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.

Mothers and their children gather at a community nutrition centre in the little village of Rantolava, Madagascar, to learn more about a healthy diet. Credit: Alain Rakotondravony/IPS

By Aruna Dutt
UNITED NATIONS, Jul 30 2015 (IPS)

The global population has now reached 7.3 billion. In the last 12 years, the world has added approximately one billion people, and in the next 15 years this is expected to occur again.

The United Nation’s new global and regional population estimates and projections entitled “World Population Prospects: The 2015 Revision” predicts the population will reach 8.5 billion in 2030, a further 9.7 billion in 2050 and 11.2 billion by 2100.

Nine per cent of the world’s population lives in the 21 “high-fertility” countries, where the average woman would have five or more children in her lifetime. Of these 21 countries, 19 are in Africa and two are in Asia.

It is estimated that over half of this population growth will occur in Africa  – even if there is a substantial reduction of fertility levels which population growth is highly dependent on. Africa also has the highest adolescent birth rate: 98 out of 1,000 women.

Africa will “play a central role in shaping the size and distribution of the world’s population over the coming decades,” says the report.

In the 48 least developed countries (LDCs), of which 27 are in Africa, the population is projected to double or even triple in most of the countries. Countries which are predicted to increase at least five-fold by 2100 include Angola, Burundi, Democratic Republic of Congo, Malawi, Niger, Somalia, Uganda, Tanzania, and Zambia.

The least developed countries are much less likely to develop unless the challenges of population growth are properly dealt with, it says.

The concentration of population growth in the poorest countries makes it harder for their governments to “eradicate poverty and inequality, combat hunger and malnutrition, expand education enrollment and health systems, improve the provision of basic services and implement other elements of the post 2015 sustainable development agenda.”

In least developed countries, steep reductions in fertility are expected. The goal is for women and families to achieve their desired family size by investing in reproductive health and family planning.

The report stresses the necessity of ensuring reproductive health, access to accurate information and the safe, effective, affordable and acceptable contraception method of their choice is necessary, according to the United Nations Population Fund. Women’s lack of support from their partners or communities is also a deterrent, and it is common for family planning to be discouraged.

Edited by Kitty Stapp

Audible gasps echoed through the United Nations’ Trusteeship Council chamber on Tuesday, with audiences told the grim impacts of unsafe reproductive practices on women worldwide.

Hosted by the High-Level Task Force for the International Conference on Population and Development as part of the mammoth Commission on the Status of Women programme, the presentation on sexual and reproductive health described the stark reality for women who lack access to safe abortion or birthing procedures.

“There are 20 million women and girls who undergo unsafe abortion every year,” said Dr. Angela Diaz, Professor of Pediatrics and Preventative Medicine, and Director of the Adolescent Health Center at Mount Sinai Hospital.

To gasps from the packed chamber, she detailed the extreme measures women have gone to when safe abortion is not available.

“Inserting coathangers, sticks, bicycle spokes, knitting needles; ingesting toxic substances like laundry detergent or turpentine, or strong prescription drugs intended to treat diseases like malaria; throwing themselves down stairs or off roofs to induce trauma that leads to abortion; all because they have no access to safe legal options,” Diaz said.

“Unsafe abortion is one of the leading causes of death around the globe… every year 47,000 women and girls die from complications from unsafe procedures.”

Diaz also claimed 25 per cent of adolescent girls who check in to Mount Sinai have a history of childhood sexual abuse.

The panel of scholars, social workers and medical professionals emphasised the damaging effects of gender inequality and intrusion on women’s rights worldwide. Manre Chirtau, a young activist fighting for sexual health services in Nigeria and internationally, said there are 13 million births to girls between the ages of 15 and 19 each year.

Barbara Young, National Organiser at the National Domestic Workers Alliance, claimed only 27 per cent of work visas given to migrant workers are held by women, making migrant women wholly dependant on their husbands’ income for survival.

“When they have no visa, it entraps them in abusive and exploitative situations, with little or no legal recourse, a lack of knowledge of their rights, language barriers,” Young said.

“Sexual and reproductive rights violations can happen as soon as they leave home… the fear of deportation compels them to stay with their abusers.”

While the panellists’ shocking statistics were met with disbelief and anger from the audience, closing speaker Dr. Gita Sen spelt out hope for the future, and how closing the gender gap could bring about a brighter future.

Adjunct Professor of Global Health and Population at Harvard University, and General Co-Ordinator of DAWN (Development Alternatives with Women for a New Era), Sen said eliminating intimate partner violence would bring a US$4.4 trillion benefit to the globe.

“Closing the gender gap in labor force participants would raise global GDP [gross domestic product] by 12%… universal access to sexual and reproductive services would return US$120 for each $1 spent. That would yield US$400billion in annual benefits.”

Follow Josh Butler on Twitter @JoshButler 

Edited by Roger Hamilton-Martin

The global rate of maternal deaths is reducing faster than any time in history, according to a new report presented to the United Nations on Tuesday.

The ‘Every Woman Every Child’ initiative has saved 2.4 million women and children since its inception in 2010, claims the report Saving Lives, Protecting Futures, presented by U.N. Secretary-General Ban Ki-moon.

The report states maternal mortality has been nearly halved since 1990, and in 2013, 6.4 million fewer children under age five died compared to 1990. Every Woman Every Child states 11 million more women have given birth in a health facility, 8.4 million more women and girls use modern contraception, and post-natal care for women increased 25 percent.

“Our task now is to maintain and build on that momentum, complete the unfinished health MDGs, end the appalling tragedy of preventable deaths and invest in the futures of women, children and adolescents,” Ban wrote in the report’s foreword.

“Yet we can and must do much more to provide access to the health care that women need… we must work to ensure that children are born into a safe environment where they will receive necessary vaccines, nutrition and care. There is still too much needless suffering.”

More than two-thirds of the $60billion pledged to the initiative by partner countries and institutions has been distributed and used. Speaking at the launch of the report, Ban said signs of progress were encouraging.

“More women are giving birth in a health facility, more women and girls are receiving the sexual and reproductive health services they want and need, and more pregnant women are receiving anti-retrovirals to prevent HIV transmission to their babies,” he said.

“Our task now is to maintain and build on that momentum, complete the unfinished health MDGs, end the appalling tragedy of preventable deaths and invest in the futures of women, children and adolescents.”

Every Woman Every Child describes itself as an “unprecedented global movement that mobilizes and intensifies global action to improve the health of women and children around the world.” The programme began in response to Millennium Development Goals (MDGs) four and five, concerning maternal health and child mortality, which were seen as the MDGs “were lagging furthest behind.”

The report urges partner to keep reproductive, maternal, newborn and child health “high on the global agenda in the post-2015 era.” The initiative has set its goal as reducing the global maternal mortality rate to 70 in 100,000 births, and newborn mortality rates to 12 per 1000 births.

Follow Josh Butler on Twitter @JoshButler

Edited by Roger Hamilton-Martin

Flooding in Malawi. Courtesy of the Malawi Red Cross Society

By Julitta Onabanjo and Michael Charles
UNITED NATIONS, Feb 2 2015 (IPS)

The flooding of the Zambezi River has had devastating consequences for three countries in Southern Africa. The three worst affected countries are Malawi, Mozambique and Zimbabwe. 

Livestock has drowned, crops have been submerged or washed away and infrastructure has been badly damaged.Imagine being a pregnant woman airlifted from the floodplains and placed in a camp with no midwives, no sterilised equipment nor medical supplies to ensure a safe delivery.

Worse still, hundreds of lives have been lost – and the dignity of women and girls is on the line.

In Malawi, an estimated 638,000 people have been affected and the president has declared a state of disaster. About 174,000 people have been displaced in three of the worst affected districts out of 15 districts hit by floods.

A total of 79 deaths have been reported and about 153 people are still missing. Data disaggregated by age and sex are not readily available, however, it is estimated that about 330,000 of the 638,000 displaced people in the camps are women and close to 108,000 are young people.

The situation is also critical in Zimbabwe. According to preliminary assessments, approximately 6,000 people (1,200 households) have been affected, of which 2,500 people from 500 households are in urgent need of assistance. An estimated 40-50 per cent will be women or girls. More than ten people have drowned while many more have been injured, displaced and left homeless.

In Mozambique, almost all 11 provinces have experienced extensive rainfall. The central province of Zambézia was the worst hit – a bridge connecting central and northern Mozambique was destroyed by the floods in Mocuba district. Niassa and Nampula provinces were also seriously affected.

These three provinces are already among the poorest in the country, and for the most vulnerable – women, girls and children – the impact of flooding can be devastating.

Around 120,000 people from 24,000 families have been affected. The death toll due to flooding, lightning and houses collapsing has risen to 64, while more than 50,000 people from 12,000 families are in need of shelter. Others have fled to neighbouring Malawi. At least 700 out of an estimated 2500 people have been repatriated to date.

Mozambique has a recent history of recurrent floods. UNFPA is supporting the government and other partners to scale up efforts to safeguard the dignity of women and girls. This includes the positioning of reproductive health kits, hygiene kits and promoting gender-based violence prevention.

Flooding in Mozambique. Courtesy of UNFPA

Health and reproductive health needs

As with most humanitarian situations, women, girls and children are usually the worst affected. In Mozambique, for example, close to 1,000 orphans and over 100 pregnant women and girls require urgent attention.

Imagine being a pregnant woman airlifted from the floodplains and placed in a camp with no midwives, no sterilised equipment nor medical supplies to ensure a safe delivery. This is a scenario that countless pregnant women are facing.

In addition to efforts by partners to address the food and infrastructural security needs of the people, women and girls are particularly vulnerable to exploitation and erosion of dignity, and deserve adequate attention.

In Malawi, about 315 visibly pregnant women were identified in the three worst affected districts. Between Jan. 10 and 24, 88 deliveries were recorded by 62 camps in the worst affected districts. Twenty-four of these deliveries were among adolescents aged between 15 and 19 years, as reported from Phalombe, where fertility rates and teenage pregnancies are generally high.

Malawi floods. Some of the pregnant women receiving dignity kits at Somba camp in T A Bwananyambi, Mangochi. Courtesy of UNFPA

Women living in camps for displaced people are fearful of gender-based violence, including rape and other types of sexual abuse. Several cases of gender-based violence have already been reported. In one of the districts, a total of 124 cases were brought to the attention of authorities.

The design of the camps and the positioning of toilets are said to be contributing to these cases. A woman from Bangula camp said: “The toilets are far away from where we are sleeping. We are afraid to walk to the toilets at night for fear of being raped. If the toilets could be located close by, this could assist us.”

Personal dignity and hygiene is a major challenge for women and young people, especially for adolescent girls. A teenager from Tchereni camp in Malawi said: “I lost everything during the floods. My biggest challenge is how to manage my menstrual cycle.”

It has been reported that women and girls are sharing sanitary materials, which seriously compromises their health and dignity.

Urgent action

In order to address the  sexual and reproductive health needs of affected populations, UNFPA Malawi has recruited and deployed full time Reproductive Health and Gender Coordinators to support the authorities with the management of SRH/HIV and gender-based violence (GBV) issues in the camps.

UNFPA has also distributed pre-positioned Reproductive Health kits as well as drugs and medical equipment to cater for clean deliveries, including by Caesarean section, and related complications of pregnancy and child birth in six districts and two central hospitals in the flood-affected areas.

Over 300 prepositioned dignity kits were distributed and 2,000 more have been procured, over half of which have already been distributed to women of child-bearing age in some of the most affected districts to allow the women to continue to live with dignity in their state of crisis.

The International Federation of Red Cross and Red Crescent Societies (IFRC) has launched an emergency appeal for CHF 2,7 million to assist Malawi Red Cross to step up emergency response activities, including a detailed needs assessment of the affected regions, the procurement of non-food items, the procurement and distribution of shelter materials, and the provision of water and sanitation services.

A similar process was applied for Mozambique and Zimbabwe, with the aim of saving more lives by providing immediate assistance to those in need.

But as partners working together to address the numerous problems that confront the affected populations – and warnings of more risks of flooding – we cannot neglect the plight of women and girls.

In humanitarian situations especially, the dignity and reproductive health and rights of women and girls deserves our full attention.

Edited by Kitty Stapp

Excerpt:

Students from Great Horizon Secondary School in Uganda's rural Kyakayege village pose proudly with their re-usable menstrual pads after a reproductive health presentation at their school. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA, Aug 15 2014 (IPS)

When Peninah Mamayi got her period last January, she was scared, confused and embarrassed. But like thousands of other girls in the developing world who experience menarche having no idea what menstruation is, Mamayi, who lives with her sister-in-law in a village in Tororo, eastern Uganda, kept quiet.

“When I went to the toilet I had blood on my knickers,” she told IPS. “I was wondering what was coming out and I was so scared I ran inside the house and stayed there crying.

“I just used rags. I feared telling anybody.”For girls, “pads are as good as schoolbooks” -- Dennis Ntale, 18, a student at co-ed Mengo Senior School in Kampala, Uganda

Not having access to or being able to afford disposable sanitary pads or tampons like millions of their Western counterparts, desperate Ugandan girls will resort to using the local ebikokooma leaves, paper, old clothes and other materials as substitutes or even, as a health minister told a menstrual hygiene management conference this week, sitting in the sand until that time of the month is over.

“We always try to give them something to use at school, just at school,” Lydia Nabazzine, a teacher at Mulago Private Primary School in Kampala, where about 300 out of 500 students are female, told IPS.

“When they go home we don’t know how they go about it, because we cannot afford funding up to home level.”

But the 2012 Study on menstrual management in Uganda, conducted by the Netherlands Development Organisation (SNV) and IRC International Wash and Sanitation Centre in seven Ugandan districts, found that over 50 percent of senior female teachers confirmed there was no provision for menstrual pads for schoolgirls.

When some girls have their period, they may miss up to 20 percent of their total school year due to the humiliation of not having protection, according to separate research from the World Bank. This profoundly affects their academic potential.

“Those days when I was menstruating I could be absent for up to five days a month until menstruation had stopped,” recalled Mayami.

It’s a continent-wide problem. The United Nations Children’s Fund says one in 10 African girls skipped school during menstruation. Some drop out entirely because they lack access to effective sanitary products.

A number of recent initiatives have, however, tried to address this.

On May 28 this year, the world marked the first Menstrual Hygiene Day to help “break the silence and build awareness about the fundamental role that good menstrual hygiene management (MHM) plays in enabling women and girls to reach their full potential.”

On Aug. 14 – 15, East Africa’s first national menstrual hygiene management conference, which has the theme “breaking the silence on menstruation, keep girls in school,” has been taking place in Uganda’s capital Kampala.

At least 100 schoolteachers, schoolgirls – and boys – NGOs, including Network for Water and Sanitation (NETWAS) Uganda, civil society members and others are taking part in the two-day event. They’re calling on the government to put in place a menstrual hygiene management school policy. They also want the government to provide free sanitary pads to girls in schools, like neighbouring Kenya has done.

Despite keeping silent about the horrors of menstruation for months, Mamayi shared with the conference attendees the solution she found to that time of the month.

The student, now 13, had been walking home from school when some older pupils told her, “madam [the teacher] said menstruation is a normal thing for every girl.”

“So I asked them about it,” she told IPS.

“Now I’m using AFRIPads.”

Invented by the eponymous Uganda-based social business, AFRIPads are washable cloth sanitary towels designed to provide effective and hygienic menstrual protection for up to a year.

Mamayi said the re-useable pads work out to be 5,500 Ugandan shillings (2.11 dollars) a year, compared to the 30,000 shillings (11.49 dollars) that disposable pads would have set her back.

“Now when I go somewhere [when I have my period] I sit and am comfortable,” said Mamayi. “I’m not bothered by anything. I don’t worry whether I’ve got anything on my skirt. I don’t miss school.”

She added: “I’m going to tell my friends that menstruation is a normal thing in girls.

“I want my friend also to be free, to tell their parents to buy for them pads. Let them not fear.”

Understanding and Managing Menstruation, was launched by Uganda’s Ministry of Education and Sports at East Africa’s first national menstrual hygiene management conference. The 50-page reader has photos and a section on how to make reusable pads at home, and sections for parents, guardians, peers, friends and schoolboys. Credit: Amy Fallon/IPS

Breaking the culture of silence around menstruation is the aim of a new book, Understanding and Managing Menstruation, launched by Uganda’s Ministry of Education and Sports at the conference. The 50-page reader has photos and a section on how to make reusable pads at home, and sections for parents, guardians, peers, friends and schoolboys.

Maggie Kasiko, a gender technical advisor at the Ministry of Education and Sports, told IPS that the government hoped the book would reach as many students, teachers and parents across the country as possible.

“Not many girls have the opportunities to have their mothers and aunties around, so they start their menstruation without knowing,” she said, adding many parents and relatives were busy trying to earn a living for their families.

Dennis Ntale, 18, a senior five student at co-ed Mengo Senior School in Kampala, said he didn’t know what menstruation was when he encountered a fellow student with her period in class earlier this year, and tried to comfort her. It was only sometime later when he relayed the incident to his male friends and they told him she was “undergoing her MP [menstrual period].”

“They’re [teachers] not teaching this to the boys in schools,” Ntale told IPS.

“I believe boys should be informed about this because there are many of them out there who have no idea about this.”

He said for girls, “pads are as good as schoolbooks”.

“If you don’t have that pad she won’t be able to do a thing,” Ntale said. “[We should] make sure she has what will keep her in school.”

Kasiko said the Ministry of Education and Sports was continuing to ensure schools had separate facilities for boys and girls, with the girls having washrooms and changing rooms where they could bathe and change, had access to clean water, extra pads and Panadol.

But she said she didn’t see the government providing free pads to girls “in the short-term or the long-term”.

“Starting to distribute sanitary towels to each and every girl, every month, is quite a cost for the ministry when you look at all the other areas that the ministry needs to take care of,” she said.

“That, our guidelines for Universal Primary Education (UPE) is very clear, is a role of parents. It’s sanitary wear. Just like you buy a panty for your child, you should be responsible for buying a sanitary towel for your child.

Kasiko added: “But we’ll support the parents and work together with the parents to give them knowledge to ensure the environment is clean and girls stay in school.”

Edited by: Nalisha Adams

The writer can be contacted on Twitter @amyfallon 

Many pharmacies and herbalists in Egypt prescribe their own 'wasfa' (secret drug or herbal elixir). Credit: Cam McGrath/IPS

By Cam McGrath
CAIRO, Aug 10 2014 (IPS)

Magda Ibrahim first learnt that she had endometrial cancer when she went to a clinic to diagnose recurring bladder pain and an abnormal menstrual discharge. Unable to afford the recommended hospital treatment, the uninsured 53-year-old widow turned to what she hoped would be a quicker and cheaper therapy.

A local Muslim sheikh claimed religious incantations, and a suitable donation to his pocket, could cure the cancer. But when her symptoms persisted, Ibrahim consulted a popular herbalist, whose wasfa (secret drug or herbal elixir) was reputed to shrink tumours.

“I felt much better for a few months and thought the tumour was shrinking,” she says. “But then I got much worse.”

When she returned to hospital the following year, tests revealed that the tumour was still there, and the cancer had spread to her lymph nodes. Moreover, the herbal mixture she was taking had caused her kidneys to fail.“Successive [Egyptian] governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery” – Dr Ahmad Bakr, Egyptian health care reform lobbyist

Egypt is a “minefield” of bad medicine, says paediatrician Dr Ahmad Bakr, a health care reform lobbyist. He says successive governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery.

“Our health care system is deeply deformed,” Bakr told IPS. “It’s not just a matter of low funding and corruption, ignorance (pervades every tier of) the health system, from government and doctors to the patients themselves.”

He says Egypt’s lax regulation and poor enforcement has created room for unqualified doctors to perform plastic surgery out of mobile clinics, peddle snake tonic on satellite television, and dabble dangerously in reproductive health.

It is estimated that one in every five private medical clinics in Egypt is unlicensed, and thousands of medical practitioners are suspected of using false credentials or having no formal training.

“There are a lot of so-called doctors who practise medicine in Egypt,” says Bakr. “They mostly work out of small clinics, but you’ll even find them in the most prestigious hospitals.”

The incompetency goes all the way to the top.

In February, Egypt’s military announced it had invented a device to remotely detect hepatitis C – along with acquired immunodeficiency syndrome (AIDS), swine flu and a host of other diseases. The device, which is said to work by detecting electromagnetic waves emitted by infected liver cells, is based on a fake bomb detector marketed by a British con artist.

The military also claimed that it had invented a revolutionary blood dialysis machine that can cure hepatitis C, AIDS and even cancer in a single treatment.

“I was shocked when I saw these incredible claims were being made with barely any clinical evidence,” says Dr Mohamed Abdel Hamid, director of the government-run Viral Hepatitis Research Lab (VHRL). “With any new medical treatment you should perform peer-reviewed, double-blind clinical trials before announcing it.”

Critics say Egypt’s government contributes to a climate of medical irresponsibility. State media routinely exaggerates health threats and feeds public hysteria, while the knee-jerk reactions of government authorities – including high-ranking health officials – are coloured by popular sentiment and political motives.

Reacting to the global swine flu pandemic in 2009, overzealous parliamentarians passed a motion to slaughter all of Egypt’s 300,000 pigs.

There was no evidence that pigs transmitted swine flu to humans, nor had the virus been detected in Egypt. But officials, swayed by the Islamic prohibition on eating pork, appeared to seize the opportunity of a like-named virus to rid the Muslim-majority nation of its swine.

“The pigs were kept almost exclusively by poor Christian zebaleen (rubbish collectors), who used them to digest the organic waste,” says Milad Shoukri, a zebaleen community leader. “Thousands of families lost their livelihoods to this absurd decree, which had no scientific basis.”

Global pandemics such as severe acute respiratory syndrome (SARS), avian flu and the latest contagion, Middle East Respiratory Syndrome (MERS), have presented golden opportunities for Egypt’s myriad quacks and swindlers to fleece the uninformed masses.

“With each health scare we see the same patterns,” says Cairo pharmacist Amgad Sherif. “People panic and throw science out the window. The low level of education and high illiteracy among Egyptians makes them susceptible to believe even the most ridiculous medical claims.”

When a swarm of desert locusts descended on Cairo, enterprising charlatans took out ad space in local newspapers offering a “locust vaccine” to anxious citizens.

Not surprisingly, the injected serum, which turned out to be tap water dyed with orange food colouring, offered no protection against “locust venom”. But it did leave duped households poorer, and at risk of blood contamination or hepatitis C infection from jabs with unsterilised needles.

“The people doing this only care about getting money from people who don’t know any better,” says Sherif. “They know nothing about medicine and do not follow even the most basic hygiene practices.”

In one popular scam, people claiming to be state health officials troll low- and middle-income neighbourhoods offering costly “preventative medicine” for infectious diseases. The fake medical personnel, dressed in lab coats and wearing official-looking badges, administer bogus vaccinations to unsuspecting families.

“Sometimes they give people injections – who knows what’s in them,” says Sherif.

Health officials say the sham physicians create confusion that affects legitimate health campaigns, such as Egypt’s national door-to-door polio eradication campaign.

Egyptian authorities have also found themselves in a cat-and-mouse game with thousands of “sorcerers”, whose superstition-based folk medicine draws desperate working-class patients suffering physical and psychological ailments. The self-proclaimed doctors and faith healers are particularly difficult to catch, say prosecutors, because they tend to work out of rented apartments and advertise mostly by word of mouth.

An Egyptian judicial official told pan-Arab newspaper Al Arabiya that despite attempts to prosecute sorcerers for swindling and fraud, most cases are dropped when the sorcerers reach a settlement with their victims. “There is almost one sorcerer for every citizen,” he concluded.

(Edited by Phil Harris)

Circumcisers in the Gambia publicly declaring that they have abandoned the practice of FGM. Credit: Saikou Jammeh/IPS

By Saikou Jammeh
BANJUL, Jul 13 2014 (IPS)

Women’s rights activists in the Gambia are insisting that more than 30 years of campaigning to raise awareness should be sufficient to move the government to outlaw female genital mutilation (FMG).

The practice remains widespread in this tiny West African country of 1.8 million people, but rights activists believe that their campaign has now reached the tipping point.

Two years ago, GAMCOTRAP, an apolitical non-governmental organisation (NGO) committed to the promotion and protection of women and girl children’s political, social, sexual, reproductive health and educational rights in The Gambia, and one of the groups behind the anti-FGM campaign, sponsored a draft bill which has been subjected to wide stakeholder consultations.

Several previous attempts to legislate against FGM have failed, with no fewer than three pro-women laws having had clauses on FGM removed from draft bills. But activists now appear determined to make the final push and hope that when introduced this time round, the bill will go through.“We’ve caused lots of suffering to our women ... if my grandparents had known what I know today, they would not have circumcised anyone. Ignorance was the problem” – former circumciser Babung Sidibeh

The time has now come for final action, says Amie Bensouda, legal consultant for the draft bill. “There can be no half measures. The law has to be clear. It’s proposed by the law that FGM in all its forms is prohibited. This discussion cannot go on forever. The government should do what is right.”

“The campaign has reached its climax,” Dr Isatou Touray, executive director of GAMCOTRAP, told IPS. “A lot of work has been done. I am hopeful of having a law because women are calling for it, men are calling for it. I know there are pockets of resistance but that’s always the case when it comes to women’s issues.”

“In 2010, we organised a workshop for the National Assembly,” she continued. “They made a declaration, pledging to support any bill that criminalises FGM. I am happy to report that, since 2007, more than 128 circumcisers and 900 communities have abandoned the practice. This trend will continue to grow.”

Seventy-eight percent of Gambian women undergo FGM as a ‘rite of passage’. However, after more than three decades of the anti-FGM campaign in Gambia, a wind of change is blowing, sweeping even conservative rural communities.

Sustained awareness-raising programmes have resulted in public declarations of abandonment of FGM by hundreds of circumcisers. Babung Sidibeh, custodian of the tradition in her native Janjanbureh, the provincial capital of Central River Region, 196 kilometres from Banjul, was one of them. The old woman assumed the role after the death of her parents, but she has since “dropped the knife”, as no longer practising FGM is known here.

Sidibeh did so after receiving training in reproductive health and women’s rights. “Soon after we circumcised our children in 2011,” she told IPS, “Gamcotrap invited me for training. I was exposed to the harm we’ve been doing to our fellow women. If I had known that before what I know today, I would never have circumcised anyone.”

With a tinge of remorse, she added: “We’ve caused lots of suffering to our women. That’s why I told you that if my grandparents had known what I know today, they would not have circumcised anyone. Ignorance was the problem.”

Mrs Camara-Touray, a senior public health worker at the country’s heath ministry confirmed to IPS that her ministry has since taken a more proactive role on FGM.

She explained: “The ministry has created an FGM complication register. We’ve also trained nurses on FGM. Until recently, when you asked most health workers about the complications that can arise with FMG, they would say it has no complications. That’s because they were not trained. Since 2011, we’ve changed our curriculum to include these complications. After we put the register in place, within three months, we’d go to a region and see that hundreds of complications due to FGM had been recorded.”

In March, Gamcotrap organised a regional religious dialogue that sought to de-link FGM from Islam. Touray said that the workshop was a prelude to the introduction of the proposed law in parliament.

“Islamic scholars were brought together from Mali, Guinea, Mauritania and Gambia,” she told IPS. “We had a constructive debate and it was overwhelmingly accepted that FGM is not an Islamic injunction, it’s a cultural practice. It was recommended that a specific law should be passed and a declaration was made to that effect.”

However, there is resistance in some quarters. An influential group of Islamic scholars, backed by the leadership of the Supreme Islamic Council, continue to maintain that FGM is a religious injunction.

With a large following and having the ears of the politicians, these clerics have in recent times also intensified their pro-FGM campaign.

“It will be a big mistake if they legislate against FGM,” Ebrima Jarjue, an executive member of the Supreme Islamic Council, told IPS.

“Our religion says we cut just small. We should be allowed to practise our religion. If some people are doing it and doing it bad, let them stop it. Let them go and learn how to do it. If circumcising the girl child when she’s young is causing problems, then let’s wait until she grows up. That’s what used to happen.”

Meanwhile, the Women’s Bureau, the implementing arm of the Ministry of Women’s Affairs, is hesitant about legislating against FGM.

“As far FGM is concerned, the position of the Women’s Bureau is that there’s need for more sensitisation and dialogue to push the course forward,” Neneh Touray, information and communication officer of the Women’s Bureau, told IPS. She declined to comment on whether the bureau thought that the bill was premature.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Excerpt:

Nasreen Jehan, a high school student in eastern India, studies a leaflet on menstrual hygiene. Credit: Stella Paul/IPS

By Stella Paul
BETTIAH, India, May 28 2014 (IPS)

Fifteen-year-old Nasreen Jehan, a student in the eastern Indian state of Bihar, proudly flaunts a yellow and red beaded bracelet encircling her wrist. This humble accessory, she tells IPS, is her most treasured possession.

“It helps me keep track of my menstrual calendar,” says the 9^th-grader, who attends a government-run, all-girls school in a town called Bettiah. “Also, it helps me talk about menstruation with my friends.”

Of the 24 small beads that comprise the delicate adornment, six are read, symbolising the days of her monthly period. Jehan made the bracelet herself at a menstrual hygiene workshop in Bettiah last year, organised by Nirmal Bharat Yatra (NBY) – a nationwide sanitation campaign spearheaded by the Geneva-based Water Supply and Sanitation Collaborative Council (WSSCC).

Educators at the workshop talked Jehan and her peers through the biological process of menstruation, offering tips on how to properly wash and dry menstrual cloths if sanitary napkins are unavailable.

“My mother and my aunt never stepped out of the house when they had their periods. That was our family tradition." -- Soumya Selvi, a 10th-grader in southern India
Finally, they gave Jehan the most important message of all: that menstruation is just as natural as hunger or sweating, and that there is nothing to be ashamed or afraid of.

It is rudimentary advice, but crucial in a country like India, where menstruation has long been perceived as a social taboo. In many parts of the country, a woman on her period becomes essentially “untouchable” – banned from cooking, handling water or entering places of worship.

According to a study undertaken by the United Nations Educational, Scientific and Cultural Organisation (UNESCO) back in 2012, some 225 million adolescent girls attend one of the 1.37 million schools spread across the country. Of them, roughly 66 percent have no knowledge of menstruation before they reach puberty.

A full 88 percent of these girls do not have access to what the United Nations Children’s Fund (UNICEF) calls WASH facilities: water, sanitation and hygiene, including soap or sanitary supplies.

According to data compiled by AC Nielsen in 2011, the average Indian adolescent girl (between the ages of 12 and 18) misses 50 days of school a year as a result of inadequate facilities, or a lack of awareness of menstruation. Some 23 percent of all schoolgirls – over 50 million in total – drop out of school altogether once they hit puberty.

Of India’s roughly 335 million women, a mere 12 percent have access to sanitary napkins.

Because the subject is seldom discussed, even among families, peers or community members, many women resort to extremely unsanitary options during their period, including the use of unsanitised cloth, ashes or sand. Reproductive tract infections (RTIs) are 70 percent more common among women who engage in these practices.

This year, for the first time, the world will mark May 28 as Menstrual Hygiene Day, designed to address the very challenges countries like India are facing.

Against this backdrop, the NYB campaign is not only timely, it is essential if India hopes to achieve the Millennium Development Goals (MDGs), development targets set by the world body in 2000 and set to expire in 2015.

Also known as the Great WASH Yatra, NYB aims to “improve policy and practice in an extremely challenging and taboo area of sanitation and hygiene: Menstrual Hygiene Management (MHM).”

Launched in 2012, the 150,000-dollar campaign – generously supported by the Swiss Agency for Development and Cooperation and the Bill and Melinda Gates Foundation – will continue until 2016.

Already it has reached over 12,000 women and girls around the country, an overwhelming majority of who are adolescent students who say that being empowered to break the silence around menstruation is making a huge difference in their lives.

This process, though, has not been easy. Urmila Chanam, a Bangalore-based MHM educator who travelled to six states during the early stages of the campaign, said the stigma against menstruation runs deep, having been embedded for years in the minds of men and women alike.

“When a girl in India gets her first period, everyone tells her that she is impure because the blood flowing out of her is dirty,” Chanam told IPS.

“So, she grows up convinced that this is a shameful thing that she must not discuss. The first challenge of an educator is to have the girl overcome this sense of shame and fear. Everything else comes after that,” added Chanam, who also runs a web-based campaign called ‘Breaking the Silence’ that encourages both women and men to openly discuss the issue.

The determined efforts of a handful of NGOs and activists like Chanam have set the wheels of a full-blown movement in motion, with thousands of young women across the country coming forward to share their experiences.

A fine example of this is Soumya Selvi, a 10^th-grade student in a girls’ school in Srirangam, a town located about 320 km south of Chennai city in southern India.

Three years ago, Selvi and her fellow classmates were privy to a UNESCO-led reproductive health campaign, and became virtual ambassadors for the issue. Selvi alone has shared her knowledge with nearly 50 other girls in her school and her neighborhood. She has also not missed a single day of school during her period.

“My mother and my aunt never stepped out of the house when they had their periods,” she told IPS. “That was our family tradition. But, I told them, ‘this will happen to me until I am 50 years old, perhaps older. Should I sit at home all my life?’

“After that, they never asked me to miss school,” she recounted with a wide smile.

Still, experts agree that independent efforts can only achieve so much. Without government support, it could take decades to reach every woman and girl who remains fearful and silent. What is needed, they say, are inclusive and targeted training programmes that can help scale up impacts of individual campaigns.

Mukti Bosco, an eminent activist and founder of Healing Fields, a Hyderabad-based NGO that works with schools on menstrual hygiene management, told IPS it is time for campaigns to target female teachers and mothers, who can “instill positive behaviour in the girls.”

Others emphasise the role of communication as in invaluable tool in spreading the message. Sinu Joseph, a Bangalore-based MHM educator, has so far trained 8,000 girls across the southwestern state of Karnataka using an animation video.

“Young girls often ask, ‘Why can’t I visit a temple when I have my period?’” Joseph told IPS. “To answer such questions, one has to first know the cultural history. [Educators] must earn the trust of women and girls, so that they are comfortable enough to speak. Then they… not only learn, but also feel empowered.”

(END)

A fertility clinic in Cairo. Credit: Rachel Williamson/IPS

By Rachel Williamson
CAIRO, Oct 3 2013 (IPS)

The young couple inspecting Dr Bassem Elhelw’s Cairo Fertility Clinic knew what they wanted from him: a baby boy. They also knew they wanted the child by in vitro fertilisation (IVF).

After only four months of marriage they were already experienced at this game. They had seen two other fertility doctors, and the young woman had undergone two ovulation inductions to stimulate egg development.

Elhelw said that had his advice been to be patient and try less invasive procedures before going straight to IVF, the couple would have moved on to their fourth doctor.

Assisted reproductive technologies (ART) in Egypt have boomed of late. According to specialists such as Elhelw this is now a fertile area for practitioners in it only for the cash.

Doctors and reproductive experts say IVF treatments have risen significantly after the Jan. 25 revolution of 2011. "It's easy for the wealthy but fertility is too important for Egyptians, even the poor will ask for money to get it done." -- Dr Ashraf Sabry, director of three fertility clinics

Across-the-board restrictions of what could be shown on television channels ended with the departure of former president Hosni Mubarak after the revolution. IVF clinics in Cairo and Alexandria began heavy advertising campaigns following the easing of restrictions.

Elhelw said a profusion of “infomercial”–style television advertising is now reaching once-isolated rural provinces, and greater awareness was creating excessive expectations of what the technology could do.

But beyond such specific changes, medical personnel say the 2011 revolution and the turmoil since have created a new dynamic. With the revolution came a governmental vacuum and a societal shift.

“I think what’s changed now is an attitude to infertility rather than cases of infertility,” Elhelw told IPS. “Attitudes changed because in the last two years things were happening very fast. The pace of life in Cairo used to be very slow.”

Sperm counts among Egyptian men are already low, as documented by Yale reproductive researcher Marcia Inhorn in her 2004 study Middle Eastern Masculinities in the Age of New Reproductive Technologies: Male Infertility and Stigma in Egypt and Lebanon.

Inhorn told IPS that Middle Eastern women, besides, suffer from an above-average incidence of polycystic ovary syndrome, and obesity-related problems are a major fertility issue for Egyptian women.

These problems have been exacerbated since the revolution, medical personnel say. Unemployment and social tensions are driving a change that has put shisha cafes at the centre of the social lives of young men and women, leading them to spend long hours in smoke-filled environments. Smoking is a known cause of infertility.

“Smoking is hematotoxic, it’s not good for sperm quality,” Inhorn said, adding that at least 50 percent of men in the Middle East smoke.

Dr Ashraf Sabry, director of three eponymous fertility clinics in and around Cairo, said 60 to 70 percent of his business was from male infertility. He attributes this partly to cigarettes and partly to a rise in the social acceptability of young men smoking in shisha cafes since 2011. 

“It’s too easy to smoke,” he said. “These boys spend so much time in these cafes, they can go through two or three shishas at one time.”

He said unlicensed cafes were now common and it had become socially acceptable for young women to smoke shisha in cafes, as well as cigarettes, and young men and even boys were spending hours in shisha cafes where once they would not have been permitted entry.

Such factors are pushing more Egyptians into seeking medical help to conceive, medical personnel say.

“Our observation in the infertility centre in Maadi or the infertility centre at Al-Azhar University, where we have a public unit for IVF, is that the number of couples who are coming for treatment of male infertility is on the rise,” said Dr Gamal Serour, director of the IVF Unit at Al-Azhar University in Cairo and expert in Islamic reproductive law. He added that male and female infertility affects about 10 to 15 percent of Egyptian couples.

Regulation of medical treatments has not been on the Egyptian government’s radar since January 2011. A draft law proposed in late 2010 to further regulate aspects of IVF such as sex selection fell by the wayside.

Ministry of Health spokesman Dr Mohamed Fathalla declined to say whether legislation would be introduced to control fertility centres.

The sector is loosely supervised by the Health Ministry and the Egyptian Medical Syndicate, and guided by Islamic law.

With governmental attention focussed elsewhere, bad practices are flourishing. Expensive and unnecessary procedures are thrust on patients such as full IVF treatment where only hormone regulation may be required.

Elhelw said he had not personally seen many women physically hurt by other doctors, but these cases were not uncommon in his clinic. Sabry said he saw “a lot” of women who had been physically, mentally and financially hurt by reckless practitioners.

“I will be happy [to see greater regulation]. These cowboys are hurting our business.”

Sabry said he had refused egg donation in his clinics. The practice is forbidden under Islamic law, though IVF is not.

IVF was introduced into Egypt in 1986 and a set of Islamic guidelines quickly followed. Many were reassured that such treatment was not forbidden by religion.

But since then, calls for a dedicated national supervisor, clinic registration, doctor accreditation, and the draft law in 2010 have fallen by the wayside as Egyptians focussed on building a new democracy.

This also means the precise number of clinics and practitioners is unknown.

Dr Ragaa Mansour, one of the pioneers of IVF in Egypt and a director of the Egyptian IVF&ET Centre, told IPS that “there is no national accreditation specific to IVF and there is no body that monitors and follows up the practice in each IVF centre.”

Serour does not believe legislation is needed.

Such legislation would inhibit flexibility with new technologies, he said.

The cost for a round of treatment ranges between 6,000 to 12,000 Egyptian pounds (870 to 1,740 dollars) for basic IVF, and between 25,000 to 30,000 Egyptian pounds (3,600 to 4,300 dollars) to choose the sex of a child.

By developed world standards these prices are low but minimum wage in Egypt is around 730 Egyptian pounds (105 dollars) a month. Yet people find the money somehow, says Sabry.

“It’s easy for the wealthy but fertility is too important for Egyptians, even the poor will ask for money to get it done.”

When the U.N. Population Fund (UNFPA) participates in a regional review conference in the Uruguayan capital of Montevideo next week, it will take stock of the successes and failures of a wide range of gender-related issues, including reproductive health, sexual violence, women’s rights, maternal mortality, and the spread of HIV/AIDS – all of them relating to Latin America and the Caribbean (LAC).

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

And the question lingering in the minds of most delegates will be how LAC has fared in implementing the landmark Programme of Action (PoA) adopted at the 1994 International Conference on Population and Development (ICPD) in Cairo.

The question appears even more relevant considering the fact that a high-level meeting of the General Assembly is due to take place in 2014 to review ICPD achievements – and shortcomings – over the last 20 years.

Maria Jose Alcala, director of the Secretariat of the High-Level Task Force for ICPD, insists the international community must build on the Cairo commitments.

She told IPS that Cairo was a landmark, placing the reproductive rights of women at the centre of sustainable development.

“Their implementation has brought tremendous benefits to individuals, families, economies and countries, though they remain unfulfilled for millions across the region,” Alcala said.

But at the Montevideo Conference, scheduled to take place Aug. 12-15 and organised by the U.N. Economic Commission for Latin America and the Caribbean (ECLAC), “We must also go beyond agreements made 20 years ago to make the promise of Cairo, and the sexual and reproductive rights for all, a reality regardless of who you are or where you come from,” she noted.

Speaking at the 30th anniversary of the UNFPA Population Awards ceremony last week, Secretary-General Ban Ki-moon underlined the fact that “population is not a matter of numbers”.

“It is all about people – the choices they make and the choices they are able to make,” he said. “We must empower individuals. We must protect their freedom, ability and right to make informed decisions. This will enable people to fulfil their potential. And that will advance whole societies.”

UNFPA Executive Director Dr. Babatunde Osotimehin concurs with Ban’s view that development is not sustainable unless it is equitable and serves all people.

“I couldn’t agree with him more. We at UNFPA continue to emphasise that people and the principle of equity must be kept at the centre of sustainable development,” he said.

Dr. Osotimehin says it means recognising the need to invest in women and young people and promoting human rights. “It means increasing equity to build a world of opportunity for all.”

Alcala said that among the issues to be discussed at Montevideo, a high priority would be fundamental human rights.

“Governments in the region need to make strong commitments to advance gender equality, the rights of women and girls, the empowerment of young people, and sexual and reproductive health and rights,” she said.

These are basic rights to make decisions about one’s own private life and free of any form of discrimination, coercion or violence.

“They include deciding if, when and how many children to have, if and whom to marry, decisions about one’s body, sexuality and health and to have the information and services to do so,” she noted.

But for too many women and adolescent girls in the LAC region – and for too many young people and communities living in poverty – enjoyment of these rights is still far from reality, she warned.

As the United Nations embarks on its post-2015 development agenda, described as a logical successor to its Millennium Development Goals (MDGs) with a 2015 deadline, population and reproductive health are expected to be an integral part of the new agenda, including the proposed Sustainable Development Goals (SDGs).

The Montevideo conference will include a general discussion on national experiences relating to population and development, prospects for the period beyond 2014, and the role of adolescents and youth.

Alcala told IPS a key issue is bringing more policy attention and investments to adolescents and youth.

She pointed out adolescent girls in Latin America and the Caribbean, have the second highest pregnancy rates in the world after sub-Saharan Africa. About 20 percent of all births in the region are to adolescent mothers between 10 and 19 years of age.

And young women in the Caribbean are 2.5 times more likely to be infected with HIV than young men, she added.

She said her task force is calling for universal access to comprehensive sexuality education for all young people, in and out of school.

Countries in the region are already taking concrete steps in this direction: this must be a priority of any common-sense 21st century education agenda, Alcala said.

She said more needs to be done to intensify prevention of violence against women and girls and bring perpetrators to justice. Some 36 percent of women in the LAC region have experienced sexual or physical violence in their lifetime and, despite increased efforts in various countries, impunity for these crimes remains rampant.

Alcala said governments meeting in Montevideo must also address ending unsafe abortion as a major killer of women and adolescent girls. Latin America and the Caribbean has the highest rate of unsafe abortions in the world: 4.2 million unsafe abortions every year.

Beyond ensuring every woman and adolescent girl has access to sexual and reproductive health information and modern contraception – including emergency contraception – this includes expanding access to safe abortion, which is one of the safest medical procedures available.

“We must put a stop to the fear unleashed upon women, and the cruel imprisonment and punishment of women and girls who have sought life-saving care after undergoing an unsafe abortion,” Alcala said.

“We must remember that even where it is illegal, in the region as across the world, wealthy women and couples will find a way to obtain a safe procedure; but it is poor women and girls who will be forced to risk their lives when they are left with no other recourse but an unsafe abortion.”

This issue is a fundamental matter of social equity, she said, adding that the need for abortion will not go away.

“So we have a choice: to continue standing on the sidelines as women and girls risk and lose their lives, or allow women and adolescent girls the basic right to make decisions about their own bodies, health and lives,” she said.

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

By Ariam Frezghi
ISTANBUL, Jul 13 2013 (IPS)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Breaking the stereotypes

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

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

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

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

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

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

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

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

Government intervention

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Some experts like Sow believe change will only come slowly.

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

(END)

By Sabine Clappaert
BRUSSELS, Jan 20 2013 (IPS)

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

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

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

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

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

Excerpts from the interview follow:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(END)

Excerpt:

In 1996, Maria Mamerita Mestanza Chavez, a 33-year-old Peruvian mother of seven, was threatened with imprisonment if she did not comply with the government policy of undergoing sterilisation. After suffering post-operative complications for which she was refused treatment, Chavez died nine days later.

After years of legal proceedings in the Inter-American Commission on Human Rights (IACHR), in 2003 the Peruvian government finally acknowledged international legal responsibility for its actions.

Chavez’s story is not the only case in which national law has forced women to undergo involuntary sterilisation. Although many women’s and disability rights organisations and other human rights bodies have condemned coercive sterilisation, thousands of women and girls worldwide are still denied the right to make decisions about their own reproduction.

Participants on the first day of the Fifth Session on the Conference of States Parties to the Convention of the Rights of Persons with Disabilities, hosted by the U.N. Sep. 12-14, 2012. Credit: UN Photo/Rick Bajornas

Involuntary sterilisation, an operation which, without an individual’s consent, permanently ends his or her ability to reproduce, has occurred in regions with many different cultural backgrounds, ranging from the United States and Switzerland to Japan, China, Puerto Rico, Brazil and others.

The operation “has historically targeted…marginalised groups of women such as women with disabilities, women from ethnic minorities, indigenous women, low-income women and women living with HIV”, said Luisa Cabal, vice president of the New York-based Centre for Reproductive Rights, at a side event organised by the World Health Organisation (WHO) at the U.N. headquarters Sep. 13.

WHO estimates that over a billion people in the world, or approximately 15 percent of the global population, have disabilities.  According to a WHO report, disabled women are particularly vulnerable to involuntary sterilisation.

Forced sterilisations on disabled women are often performed under the auspices of medical legal services or with the consent of court-appointed guardians, who have the authority to decide on behalf of the patient. Various justifications are offered for the procedure, including disabled women’s inability to parent, protection from sexual exploitation and abuse, population control, or so-called menstrual management.

An international approach

The United Nations Convention on the Rights of People with Disabilities (CRPD), adopted in 2006 and ratified so far by 119 countries, recognises that disabled individuals have the right to make decisions freely and responsibly regarding their reproductive lives.

These rights and others were discussed at the Fifth Session of the Conference of States Parties to the CRPD, which concluded at U.N. headquarters Sep. 14. This year’s conference focused on women and children.

Strongly advocating the rights of women with disabilities at the conference was Prince Zeid Ra’ad Zeid Al-Hussein, Jordan’s ambassador and permanent representative to the United Nations.

In his remarks at the opening session, Hussein outlined the role Jordan’s Higher Council for Affairs of Persons with Disabilities (HCD) has played in raising awareness of and advocating for the rights of Jordanian women with disabilities who are subject to sterilisation, which he called a “misconceived and shameful practise”.

“The committee targeted parents, doctors and gynecologists, legal experts and judges as well as religious leaders to address this issue,” Hussein explained.

Despite the existence of the CRPD, disability is not even explicitly mentioned in the U.N.’s Millennium Development Goals (MDGs), pointed out Ahmed Abul Kheir, Egypt’s ambassador and advisor to the Minister of Social Affairs. He urged the U.N. to tackle the issue at a high-level meeting of the General Assembly on disability and development in September 2013.

Government accountability

In 2011 five women with mental disabilities brought their case before the European Court of Human Rights. Each had involuntary undergone the process of tubal ligation without their informed consent. This case, Gauer and Others vs. France, remains open but is considered best example of how involuntary sterilisation can be effectively tackled by international institutions.

“A positive decision from the court in this important case would have a tremendous impact on reinforcing the autonomy of women with disabilities with respect to their reproductive health,” said Yannis Vardakastanis, president of the Brussels-based European Disability Forum, in a press release.

“States are under an obligation to take measures to prevent such violations and to investigate and prosecute them to the fullest extent when they do occur,” he added.

Nevertheless, preventive measures and support services are often limited and insufficient, according to Cabal, the Centre for Reproductive Rights vice president.

“Governments and health institutions have weak or inadequately implemented informed consent policies, guidelines, procedures to protect patient rights,” she said. “There is very little accountability for the ethical and human rights violations.”

“The human rights obligations of each state requires the adoption of all necessary measures – legislative, budgetary, judicial and administrative – to ensure women with disabilities access to reproductive health services,” Cabal told IPS. States must also establish accountability mechanisms to ensure laws and policies are fully implemented.

Moreover, victims of forced sterilisation must have access to the court system to vindicate their rights, Cabal said.

According to Erszébet Földesi, the vice president of the European Disability Forum, one of the main challenges preventing forced sterilisations is providing women with disabilities with appropriate information about their sexual and reproductive health care options. Another challenge is obtaining their free, full and informed consent to such procedures.

Health professionals ought to be “trained to deal with and assist women with disabilities in the area of sexuality and reproductive health and motherhood”, she added.

Asked what support must be delivered to the victims of forced sterilisation, Földesi told IPS that victims must have access to “recovery, rehabilitation and social integration”.

Highlighting the issue through social media networks or elsewhere online could help raise the awareness of the general public and policymakers about forced sterilisations, Földesi added.

When Philippines President Benigno Aquino III delivered his annual state of the union address in July, he appealed to the country’s lawmakers to break a  deadlock on progressive birth control laws in this predominantly Catholic nation.

An estimated 15 Filipina women currently die from pregnancy-related complications every day – up from a daily average of 11 a decade ago – and many of these are teenagers from among the urban and rural poor, according to a government survey.

In the decade after the law was originally proposed, unintended pregnancies have risen by 54 percent, according to the government’s ‘Family Health Survey-2011.’  The bill seeks to addresses this situation by offering contraceptive options, reproductive health care and sex education in schools.

According to the survey, the maternal mortality rate (MMR) reached 221 deaths for every 10,000 live births during the 2006 – 2010 period, marking a 36 percent increase from the 162 deaths during the 2000 – 2005 period.

In early August, the President’s allies in the House of Representatives had occasion to cheer as lawmakers in the Congress voted to end the fractious debate that had trapped ‘The Responsible Parenthood, Reproductive Health and Population Development Act’ in a Lower House parliamentary committee.

But, as the reproductive health (RH) bill makes its way through the Senate and the House for amendments, its sponsors face filibustering by a vocal minority trying to delay passage of the bill before Oct. 15 when the term of the current Congress expires.

“The anti-RH forces know that at the moment the pro-RH forces are likely to have the majority, so their strategy is to prolong the parliamentary process,” Congressman Walden Bello of the Citizens Action Party told IPS in an interview.

“Once we get to mid-October, it will be very difficult to muster quorums to take up legislation since most members of the House will be busy campaigning for reelection (for next May’s election),” Bello said.

According to Bello, the strategy of the vocal minority – about 120 members in the 285-strong Lower House –  is to leverage the political influence that the Catholic Church wields in this archipelago of 96.5 million people.

“The anti-RH forces hope that some of the pro-RH forces will waver and decide against voting for the bill for fear that the Catholic Church hierarchy will tell their Catholic constituents to vote against them,” Bello said.

The clout of the Church is playing out in the  Jesuit-run Ateneo de Manila University where some 190 academics supporting the RH bill have been threatened with heresy proceedings, according to local media.

“The first principle of canon law is that we don’t allow teaching that is against the official teachings of the Church,” Bishop Leonardo Medroso told a local radio station in an interview. “If there is somebody who is giving instructions against the teachings of the Church, then they have to be investigated immediately.”

The Church has also backed street protests against the controversial bill and one “people power” gathering drew an estimated 10,000 people in the capital.

Arguments trotted out against the bill at such meetings include loss of family values in a ‘contraceptive society’ and state interference in what is seen by many as a religious domain.

“The RH bill has become a political question because of the role of the Church in opposing it,” says Harry Roque, professor of constitutional law at the University of the Philippines. “The influence of the Church is ever persuasive.”

“But the reality is that we need this bill,” Roque said in a telephone interview from Manila. “It is important for the President to do what is right. He is deeply committed to supporting this bill.”

To do otherwise would expose the Aquino administration to charges of  being remiss in meeting United Nation’s Millennium Development Goal (MDG)  of slashing by three-quarters the maternal mortality ratio (MMR) by 2015 against what it was in 1990.

Local women’s rights groups and U.N. agencies monitoring the country’s progress in meeting MDG 5 (one of eight goals) relating to maternal health and reducing the MMR hold that the Philippines is likely to miss the target.

“The first RH bill, which was proposed in the Upper and Lower House in 2001, was meant to “respond to the various RH problems in an integrated and rights-based fashion,” says Junice L. Demeterio-Melgar, executive director of Likhaan, a centre for women’s rights and health that is backed by a national network of grassroots activists.

“It specifically wanted to call attention to existing but essentially tabooed issues like adolescent RH, post-abortion care and sex education,” Demetrio-Melgar said.

“A law was needed to mainstream the integrated health and rights-based approach, as well as to override the devolution of the Philippines healthcare system,” she told IPS. “The bill was meant to institutionalise the department of health’s RH programmes.”

The non-passage of the bill has adversely affected lingering poverty in a country  where nearly 20 percent live below the U.N.’s 1.25 dollars-a-day poverty line.

“The richest women want 1.9 children and have two; the poorest women want four children but have six,” says Demeterio-Melgar. “Unintended fertility keeps families poor and families with more than three children have difficulty feeding their children and sending them to school.”

At the Kakonko Health Centre, about 250 kilometres from the nearest hospital in Kigoma Region, Western Tanzania, assistant medical officer Abdu Mapinduzi prepares to operate on Joanitha, a young pregnant mother.

She has given birth via caesarean section three times before at a regional hospital. But now, for her fourth child, she is able to have the baby at her nearest medical health centre.

Despite the fact that the Kakonko Health Centre is 150 km away from Joanitha’s home village, it is still closer than her nearest regional hospital, which is the only other facility able to conduct caesareans. Health centres here cater for 50,000 people, approximately the population of one administrative division, but are not equipped to perform surgeries. They are the third level of health care in the country after village health and dispensary services.

But the Kigoma Region has become one of the first places in East Africa to train assistant medical officers to conduct life-saving c-sections at its rural health centres.

After her caesarean, Joanitha told IPS that she was grateful to be able to deliver her baby safely at a health centre.

The Kakonko Health Centre in rural Tanzania is now equipped to perform surgeries, including caesarean sections. Credit: Erick Kabendera/IPS

“A friend of mine died while giving birth at a traditional birth attendant’s home last year, and about four months ago another one gave birth to a dead child as she travelled to the hospital.”

The World Lung Foundation renovated nine rural health centres in Kigoma Region, including the Kakonko Health Centre, under a pilot project in 2009. As part of the initiative, assistant medical officers were trained in basic surgery.

“We have successfully handled all our complicated cases and mothers have delivered safely,” Mapinduzi, who is also the supervisor of the centre, told IPS.

“When we have a complicated birth, it is like everything has stopped so as to save a life,” he said.

Mapinduzi said that when the centre began operating on expectant mothers in 2010, the number of deliveries at the health centre went up to 120 per month from 20, and an average of six caesarean sections were conducted every week.

“We have established a network at the grassroots level where women with complications are advised to deliver at the health centre or district hospital.

“Previously, some mothers didn’t see the need to come to the health centre, especially those with complications, because they knew that we were unable to help them then. Some would stay at home and wait for the grace of God, while others went to other places,” he said.

Tanzania has a high maternal mortality rate: 578 deaths per 100,000 live births. According to the World Health Organization “the maternal mortality ratio in developing countries is 240 per 100,000 births versus 16 per 100,000 in developed countries.” Kate Gilmore, assistant secretary-general and deputy executive director (Programme) of the U.N. Population Fund said that South Sudan had the highest rate in the world with over 2,000 deaths per 100,000. But at one point the Kigoma Region had the highest rate in the country, at 933 per 100,000 live births in the early 1980s.

But in the 1980s, a newly qualified gynaecologist, Dr. Godfrey Mbaruku, who is now the Deputy Director of the Ifakara Health Institute, Tanzania’s main health research institution, developed successful initiatives that led to a huge drop in the maternal mortality ratio here – to 186 per 100,000 live births in 1991.

While recent statistics are unavailable, maternal mortality in this region is considered to be lower than in the rest of the country.

It was Mbaruku’s work here that inspired development partners to set up the project. He told IPS that it made perfect sense to equip health centres to perform surgeries.

“The majority of Tanzanians live in rural areas, and you must be joking to suggest that they should access health services at the regional and district hospitals. Mothers are not dying due to chronic illnesses, but because of emergencies,” Mbaruku said.

Dr. Amri Mulamuzi, coordinator of the project in Kigoma Region, told IPS that a combination of factors helped reduce maternal deaths here recently.

“We have also provided ambulances to all the health centres so they can refer complicated cases to the district or regional hospitals…We also started campaigns on the ground, in collaboration with local government authorities, to ensure that each expectant mother realises that it is important for her to receive antenatal care,” said Mulamuzi.

While the Kigoma Region health centres have become a success story, health activists fear that programmes like this are unlikely to be sustainable because they are donor-driven, and will collapse when donors phase out their initial financial commitments.

For example, the government’s “Support to Maternal Mortality Reduction Project” that began in 2006, and is being implemented as a trial in three regions, only receives 10 percent government funding. The rest comes from donors.

Irenei Kiria, the executive director of Sikika, a non-governmental organisation that advocates for the provision of quality health services, told IPS that there would be no significant change in the country’s maternal mortality rate until the government invested more in it, and translated policies into action.

“Things on the ground must change for the government to be seen as serious in addressing maternal health,” said Kiria.

Mbaruku agreed.

“You can’t expect donors to help you with this – forget about reducing the deaths. The government must commit its own resources to reduce maternal deaths,” he said.

A 2009 report on the assessment of Tanzania’s progress in achieving the United Nations Millennium Development Goals (MDGs) entitled “Tanzania Midway Assessment at a Glance” showed that the country was unlikely to cut its maternal mortality rate or increase the number of births attended by skilled health personnel by 2015. The eight MDGs are promises that 189 U.N. member countries “made to free people from extreme poverty and multiple deprivations.”

For example, maternal mortality in Kilwa District, in south eastern Tanzania, is glaringly high. In 2008, Kilwa District statistics showed that the maternal mortality rate was 442 per 100,000 deaths.

This is despite the fact that the Kilwa municipal council allocates 40 percent of its budget to health, part of which is for addressing maternal mortality. According to Joanitha Mangosongo, the reproductive health coordinator at Kilwa Kivinje District Hospital, the money is largely spent on purchasing essential drugs for pregnant women and delivery kits.

But a lack of medication is not the reason for the high number of deaths in this region. In Kilwa District, unlike other parts of the country where most deaths occur in communities before mothers reach health facilities, over 90 percent of maternal deaths here occur at registered health facilities.

It is partially because health facilities have an acute shortage of skilled health workers, said Mangosongo. District statistics show that 80 percent of health staff is relatively unskilled.

“This affects almost all our efforts to fight maternal deaths. We are trying to provide on-the-job training and distance learning, but it is proving to be tough,” said Mangosongo.

Mbaruku believes that the solution to the high number of maternal deaths in Kilwa can only come after authorities acknowledge that there is a problem.

He told IPS that all districts have the same health budget and that Kilwa needs to formulate its own plan to combat the high maternal mortality before it asks for external support.

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

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

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

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

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

Cultural barriers

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

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

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

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

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

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

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

Education as the foundation

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

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

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

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

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

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

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

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

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

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

A family inside its home in Cannon Camp in Haiti. Credit: Susan Robens-Brannon/IPS

By Susan Robens-Brannon
PORT-AU-PRINCE, Jun 21 2012 (IPS)

In the remote, dusty and barren area of northern Port-au-Prince, Cannon Camp houses nearly 6,000 displaced Haitians in tiny and cramped spaces. Nestled among the smattering of tents is the home of a 50-something-year-old mother of 12.

The mother, who asked that her name not be used, was moved to the camp after she lost her small home after the earthquake in Haiti in January 2010. Her new home is a battered one-room tent extended by a partial tarp to make a second room.

Inside are two broken chairs, some blankets, a yellow laundry basket and a small charcoal grill. The hard-packed floor has been neatly swept thousands of times in the attempt to keep away dust so that the mother and her family can sleep and eat on the ground.

After the earthquake in 2010, international donations allowed the Haitian government to help displaced Haitians, with United Nations (U.N.) countries pledging a total of 9.9 billion dollars over three years. The money was to be deposited into the World Bank and distributed by the Interim Haiti Recovery Commission (IHRC).

But after a few years, the flow of money stopped. Unlike other camps, Cannon Camp is on government land, so navigating bureaucratic processes renders negotiating and providing assistance even more difficult for non-profit organisations. Many Haitians have been left to their own devices, forced to cobble together a hardscrabble existence under brutal conditions.

Life in Cannon Camp

Cannon camp has no running water and no electricity. Rarely cleaned, the camp’s toilets are small and cramped and dirty. The roads are terrible and there is no place to store food.

The mother’s 22-year-old daughter is propped up against a wall of the tent, sitting on the ground on a cotton sheet, in pain during her last trimester of pregnancy with twins. She already has two other children. Her three-year-old daughter sits at her feet with a runny nose and semi-watery eyes.

Another of the mother’s daughters, this one younger, stands against a pole inside the tent, holding a crying one-year-old. Sitting on the floor near the laundry basket is another daughter trying to find the energy to fold the clean clothes that are tucked inside.

Not all of the mother’s children live in the same tent. The pregnant daughter has her own tent nearby. The mother informs me that her pregnant daughter, who is unmarried, is going to have the baby at the camp because the hospital will not take her until her water is broken.

“The camp is owned by the Haitian government,” she begins when asked whether the camp had any medical assistance. “At first they supplied water, medical assistance, food, and schools.  However, today these services have stopped and we do not receive any assistance of any kind. All the non-profits left too; we are left on our own without any help.”

As a result, the families in the camp, living in an utterly impoverished environment, must spend their own resources on critical supplies and services. It costs about 200 Haitian dollars to have a baby in the hospital, the mother tells IPS. “I don’t have the money.”

“I have had 12 children,” she adds. “I know what to expect.”

If the daughter had the money to go to the hospital, it would be difficult for her to get there while in labor, after her water breaks. The camp’s tents seem to have been arranged randomly, without any consideration for the terrain, and her tent is located near the top of a hill, about a kilometer away from the camp’s exist. The way down is rugged, torturous either by car or on foot in the hot and dusty climate.

The makeshift roads are laden with potholes of all sizes. And even if the daughter could exit the camp and can reach the asphalt road, the hospital is located near the centre of Port-au-Prince. It could take her hours to get to the hospital, depending on traffic and the time of day.

Ultimately, there seem to be only two possible solutions. One is to come up with the money so the daughter can go to the hospital early. The other is to give birth in the tent.

Water shortages

Water is not easily accessible in the camp, as residents must walk down the same treacherous road to the outside of the walled camp to purchase non-potable water. The return journey is even more difficult with a five-gallon bucket of water.

Fortunately, the government has done a good job educating Haitians about water safety. It has become routine for them to add chlorine tablets to the water to make it potable, and it is hoped that the number of deaths from cholera will be greatly reduced this rainy season in July.

One non-profit installed a container that would hold drinking water, but it was only filled one time. “They never came back to refill it,” says the mother. Filling it costs 300 U.S. dollars, and given the number of people living in the camp, the water does not last long. In many camps, violence often breaks out over control of this critical resource.

A few residents have learnt to be economically creative, converting their tents into shops to resell water at a higher price. Others are selling rice, beans and other items to help earn an income and to make it easier for residents to gather items without having to travel outside of the camp.

In this camp, everyone must find his or her own creative way to earn an income. Many of the residents sit at the base of the camp and sell various items on the streets.

Asked what she thought the camp needed most, the mother replies, “I want a new home,” then pauses and adds, “How can I say what is the most important? Everything is important – just look around. All of us are going to be here for a very long time…maybe forever.”