In honor of Mother’s Day, the Gender-Based Violence Task Force of the Interagency Gender Working Group (IGWG) held a May 10th event on “Maternal Health and Gender-Based Violence: Research on and Responses to Service Provider Abuse in Childbirth and Intimate Partner Violence During Pregnancy” at the National Press Club in Washington, DC. The event featured two panels; the first was an overview of Intimate Partner Violence (IPV) during pregnancy and of service provider abuse during labor and delivery, and the second panel focused on ongoing interventions and approaches to the issue.
Presenters on the first panel included Sunita Kishor of ICF International, Diana Bowser of the Harvard School of Public Health, and Neal Brandes of USAID’s Office of Health, Infectious Diseases, and Nutrition. Attendees learned the results of studies on IPV or caregiver abuse during labor and delivery. Providing a base of qualitative and quantitative data, the individual panelists were able to convey the prevalence and urgency of such frequently overlooked issues.
The second panel consisted of Michele Kiely of the National Institutes of Health, Kristin Savard of the White Ribbon Alliance, Nancy Termini of the Population Council, and Ariel Frisancho of CARE Peru. The presenters provided snapshots into current programs geared toward stopping and preventing IPV and abuse during labor and delivery, which included a mix of awareness campaigns and interventions.
Presentations and more information on the event are available on the IGWG website.
Check out a short video of the event with reflections from some of the presenters:
One area that has seen tremendous growth is Nairobi’s largest slum, Kibera. While experts have given estimates ranging from 270,000 to 2 million residents, Kibera is a large area of informal settlements plagued by challenges such as the lack of electricity, job opportunities, and high levels of violence.
While it may be easier to focus on what is lacking in Kibera, there are also many services being provided in the community including affordable and quality reproductive health care by organizations such as Marie Stopes Kenya.
Marie Stopes Kenya was established in Kenya in 1985 as a locally registered nongovernmental organization. It is Kenya’s largest and most specialized sexual reproductive health and family planning organization and is known for providing a wide range of high-quality, affordable, and client-centered services to men, women, and youth throughout Kenya. In 1997, Marie Stopes Kenya opened its first clinic in Kibera and began offering reproductive health services at an affordable rate for residents.
During a visit to the clinic, I had the honor of interviewing the Kibera Clinic Manager, Pamela Warinda. Pamela is a nurse and midwife by training and has been working with Marie Stopes since 1995. She began managing the clinic in Kibera in September, 2010.
by Mia Foreman, policy analyst, International Programs
Kibera, located 5 km from the city center of Nairobi, has been called Africa’s second-largest slum with estimates of around 200,000 to 270,000 residents. Kibera has many challenges, including lack of employment, electricity, proper sanitation, and housing, and high rates of drug use and violence — especially rape. The lack of employment and education are among the biggest contributing factors to the cycle of poverty with many young people surviving through illegal activities, such as prostitution or drug dealing.
Although there are many hardships, every day local citizens are making a difference in this community. I was fortunate enough to spend time with two young ladies, ages 20 and 22, who are doing just that as members of the community-based organization Kibera Hamlet.
Kibera Hamlet was founded in 2004 by youth in Kibera and currently serves more than 150 adolescents and children from the area, 65 percent of whom are orphans and 10 percent of whom are HIV positive. The organization is involved in many activities including The Girls Empowerment Project. The overall goal of the project is to empower young girls to change their lives and decide for themselves what they want their future to look like.
The Girls Empowerment Project was created to bring together young girls to discuss the daily challenges of living in Kibera, such as early marriage, unsafe abortion, pregnancy, and female genital mutilation. The average situation for a girl growing up in Kibera is quite dire. If she is still single at a young age, chances are her family will send her out to look for money to help with the cost of living. Most of the time, this means prostitution. A girl will sleep with a man for 50 Kenya shillings (KSH), less than one U.S. dollar. This is not enough to put food on the table so she will need to sleep with four to five men a day to make enough money to bring back to her family. If she asks the man to use a condom, the price goes down so most girls don’t use condoms.
by Amanda Roach, program assistant, International Programs
At the March 7, 2012 event “A New Century: African Women, Health and the Future of Development,” Dr. Daniel Singer, Director for Global Health Research and International Activities at National Institutes of Health remarked, “Public health is like sex. Thinking about it and talking about it is not the same as doing it.” Those in attendance at the Africare-sponsored event shared his sentiment that more work is needed to implement women’s health initiatives in Africa.
On the eve of the 101st International Women’s Day, Africare, in partnership with the United Nations Foundation and Global Health and Diplomacy, assembled a panel of advocates to discuss the state of women’s health in sub-Saharan Africa. Dr. Singer was joined by an impressive list of women’s health and development supporters including: Kathy Calvin, CEO, United Nations Foundation; U.S. Congresswoman Karen Bass of the House Subcommittee on Africa, Global Health and Human Rights; Ambassador Amina Salum Ali, African Union Ambassador to the U.S.; and Ambassador Mwanaidi S. Maajar, United Republic of Tanzania Ambassador to the U.S. The prevailing theme was how to best move forward the women’s health agenda in Africa.
Current statistics show it is very unlikely that sub-Saharan Africa will reach its target for UN Millennium Development Goal (MDG) 5, which aims to reduce the maternal mortality ratio by three quarters between 1990 and 2015, and achieve universal access to reproductive health by 2015. Though progress has been made in the majority of African nations, many countries in sub-Saharan Africa still report low rates of births attended by skilled professionals as well as high rates of maternal mortality and lifetime chances of women dying from maternal causes. In Ethiopia only 6 percent of births are attended by skilled professionals, only 14 percent in Chad, and 46 percent in sub-Saharan Africa as a whole. In Chad and Somalia, 1,200 out of every 100,000 women die while giving birth, nearly twice the ratio in all of sub-Saharan Africa. Comparatively, while there is a 1 in 3,600 chance a woman will die from maternal causes in the developed world, sub-Saharan women face a ghastly 1 in 31 chance of dying from such causes. (Data from PRB’s 2011 World’s Women and Girls Data Sheet)
The abortion of female fetuses in India following a sex determination test, such as ultrasound, has gained worldwide attention. The preference for male children is quite evident in the sex ratio (SRB) at birth as reported in the Sample Registration System (SRS) of the office of the Registrar General of India (RGI). The SRS is a monthly survey of about 1.5 million households inquiring about the number of births, deaths, and infant deaths. As in any survey, errors in reporting undoubtedly occur but the SRS is a remarkable source of demographic information for a developing country. The latest survey data on the sex ratio at birth has been released for the 2007-2009 period. Three-year periods are given by the RGI to smooth out year-to-year fluctuations in reported vital events.
The three graphs below show the SRB for 16 states with the largest population, beginning with 1999-2001, the first period for which data were published. India publishes SRB data the reverse of most other countries, female births per 1,000 male births. Globally, the normal biological SRB is 5 percent more male than female births. So, in India, about 950 female per 1,000 male births would be considered normal (as in, absent any sex-selective abortion). The first graph is for the poorest-performing states, the second for those in the middle, and the third for the best-performing states. (Click on each graph for a full-size version)
Secretary of State Hillary Clinton hosted the first-ever event at the State Department to commemorate Zero Tolerance to Female Genital Mutilation/Cutting (FGM/C) Day on Feb. 16. Guest speakers and a panel of experts included Congressman Joseph Crowley (who has co-sponsored the “Girls Protection Act of 2011” that would make it a crime to transport girls overseas for FGM/C), and representatives from NGOs, Islamic organizations, and the UN who have worked on ending FGM/C.
State Department photo by Michael Gross.
At the Fourth World Conference on Women in Beijing in 1995, Clinton, then-U.S. First Lady, proclaimed that FGM/C is a violation of human rights. Human rights are women’s rights, and that women’s rights are human rights, she said. Since then, there has been significant global progress in the movement to stop this harmful practice that has affected between 100 million to 140 million girls worldwide, with negative physical and mental health effects. Much more attention is being paid to the harmful effects and the magnitude of the practice, from the international level down to small villages. To date, 18 African countries have outlawed the practice of FGM/C.
Clinton recalled visiting a village in Senegal in 1997 and seeing how progress can be made firsthand. The village elders had been thinking of the detrimental health and quality of life effects of FGM/C on their daughters and they decided the practice had to end, despite generations of tradition. Tostan worked with the community to put the emphasis of this social change on democracy and ensuring participation. Imams explicitly argued that there was no religious basis for FGM/C. The key, according to Clinton, was that there was no finger pointing; no one came from the outside to enforce a change of tradition. PRB’s Women’s Edition journalists learned the same lessons in their field visit to two villages in Senegal where Tostan has worked to further education and knowledge about democracy and human rights. This visit, during the recent International Conference on Family Planning, highlighted the gains that have been made in the empowerment of girls, the end of harmful traditional practices, and economic advances throughout the villages (see the slideshow below).
In Guinea, a woman receives training in problem-solving skills as part of USAID-supported efforts to encourage communities to abandon female genital mutilation. Photo Credit: Elizabeth Fakan, USAID
by Sandra Jordan, Communication and Outreach Advisor, USAID Bureau for Global Health
Today is the International Day of Zero Tolerance for Female Genital Mutilation and Cutting (FGM/C). Worldwide, 100 to 145 million women have been subjected to this practice, which can range from nicking the skin to a total removal of the external female genitalia. Every day, 6,000 girls are at risk.
Zero Tolerance Day is an opportunity to raise awareness about the harmful effects of FGM/C and unite communities around the world in calling for an end to the practice. FGM/C is practiced across cultures and religions—though notably, major religious doctrines do not mandate the practice. It is most common in Africa, the Middle East, and some countries in Asia. However, it also can be found in the United States, Europe, and other places where migrants bring their cultural traditions with them. Parents and communities practice FGM/C based on cultural beliefs about health, hygiene, and women’s sexuality. In many cases, it is considered a traditional rite of passage.
However, research has consistently shown that all forms of the practice harm women’s health. It causes serious pain, trauma, and frequently severe physical complications such as bleeding, infections, or even death. In the long term, it can also lead to recurrent infections, infertility, and difficult or dangerous childbirth that threatens the lives of both mother and infant.
A young mother lies with her newborn child. Photo Credit: UNFPA
by Mary Ellen Stanton, CNM, USAID Senior Maternal Health Advisor
When I started midwifery training decades ago in the United States, in the hospital where I worked, I first saw evidence of disrespect and abuse of women in labor. Women were separated from families and visitors from admission to discharge four days later and, in the second and third stages of labor, their legs were secured by stirrups and their wrists put in leather restraints. Soon after, I worked in West Africa in a government maternity and witnessed women being verbally abused — “if you don’t push and your baby is born dead, it will be your fault” – and physically abused by slapping and massive fundal pressure to force delivery. Women were ridiculed for making too much noise in labor — and then were chastised if they were silent and delivered alone.
Fast forward decades later. As I visit maternity services in a number of countries, I don’t need to look far to see and hear evidence of disrespect and abuse of women in childbirth. A convulsing woman in labor on the steps of an urban referral hospital turned away from because she cannot pay. A doctor who derides poor women for not using family planning to control their fertility. A nurse who tells me that postpartum mothers “sneak in” to see their hospitalized newborns at night, while the families seek to find funds to pay the bills in order to get their newborns discharged. Unclothed women laboring and giving birth as visitors walk by. A researcher who tells of a postpartum mother being detained for months because she could not pay her bill. The human rights worker who tells me that refugee women are discriminated against in childbirth and that one refugee was forced to keep her stillborn in her bed with her for 24 hours against her will.
In an essay in the Sunday, Oct. 23 New York Times, Helen Epstein asks, “Could a ‘contraceptive talking cure’ work in Africa in our own century?” With this question, Epstein zeroes in on a critical aspect of successful family planning: communication between spouses.
As she goes on to note, researchers have long known that open communication between husbands and wives is positively and strongly associated with contraceptive use. Unfortunately, the presumption that men are the decision-makers and the taboo nature of sex means that most African couples do not frequently engage in frank discussions about family planning. Women may be afraid to raise the issue with their husband, assuming that he is opposed to contraception, while men may lack information about contraceptive methods and the benefits of family planning. This absence of communication is not only an impediment to contraceptive uptake, it is also a missed opportunity for increasing gender equity.
Empowering women to make decisions about family planning often means involving men as partners. Constructive men’s engagement is an approach that increases men’s support for women’s sexual and reproductive health, promotes gender equity, and improves the reproductive health of men as well as women. Reproductive health and family planning programs that seek to constructively engage men by fostering open communication and joint decision-making between spouses not only increase contraceptive use but also promote equality within the relationship and increase women’s decision-making power overall.
by Farahnaz Zahidi Moazzam, PRB Women’s Edition Journalist
My name is Farahnaz Zahidi Moazzam, and I’m a freelance journalist, writer, and editor from Pakistan. My passion is writing about human rights with a special focus on gender issues and reproductive health. Blogging is a personal joy to me, as I put my heart into my writing and blogging allows for a more personalized style. Digital journalism is a sign of evolution – one I happily accept. My pet peeve is marginalization on any grounds. I am a mother of a teenage daughter and live in Karachi.
As part of PRB’s group of journalists in Women’s Edition 2010-2012, I recently had the chance to travel to Ethiopia on a visit that was unforgettable. The visit inspired a series of seven brief travel-blogs, based on my seven days there. Women’s Edition is a wonderful opportunity to connect with other like-minded female journalists from developing countries around the world, and learn solutions to the problems from this interaction. The program has reaffirmed my belief that our commonalities are more than the differences.
Read Farahnaz Zahidi Moazzam’s posts from her trip to Ethiopia on her blog,Impassioned Ramblings.
