnancy and was there by my side all along, so I knew I would feel safer,” said Pinheiro. She said that having the midwife carry out the delivery at home also made her feel more private. “If you are in a safe environment, you will be fine.”

Sandra Londino, a licensed midwife who runs a private practice in Ithaca, New York, says more than 90 percent of births with obstetricians occur in hospitals. For the most part, the use of modern technology proved effective in the early detection of complications and providing faster solutions, but there are drawbacks as well.

Londino says that when women ask questions about the birth and delivery, they are too often “brushed off” or they are not told the truth.

“Many just agree to an epidural [spinal anesthesia] or a quick C-section just because the doctor says so,” she adds. “Perhaps it is due to money and power, because we don’t see physiological births any more. There are hardly normal births in this country.”

Many women who first chose midwifery for pre-natal and birthing assistance are now opting for at-home birthing with therapeutic guidance from a doula, a phenomenon that grew 41 percent from 2004 to 2010, according to Londino.

Saraswathi Vedam, chair of Home Birth at the American College of Nurse-Midwives, says that this method is increasingly within the mainstream.

“One can always change their mind and go to the hospital,” Vedam says. “Women just enjoy the comfort and continuing care from someone who they feel a more personal relationship with, such as a midwife.”

Results of a survey show that expectant mothers chose an at-home birth in order to avoid unnecessary interventions and to have more control over her birthing decisions. Some said they trust in natural birth as a normal healthy process and did not want any separation from their newborn.

Others said that since they underwent a healthy pregnancy, having the baby at home would make them feel safer by decreasing the possibility of contracting an infection or being coaxed into a Caesarean.

Still, the American College of Obstetricians and Gynecologists argues that home births are unsafe and does not support them.

“It’s important to remember that home births don’t always go well, so as physicians, we have an obligation to provide families with information about risks, benefits, limitations and advantages,” said Richard N. Waldman, the group’s president.

Insurance companies have decided to follow ACOG’s advice by refusing to reimburse clients for at-home births. Londino says she doesn’t understand the logic from a financial perspective.

“Hospital births, without intervention or complication, cost roughly 9,500 dollars, which an insurance company is willing to pay,” she says. “Yet an at-home birth performed by a midwife, whose invoice includes regular pre-natal visits, all necessary tools and delivery, is only 3,500 dollars – which is refused reimbursement.”

Retired hospital midwife Ellen Cohen, who wrote a book about the effectiveness of pre-natal care in order to deliver safe babies without modern technology, says bearing a child is a vulnerable time in women’s lives where they try to do the best for themselves and their newborns.

“If one looks at childbirth as a pathological incident as opposed to something natural, then they will use a machine to help them feel safe – even something like the electrical fetal [heartbeat] monitoring,” Cohen added.

This method is not for everyone though, Pinheiro cautioned. “If you feel safer in a hospital then do that, but there should not be an assumption that hospitals are safer than home. One responds better when they are in their own environment. For me, it was a remarkable experience.”

In Uganda, two percent of women of a reproductive age have experienced fistula, according to the Uganda Demographic Health Survey 2011. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA
, Nov 19 2013 (IPS)

Ever since giving birth to a stillborn baby 15 years ago, Mary*, a peasant farmer from Mubende District in central Uganda, has continuously leaked urine.

“I am home all the time. I don’t go out to the market, I don’t go to church,” says the 35-year-old, speaking through a translator in a crowded ward at the Mulago National Referral Hospital in the country’s capital, Kampala.

Every time Mary drinks something, her bladder empties out the contents and she is forced to constantly pat herself dry with old clothes.

Mary has obstetric fistula. Defined as a hole between the vagina and the bladder, or between the vagina and rectum of a woman that results in the constant leakage of urine and/or faeces through the vagina. The medical condition is predominantly caused by prolonged or obstructed labour lasting more than 24 hours.

Mary’s labour lasted three days. As the nearest hospital was too far away, Mubende District is some 144 km west of Kampala, a traditional birth attendant took Mary to a small health facility when she went into labour. For 48 hours she remained there, trying to give birth to her child. On the third day she was taken to a district hospital where she was able to deliver her stillborn baby.

Abandoned by the father of her child, Mary was later ostracised by her own family.

“Even my sisters who I was living with shunned me. I am stigmatised because I smell all the time,” she tells IPS.

Mary’s story is “typical”, Dr. Susan Obore, an obstetrician who specialises in urogynaecology at the Mulago National Referral Hospital, tells IPS.

In Uganda, two percent of women of a reproductive age have experienced fistula, according to the Uganda Demographic Health Survey 2011. This means there are an estimated 140,000 to 200,000 women with fistula in the country, the Ugandan Ministry of Health (MoH) said in June.

“The true figures are not known because [women] do not come out, they are so stigmatised,” says Obore. “So what we see is probably the tip of the iceberg.”

Uganda grapples with an incredibly low number of surgeons who have the required training to carry out fistula repairs. Currently there are only 24 in this East African nation.

“Twenty-four in a population of about 34 to 37 million. It’s like a drop in the ocean,” national fistula specialist and specialist in the MoH, Peter Mukasa, tells IPS.

“Every hospital should be able to repair a woman with fistula.”

Mukasa says the country has 1,900 new cases a year and can operate on 2,000 women annually. But according to the MoH, the large backlog of fistula cases, coupled with the increasing number of new cases, has “surpassed the existing capacity of our health facilities to repair the cases.”

“We are in a static position; the backlog remains. It will take us so many years to eliminate this,” Mukasa says.

“As we speak now there’s a fistula being formed, one or two or three or four hundred women are getting obstructed (in labour).”

He says fistula repair costs on average about 400 dollars, including the cost of transport to hospital, hospitalisation and other care.

“It is a lot of money,” he concedes, adding that in Uganda the expense is mainly catered for by the United Nations Population Fund (UNFPA).

Ethiopia, where according to the World Health Organisation at least 8,000 women develop new fistulas every year, is home to the world’s first dedicated fistula hospital, the Addis Ababa Fistula Hospital. But Obore insists a similar facility is not needed in Uganda.

“We are hoping to kick out fistula, so there’s no reason why we should have a dedicated hospital,” she says.

“Empowerment of women is one of the best ways to prevent fistula,” Obore adds.

Those most vulnerable to contracting fistula are young, illiterate and rural dwellers.

Worldwide, there are over two million women in Africa, Asia and the Arab region living with untreated obstetric fistula, according to the global Campaign to End Fistula, a programme by UNFPA and various partners.

Between 50,000 and 100,000 new cases of fistula, treatable through reconstructive surgery, occur globally each year, according to UNFPA.

International NGO Uganda Village Project (UVP) run fistula repair camps three times a year at Kamuli Mission Hospital, in Kamuli, eastern Uganda. Patients are identified through radio shows, village outreach programmes, health centre referrals and by word of mouth. They are transported to hospital and operated on by surgeons from the Uganda Childbirth Injuries Fund, a United Kingdom-based organisation.

The last camp was held in early September and 15 patients had surgery. For nine of them, the surgery was successful. The remaining four women still require a second operation, which will take place during the next camp that begins on Jan. 18, says the managing director of UVP’s Iganga office, Kait Maloney.

Mary was not aware she could be operated on until she heard a radio announcement. The first surgery she had at a rural hospital was unsuccessful. She was referred to the Mulago National Referral Hospital, where she will be operated on in the coming months.

“I’m happy to have the surgery. I have no problem going for it,” she says.

But Mary says that even after she has the surgery she will still think about her fistula. She acknowledges that it is unlikely she will have another baby because of her ordeal.

*Name withheld to protect patient’s identity.