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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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By Marcy Hersh
BEIRUT, Aug 19 2019 (IPS)

To mark World Humanitarian Day, we celebrate the overlooked women leaders who are first responders, unwavering advocates, and powerful change-makers in humanitarian emergencies.

Yet to truly power progress, we can’t stop at celebrating their efforts – we must also push for the support and investment women humanitarians need to continue their vital work.

Women Deliver spoke with Cecilia Chami, Programs Director for the Lebanon Family Planning Association for Development and Family Empowerment (LFPADE)  on what women-focused civil society organisations (CSOs) need to maximise their impact.

World Humanitarian Day also coincides with a special milestone for LFPADE: today, August 19, marks their 50th anniversary as the first and oldest family planning organisation in Lebanon.

Drawing from LFPADE’s five decades of experience, Chami highlights the power of women-focused CSOs, and what the world can do to help continue their vital work.

Excerpts from the interview:

HERSH: Women make up a large part of LFPADE’s team, including in leadership positions and as direct service providers. How does having strong women on your team help advance LFPADE’s work and mission?

CHAMI:  LFPADE works to empower women in all aspects of their lives to achieve gender equality – so having strong women on our team is essential. Women are the best experts on our lives, so we understand what women in our communities need, can relate to the challenges they face, and appreciate the quality of services they deserve.

 For example, we know from experience that access to family planning and sexual and reproductive health (SRH) services improves lives and futures of girls, women, and their whole communities. So, while these services might be sidelined in many traditional humanitarian responses, we prioritise a woman’s ability to control her fertility at the core of all our work.

 As women from Lebanon, we also know the contexts and entry points to deliver services most effectively. We work with anyone who influences the lives of girls and women – including boys, men, community leaders, and mothers-in-law – to help girls and women make more autonomous decisions about their lives and bodies. We are only able to form these partnerships because communities know us, trust us, and believe in us.

HERSH: What can the world do to better support women and women-focused organisations in humanitarian action?

CHAMI: International actors wield so much power in humanitarian action – and it’s time they share more of that power with women-focused CSOs.

First, international organisations must work hand-in-hand with women-focused CSOs as equal partners, designing programs together that really respond to the needs of girls and women in our communities.

Often, local and national organisations like LFPADE are only seen as implementing partners that can execute the projects envisioned by foreigners. We bring grassroots expertise and community voices to the table – so we must actually be engaged at the outset.

Resources are key to maximising our impact, too. We often rely on unreliable funding streams and short-term grants to sustain them, which makes it very hard for us to work. Long-term investment in women-focused CSOs is the fuel we need to achieve results that have a real impact.

HERSH: LFPADE has worked to provide SRH services to women throughout Lebanon for 50 years, including Palestinian and Syrian women. When you reflect on the organisation’s history, what have been some of the biggest successes and lessons learned?

CHAMI: The biggest success of LFPADE was pushing for the removal of regressive laws which forbade talking about family planning and contraceptives in Lebanon. By doing so, we made it possible for us – and other women-focused organisations across the country – to advocate for family planning and the sale of essential contraceptives. This also made it possible for the government ministries to begin to implement SRH programs nationwide.

Another success was our ability to mobilise quickly to ensure that refugee responses prioritise SRH services for all girls and women. We worked with the United Nations Relief and Work Agency for Palestinian Refugees (UNWRA) to provide their medical and paramedical staff with training on how to provide these services in their clinics.

Since 2013, we have also dedicated a large part of our efforts to meeting the needs of Syrian refugees who have fled from home – and to date have reached over 30,000 Syrian men, women, and children with SRH awareness campaigns and programs.

One big lesson learned throughout all these successes is that girls and women must be included in the design of all projects for them. When we take the time to speak with girls and women about their needs and challenges at the outset, we be sure to design programs to fit their realities.

HERSH: You work you do is often difficult and tiring – but you continue to be an inspiring change-maker in Lebanon. What motivates you to continue your important work as a Program Director for LFPADE, even during the most challenging times?

CHAMI: What motivates me to continue working is the impact our programs are achieving. When I meet and talk to girls and women, I see firsthand how our efforts improve their lives and the lives of their children.

One quote that will always stay with me comes from a woman who attended a course LFPADE runs on women’s leadership: “You gave us self-confidence and knowledge, and we know now that we too can make a difference.” When every woman in Lebanon realises their power to make a change, my job will be done.

Excerpt:

By Jo Baker
LONDON, Jan 7 2016 (IPS)

It is a grim fact that prisoners in most countries suffer from poorer health than non-prisoners, and that their right to health is not always protected. But for certain groups these rights can be even more elusive. Such is the case for women.

Jo Baker

For me, this was starkly illustrated during a visit to the clinic of a large women’s jail in the southern Philippines. Here, a very thin woman lay curled and still on a narrow wooden bench. Her hands were cradling her taut, bloated stomach, her eyes tightly closed. The nurse explained that she was an addict, arrested while heavily pregnant for drug possession (a sentence that keeps the country’s women’s jails lamentably stocked), and that her baby had died days earlier in a government hospital because of a condition related to her drug use, after a complicated labour. Being understaffed and short on medicine and beds in the prison, the best treatment she could offer the woman on her return, as she faced her withdrawal, post-labour pain, grief, separation from family, and possible years awaiting trial, were paracetamol, kind words and a bench. Hers would be a particular and gendered kind of purgatory.

In speaking with imprisoned women and healthcare practitioners across five countries, our research team commonly found harmful responses and barriers to healthcare that existed because the inmates were women. These included women who were imprisoned in Jordan while recovering from brutal gender-based violence (including honour crimes and rape), without adequate treatment or rehabilitation; women who prepared for and recovered from childbirth in dirty rooms with little more than substandard prison rations, water and soap; and women who were isolated and punished because of attempts to self-harm or commit suicide. “One girl used the edge of a seafood shell on her wrists,” recounted an inmate in the Philippines. “They scolded her. If you want to die, go ahead, do it now!”

These responses are of course unlikely to be particular only to these countries.

International standards (including the Bangkok Rules) now recognize that because women commonly face certain risk factors and backgrounds, they require a gender-specific framework for healthcare. More women than men suffer from particular diseases, including HIV, hepatitis and some cancers. They have differing sexual and reproductive health (SRH) needs, including those relating for example, to birth, abortion and the menopause. They are more susceptible to particular mental health problems. Studies have found self-harm in prison to be up to ten times higher among women than among men, and suicide to also be proportionally higher. This list goes on.

Women (especially those in conflict with the law) are also, crucially, more likely to have been victims of sustained gender-based violence and sexual abuse. Yet prisons, which are increasingly taking in women, are rarely equipped to respond to these forms of trauma. As I was told quietly by one prison healthcare worker, gesturing to a courtyard of around 20 women. “Almost all the women here are mothers, and a lot have maltreatment and molestation in their histories. I can look around and count more than ten women who have been raped. Some have been prostituted by their families. Then drug use comes in and makes it a vicious cycle.”

These and other cultural factors lead to a different sense of shame, which can also work as a barrier to healthcare. For example inmates in Jordan, Zambia and the Philippines told me that they often avoided reporting urinary tract infections and SRH problems to male health staff. Yet some prisons for women don’t employ female doctors, and these issues remain unrecognized, and sometimes debilitating.

My research findings with DIGNITY (see our comparative study here) therefore stress the urgent need for every prison and place of detention to follow a framework for healthcare that is gender-responsive and trauma-informed – one that treats women’s specific health needs, and trains staff accordingly. In just a few facilities did we find gestures towards this.

But not all gender-sensitive health responses are medical. The traditional prison model – designed as a harsh criminal justice response to violent men – remains the basis for many institutions detaining groups that are neither violent, nor male. In the facilities where women told me of harsh disciplinary structures, negative relationships between staff and inmates, and their isolation from caring relationships, they tended to report very low morale, forms of depression, and other signs of serious struggle, such as self harm and hunger strike. This was markedly different in facilities (such the one described here in Albania) that connected the women with the outside community – particularly their children – and gave them tools to cope, learn, communicate and prepare for the future.

Meanwhile, exercise is known to be important to health and morale, and is a right of prisoners under international law (see the Mandela Rules). Yet only in one of five countries, the Philippines, were detained women encouraged and able to exercise every day. In the other countries, exercise and sports facilities of some kind were common only in prisons for men.

Many of our findings on health fell in line with those observed by the former UN Special Rapporteur on Violence Against Women in her 2013 report on women’s incarceration, and they indicated clear and harmful examples of discrimination. Yet in reviewing issues raised by UN treaty body reports, we found women’s health to largely be a gap: UN experts are not giving this area consideration.

The human rights of these women entitle them to better, and must be championed, internationally and in their own countries. As once said by Dostoevsky, society must be judged by the way that it treats its prisoners. Or rather, and as told to me by one mother and survivor of domestic violence, sentenced to life in a Zambian prison: “If you’ve offended, certain things you must accept. But I don’t deserve to pass through some of these things. I came to prison healthy. I’m not intending to leave sick.”

(End)

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