Showing posts from category Dot-Mom.
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Kate Gilles and Marissa Pine Yeakey, Behind the Numbers
World Contraception Day
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The original version of this article, by Kate Gilles and Marissa Pine Yeakey, appeared on the Population Reference Bureau’s Behind the Numbers blog.
World Contraception Day “centers around a vision for a world where every pregnancy is wanted,” with a goal of enabling “young people to make informed choices on their sexual and reproductive health.”
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The Challenges and Benefits of Addressing Young Adolescent Reproductive Health
›There are 1.2 billion adolescents (ages 10 to 19) in the world today, accounting for 17 percent of the global population. They are the largest youth cohort in history, and 90 percent live in the developing world. Within that broad age group, very young adolescents (ages 10 to 14) often fall through the cracks of international development work, especially when it comes to health, and reproductive health in particular.
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Taking On Domestic Violence in Post-Conflict Liberia
›Liberia is a case study in post-conflict violence against women, said panelists at the Wilson Center on July 24. “Confined merely to performing household chores and childrearing duties, from early childhood, women and girls have been socialized into subservience and powerlessness and acceptance of domestic abuse as a norm,” Annette Kiawu, deputy minister for research and technical services at the Liberian Ministry of Gender and Development, told the audience. [Video Below]
Kiawu was joined by Pamela Shifman of the Novo Foundation and Esther Karnley and Elisabeth Roesch of the International Rescue Committee (IRC). They discussed the prevalence of domestic violence in Liberia after the 14-year civil war, which ended in 2003.
Violence Stemming from Changing Norms
Kiawu pointed to women’s changing roles in Liberia as a source of household tension. She noted that women are increasingly “demanding a greater role in household decision making,” which some men see as “encroachment on their sphere of influence.”
“According to the LDHS [Liberia Demographic and Health Survey], the persistence of domestic violence is directly linked to the increased status of women on the one hand and men’s [perception] of loss of power and authority on the other,” she said. Some men’s urge to assert dominance is exacerbated by higher levels of alcohol abuse and a tendency towards violence learned during the civil war.
There has been legislation against gender-based violence – including the Rape Amendment Act, also known as the “revised rape law,” the Revised Gender-Based Violence Action Plan, and the African Union Protocol – as well as action plans and community-based groups meant to decrease the rate of domestic violence, like the Gender-Based Violence Network, an initiative designed to increase community ownership of domestic violence issues and improve response at the grassroots level. But despite these advances, Kiawu stressed that there still is a long way to go, saying that increased funding and coordination between domestic and international agencies and the Liberian government is necessary to have a real impact on the lives of the “countless women” whose lives are threatened by domestic violence.
Making Reality Match Rhetoric
Pamela Shifman agreed that domestic violence prevention programs need more funding. “So often in conflict-affected settings we hear that we need to address other issues first…that domestic violence is a back-burner issue,” she said. Domestic violence is often perceived to be “not that serious” when compared to other issues in conflict-prone and post-conflict countries.
But Shifman argued that divorcing domestic violence from other types of violence is problematic. “Violence in the home normalizes violence in the street, normalizes violence in the community, and normalizes violence by the state,” she said.
NoVo is one of the few private organizations which prioritizes domestic violence and gender equity, Shifman said, but she asserted that all humanitarian organizations should devote time and money to these issues, saying that “if we ignore domestic violence, all of the other investments we make to improve the quality of life for communities will suffer.”
Empowering women can have significant results for the whole community. Shifman remarked that “investing in women is smart economics,” citing studies which suggest directing funds towards women “pays off at huge levels” for women’s families and communities. But when women experience violence, “their potential is thwarted,” she said. “They suffer, their families suffer, their community suffers, the entire nation suffers.”
Programs targeting domestic violence need greater awareness, more long-term commitment, and more funding, she said. “We don’t expect that violence is going to end overnight – no deep-seated social problem will be solved that quickly,” she said. “In order to make a dent in improving the lives of girls and women and ending violence against girls and women, we need more direct funding” from private and public sources.
“To put it bluntly, I think the reality needs to match the rhetoric,” Shifman concluded.
Perspectives from the Field: Social Isolation
Esther Karnley described the results of interviews conducted with Liberian women, both survivors of domestic violence and fellow community members. She found that a key reason women stay in abusive relationships is financial dependence. “Most of them said, ‘it’s because we depend on the men for everything… we don’t have any money, we are not empowered financially, we depend on the men for everything. Because of that, we remain in that relationship and we get killed.’”
She added that social isolation means that many women lack the resources to leave a relationship. “We are isolated socially, we don’t have access to services, we are all by ourselves,” they told her. Without support from friends, relatives, or organizations, it can be difficult to find the means to relocate.
Part of the problem in Liberia is the prevalence of informal education, especially Sande bush schools – schools run by a traditional women’s society designed to prepare girls for marriage, teaching them traditional housekeeping methods and culminating in female circumcision. Girls leave home to attend these traditional schools for several months, which severely curtails their access to formal education. Kiawu reported that “over 60 percent of girls attending Sande school drop out of regular school.” This means that “successive generations of young children, especially young girls, are expected to forgo formal education in favor of attending the Sande school.”
In addition to formal education, Karnley said financial empowerment and legislation holding perpetrators of domestic violence accountable for their actions would enable more women to leave abusive relationships.
Reaching Both Women and Men
Each of the panelists recognized that working against domestic violence requires comprehensive societal reforms. Karnley stressed that the impetus to begin working with men came from Liberian women. “Initially when we started working on GBV issues, we talked to women, and then the women came and said, ‘OK, you talk to us every day, and when we go home, we go and meet fire. Can you also talk to our men?’” In response, the IRC developed a 16-week program designed to change men’s behavior and views about violence and relationships. Karnley also mentioned a desire to reach out to the religious community to change the constant focus on the man as the head of a relationship to one based on love.
The Liberian government is also working with churches and mosques to change norms that encourage the subjugation of women, including work with a network of religious leaders known as Christian/Muslim United against SGBV (sexual and gender based violence). Kiawu said this organization emphasizes partnership within a marriage and teaching equality to children in the home. The panelists also mentioned additional efforts to increase the responsiveness and sensitivity of the police and judicial system to domestic violence issues, as well as the need for resources like safe houses to provide relief to survivors.
“The family, far from being off limits, has to be a priority for us in the humanitarian community as we help to rebuild nations where peace not only exists between nations, and among nations, and among communities, but among families,” Shifman contended. Kiawu agreed, adding that without interventions, violence and isolation prevent women “from taking advantage of opportunities that peace presents.”
Event Resources: Photo Credit: A woman prays during a Sunday morning service in Monrovia, courtesy of Bruce Strong/Newhouse School. -
‘Motherland Afghanistan’ Shows Maternal Mortality Not Just A Health Issue
›Afghanistan has one of the highest rates of maternal mortality in the world: 327 out of every 100,000 women who give birth die during childbirth. Despite some recent improvements, political, social, cultural, and economic factors present enormous challenges. Last month, the Center for Population and Development Activities hosted an online viewing and dialogue discussion of the PBS Independent Lens film Motherland Afghanistan, which follows Afghan-American filmmaker Sedika Mojadidi and her father, Dr. Qudrat Mojadid, as they return to their home country and visit the Laura Bush Maternity Ward in Kabul. The conditions they find are devastating and underscore not only the need for greater commitment to reproductive health services, but also the advancement of women’s and girl’s access to education, security, and political participation.
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Adenike Esiet: Building Support for Improving Adolescent Sexual and Reproductive Health in Nigeria
›“In Nigeria, young people under the age of 25 are driving the HIV epidemic…and that’s been the opening place for people to begin to say, ‘let’s address the issues of young people’s sexual and reproductive health,’” said Adenike Esiet, executive director of Action Health Incorporated in Lagos, during an interview with ECSP.
On any number of health indicators, girls suffer disproportionately. “For every one boy in the age bracket of 10 to 24 who is HIV positive, there are three girls who are HIV positive,” Esiet said. “Over 60 percent of cases of complications from unsafe abortion reported in Nigerian hospitals are amongst adolescent girls. In fact in literature, 10-15 years ago, this was described as ‘a schoolgirl’s problem’…and it’s still an ongoing problem.” She added: “And for girls too, the issue of sexual violence is huge. It goes largely unreported but it’s occurring at epidemic levels.”
Esiet spoke on an adolescent health panel during the April 25 “Nigeria Beyond the Headlines” event at the Wilson Center. Progress is slow on these issues, in large part because “there’s a whole lot of silence about acknowledging young people’s sexuality,” she said.
Adults “want to believe [adolescents] shouldn’t be sexually active.” But turning a blind eye to adolescent sexuality can mean that efforts “to provide access to education or services is hugely resisted by practitioners who should be doing this.”
Action Health works to fill the gap that emerges. “Our work covers advocacy, community outreach, and service provision for young people,” said Esiet.
“Our primary entry road in to work with young people is creating access to sexuality education and youth friendly services. And in the course of trying to do that, we have to do a whole lot of advocacy with government and also with ministries or education and ministries of health and youth development.”
The group has worked with government officials and agencies to establish a nationwide HIV education curriculum and paired with local healthcare providers to increase access to “youth-friendly” sexual and reproductive health services. Funding shortages and insufficient resources have hampered the curriculum’s success, though, and the pervasive attitude against youth sexuality has limited the reach of services, she said. Ultimately, “there are a whole range of issues that truly need to be addressed” for outreach efforts to be successful.
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Learning From Success: Ministers of Health Discuss Accelerating Progress in Maternal Survival
›“The gains we have made [in reducing maternal mortality rates] are remarkable; however, gains are fragile and donor resources are declining. Substantial investments must be maintained to safeguard these hard-wins,” said Afghan Minister of Health Suraya Dail at the Wilson Center on April 23. [Video Below]
As part of the Wilson Center’s Global Health Initiative, the Advancing Dialogue to Improve Maternal Health series partnered with the U.S. Agency for International Development to co-host Minister Dail, along with Honorable Dr. Mam Bunheng, Minister of Health, Cambodia; Honorable Dr. Bautista Rojas Gómez, Minister of Health, Dominican Republic; and Dr. Fidele Ngabo, Director of Maternal and Child Health, Ministry of Health, Rwanda.
These ministers spoke about the lessons learned in countries where there has been tremendous progress under challenging circumstances.
In the Dominican Republic, Bautista Rojas Gomez said the first challenge was to address the “Dominican paradox,” where maternal mortality rates were high despite the fact that 97 percent of women received prenatal care and delivered in hospitals. The government created a zero tolerance policy that included a comprehensive surveillance system, mandatory maternal death audits, and community oversight of services, which assured better quality services.
Similar political commitment improved indicators in Cambodia, where maternal mortality rates dropped from 472 to 206 per year from 2005 to 2010. “It takes a village…and the prime minister has inspired the country to act,” said Mam Bunheng. Through increased access to contraception the number of children per woman went from seven to three and commitment to family planning, education, technology, infrastructure, and community have been the key drivers of success.
“In Rwanda, the big challenge we are having is education,” said Fidele Ngabo. “Many of the maternal health indicators depend on education.” When women and girls are educated they are twice as likely to utilize modern contraception. The efforts of Rwanda’s government have been instrumental in facilitating positive change, he said, particularly the efforts of First Lady Jeannette Kagame, who he called a “champion” for women and girl’s health.
As witnessed throughout the Advancing Dialogue to Improve Maternal Health series – and reiterated by the ministers of health – the interventions to improve maternal mortality rates exist, what’s left is to generate the needed political willpower.
Event Resources
Photo Credit: David Hawxhurst/Wilson Center. -
Nabeela Ali on How PAIMAN Is Improving Maternal Health in Pakistan
›“Maternal mortality is a very complex thing – it’s not just patient-doctor relationships, it has so much to do with behaviors, with communities, with the household, with family members,” said Nabeela Ali, chief of party for the Pakistan Initiative for Mothers and Newborns (PAIMAN), which received USAID maternal and child health funding from 2004 to 2010.
Pakistan is the world’s sixth most populous country, yet has long held one of the world’s highest maternal mortality rates. Ali spoke at the Wilson Center last fall about strategies to better engage faith-based organizations on maternal and child health issues. In this interview with ECSP, she stressed that despite Pakistan’s very religious society, these interventions are possible with the right messaging.
PAIMAN aims to reach vulnerable and isolated groups, including poor, rural, or conservative women. “The areas where no one can reach [are] where we targeted,” Ali said.
In these areas, ulama – influential religious leaders and scholars – are highly trusted. “It was not a one-size-fits-all strategy,” Ali emphasized. “Religious leaders are not technical people, but they are experts in their own field. You have to approach them with trust and respect.”
“The first step is establishing rapport with them; then they listen to you,” said Ali. This is best done through another alim, not a technical person. Those ulama that were approachable proved to be valuable allies in the promotion of maternal health. PAIMAN has reached over 35 million people in Pakistan over its now eight-year run.
Projects like PAIMAN are necessary in areas of the world where religious leaders are the most respected community authorities. In Pakistan, Ali believes that now that this strategy has been demonstrated to be viable, the government should help bring it to scale. An NGO-funded project ends, but a government-funded program has much more continuity, which in turn helps build trust with local leaders, she said.
Sources: UN Population Division. -
Kavita Ramdas: Why Educating Girls Is Not Enough
›“I’m a big proponent of girl’s education. I believe that it’s a very important and a very valuable human rights obligation that all countries should be meeting,” said Kavita Ramdas, executive director for programs on social entrepreneurship at Stanford University, at the Wilson Center. However, “in the past seven to eight years we have found ourselves in a situation where there’s kind of an enchantment with girl’s education, as though it were the new microenterprise magic bullet to solve everything from poverty, to malnourishment, to inequality.”
“The outcomes that we ascribe to girl’s education…are not anything that I would argue with,” she said, yet, this enchantment “has happened simultaneously with a significant drop in both funding and support for strategies that give girls and women access to reproductive health and choices, particularly family planning.”
This is a problem, said Ramdas, because we cannot rely on education alone to do all the heavy lifting required to empower women.
“I think it’s important for us to recognize that there are societies where girls and women have achieved significantly high levels of education in which gender inequality remains,” she said, “for example, places like Japan and Saudi Arabia, where you have high per capita income, high levels of education, and yet…where women and girls are still marginalized and on the edges in terms of decision making.”
“I don’t think we have to wait for one to be able to do the other,” she said. “As we support programs for girls’ education, we also need to demand that those programs be buttressed by strong programs in adolescent health, strong programs in sex education, strong programs that actually provide girls and women with access to family planning and contraception.”
