Showing posts from category maternal health.
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Interview With Wilson Center Scholar Margaret Wamuyu Muthee: Envisioning a New Future for Kenya’s Next Generation
›July 29, 2010 // By Wilson Center StaffYouth in sub-Saharan Africa constitute a large and growing portion of the region’s population, yet remain underserved by family planning and reproductive health programs. New Security Beat recently interviewed Margaret Wamuyu Muthee, an Africa Program Scholar at the Woodrow Wilson Center, about this problem. Muthee is currently working on a project documenting both the opportunities and challenges for young people growing up in Kenya.
New Security Beat: How do you define youth?Margaret Wamuyu Muthee: The African Union has defined youth as every person between the ages of 15 to 35 years, while the United Nations defines youth as persons between the ages of 15 and 24. I will be concentrating on the age group defined by the African Union.
NSB: What are some opportunities and challenges facing youth in Kenya?
However, I will not only be relying on age. There are other aspects that I must take into consideration. Many children assume the roles of an adult or a care-taker when they are at an early age. Children in African nations face different challenges [compared to children in Western countries], as there are fewer opportunities for transition in Africa.MWM: This is a very important stage for exposing youth to the available support and teaching them about the social economy. Some of the difficulties lie in the lack of resources and corruption, such as misuse of funds that are provided to the government by outside sources.
NSB: Which programs are taking actions to empower youth in Kenya?
On a more positive outlook, youth are very resilient. They have a wide range of potential and capacity that can be utilized right away. African nations, just like China, have an enormous population that can be a human resource. All we have to do is positively tap into their potential to make good changes.MWM: The Youth Enterprise Development Fund (YEDF) works to increase economic opportunities for Kenyan youth in nation-building through enterprise development. YEDF also works to lower the unemployment rate and teach certain skills for future employment. One downside of this fund is that even though it provides money, it does not provide mentorship for the youth who execute the programs.
NSB: Are these programs enough to address youth challenges?
Another program is Yes Youth Can! This $45 million initiative was created by the U.S. ambassador to Kenya and USAID. The program is designed to create local and national networks of youth leaders to advocate peaceful economic and governmental reforms. The wonderful thing about this organization is that it is completely youth-driven.MWM: Sometimes these programs are seen as too small and too late. Youth are seen as violent, and these programs are made to keep them busy. Programs need to address all the facts, from start to finish.
NSB: Are there programs specifically targeted at female youth?MWM: We need programs that address pregnancies, HIV/AIDS, and education for young women. These education programs not only need to teach them about pregnancies and HIV/AIDS, but also educate women about their rights: how to say “no” and object to certain actions.
NSB: Are family planning and reproductive health incorporated into youth education?
However, there are complications when it comes to female rights. There are sexual offense laws that females do not even know about. The implementation of these laws can be non-existent. Either the police system is flawed or accessing lawyers is too expensive for females. And even if a lawyer is hired, the rapist can pay off a judge, so the judge will not convict him.MWM: There are already reproductive health campaigns in Kenya. One example is the ABC program: Abstinence, Be faithful, Condom use. Everyone these days, in rural and urban environments, knows about HIV/AIDS. There needs to be more programs regarding family planning and health; there is only a limited amount of knowledge getting passed around about those two issues.
Margaret Wamuyu Muthee is the Programs Manager for Kenya’s University of Nairobi Center for Human Rights and Peace, and a current scholar in the Woodrow Wilson Center’s Africa Program.
There is a new proposed Kenyan constitution that bans abortion unless a doctor permits the abortion due to health reasons, or if the mother’s health is in critical danger. Many females die because they cannot legally get an abortion and try to abort their baby on their own, or accept services from a backstreet clinic.
We also have cultural practices that put up barriers to the spread of family planning and health. One such example is the practice of early female marriages. Girls as young as 10 years old will be forced to marry a much older man. These girls have not had proper education on reproductive health or family planning.
In addition, adults are still too shy to address youth that are having sex, and are embarrassed to talk about their health if they have HIV/AIDS. We need to educate more youth and provide the means for them to live safer lives.
Josephine Kim and Marie Hokenson are cadets at the United States Military Academy at West Point and interns with the Woodrow Wilson Center’s Environmental Change and Security Program.
Photo Credit: “The Mentees and their mentors,” used courtesy of flickr user The Advocacy Project. -
Addressing Gender-Based Violence to Curb HIV
›July 28, 2010 // By Marie HokensonAt the recent International AIDS Conference in Vienna, Austria, an astonishing development in the campaign to stem the spread of HIV/AIDS was unveiled—a microbicide with the ability to reduce the risk of transmission of HIV. This welcome development coincides with an intensified focus on women’s health and security needs among donors, especially the United States.
At the conference, the “Gender Programming and Practices: Practical Approaches with HIV and AIDS” session took an integrated approach, examining the links between gender-based violence and HIV/AIDS infection. Women are more vulnerable to gender-based violence and HIV infection than men, particularly in parts of sub-Saharan Africa where “girls and women aged 15 to 19 are three times more likely” to become infected with HIV than men in the same age group, according to the World Bank.
Michelle Moloney-Kitts, with the Office of the U.S. Global AIDS Coordinator, said that gender-based violence “affects not only public health, but [also] the ability of women and girls to contribute to developing their countries.” Since women play integral roles in supporting their families and communities in developing nations, their absence or weakened capacity due to HIV infection, injuries, or unwanted pregnancy can have larger repercussions for economic development and community health.
Deep Roots: Changing Minds About Gender-Based Violence
Elizabeth Mataka, the UN Secretary-General’s special envoy for AIDS in Africa, described the obstacles facing female victims of gender-based violence as “deep-rooted social, economic, legal, and cultural affairs” in their communities. Mataka asserted that “communities must be engaged” through a “change in mindset” in order to allow these women to “claim their basic human rights.” Scrutinizing the paucity of women’s organizations, she cited a “serious shortage of women’s leadership at the grassroots level” as a problem that must be overcome to empower and protect women.
Pamela Barnes, a co-leader of the Partnership to End Sexual Violence Against Girls, highlighted the extent of this “deep-rooted societal issue.” She pointed out that a 2007 Swaziland study found the most “common venue for sexual violence was…within the homes of the victims.”
Rui Bastos, representing Mozambique’s Ministry of Health, added that there is a pressing need to “change relationships between men and women,” and called for a shift in the current relationship dynamic to “give power to the women.” Noting the low number of men receiving HIV treatment, he called on men to “increase demand in treatment” in order to stem the spread of the disease.
Silent Voices: Talking About Sexual Violence Against Minors
Since the Swaziland survey found that “30 percent of the respondents indicated that they had experienced some form of sexual violence prior to the age of 15,” Barnes said greater efforts must be made to educate children about how to protect themselves from sexual violence. She added that efforts to protect children should also address other “risk factors for abuse [which] include lack of education, exposure to emotional abuse, and witnessing sexual assault.”
At a recent Wilson Center event on sexual violence against minors, Jama Gulaid of UNICEF Swaziland said that while talking about sexuality is not easy, “when you bring in violence it is even more difficult.” For that reason, Gulaid said, “you have to do two things—you have to share information and you have to present it in certain ways.” He explained that Swaziland was addressing the issue by relying on school-based interventions, which include trained community-child protection groups, toll-free telephone lines, case investigation services, and personal counseling.
Prevention First: Scaling Up to Stop Rape
While the new microbicide might help female victims of sexual violence avoid HIV infection, it will not stop the problem of gender-based violence. That is why Moloney-Kitts called on donors and NGOs to “scale up gender-based violence programs,” but in a way that goes beyond simply improving “post-rape care” and instead places greater emphasis on prevention efforts.
Not only would better rape prevention help reduce HIV and STD infection rates, but it would also help women avoid psychological damage and unwanted pregnancies—and, as Moloney-Kitts pointed out, improve economic development and enhance public health at the same time.
For more on gender-based violence, see these Wilson Center events:- Gender-Based Violence in Sub-Saharan Africa: A Review of Demographic and Health Survey Findings and Their Use in National Planning
- From Relief to Development: Gender-Based Violence Interventions in Conflict and Post-Conflict Contexts
- Dynamics Of Sexual Violence In The Eastern Democratic Republic Of Congo: Perpetrators, Community Response, and Policy Implications
Photo Credit: “Congo Kivu Violences Panzi,” used courtesy of flickr user andré thiel. -
In Kampala, African Leaders Discuss Maternal Health While Attacks Renew Concern over Somalia
›July 19, 2010 // By Schuyler NullLeaders from 49 African countries are meeting today in Kampala, Uganda, at the start of a scheduled week-long African Union (AU) summit on maternal and child health. Uganda is a fitting location, as it faces some of the toughest health and demographic challenges in Africa, including a very young and rapidly growing population and poor maternal health services. However, with the memory of last week’s twin bomb blasts still fresh, peace and security issues will surely be on the agenda as well.
Somalia’s lead insurgency group, Al Shabab, took responsibility for the attacks in Kampala, which killed more than 70 people. Al Shabab’s first prominent cross-border attack is only the latest sign that Somalia’s issues – which also include a very young and rapidly growing population – are starting to spill over its borders. For more on Somalia’s deepening crisis and its effects on the East African region, see New Security Beat’s recent analysis: “As Somalia Sinks, Neighbors Face a Fight to Stay Afloat.”
Sources: AP, Washington Post.
Photo Credit: Adapted from “Ugandan African Union contingent in Mogadishu, Nov. 25, 2007” courtesy of flickr user david axe. -
New Film Looks at Sub-Saharan Africa’s Unmet Need for Family Planning
›A new documentary film released recently by Population Action International brings attention to the plight of women across sub-Saharan Africa who lack access to basic reproductive health supplies, such as condoms and contraceptives. Funded with the support of the Reproductive Health Supplies Coalition, “Empty Handed” documents the unmet need for family planning services in the region, which has some of the world’s highest fertility rates.
PAI filmmaker Nathan Golon shot the film in Uganda earlier this year. The film’s focus on Ugandan women’s struggles in particular is with good reason, as the country has a well-documented history of providing insufficient family planning services. According to the CIA’s World Factbook, Uganda has the world’s second highest total fertility rate at 6.73 children per woman.
“Empty Handed” examines how a lack of family planning tools and services can lead to a slippery slope of unintended consequences, from unplanned pregnancies to the rampant spread of sexually transmitted diseases. The film revolves around interviews conducted with women who share common hardships as they try to access family planning from under-resourced local healthcare clinics, often traveling long distances only to find upon arrival that no contraceptives or condoms are available.
In addition to identifying past and current issues with reproductive healthcare access in sub-Saharan Africa, “Empty Handed” also puts forward some ideas for better meeting family planning needs of the more than 200 million women throughout the world without access to even basic contraception.
To watch the full film online, visit the “Empty Handed” website.
Sources: C.I.A., FHI, Population Action International, Reproductive Health Supplies Coalition -
USAID Head Calls for Integrating Health Services in New Global Health Initiative
›July 2, 2010 // By Russell SticklorThis Tuesday, Dr. Rajiv Shah, administrator for U.S. Agency for International Development gave a major speech at the Center for Strategic & International Studies on USAID’s Global Health Initiative. With $63 billion earmarked for GHI over the next six years, there are high expectations for the program.
Shah laid out some details of GHI’s main priorities, which include improving family planning services, enhancing nutrition initiatives, and building stronger and broader-based healthcare systems across the developing world, with special attention paid to the health needs of mothers and their young children. He offered a number of examples of the benefits of integrating family planning with other health services for women and children, including maternal health and nutrition.
Shah did not, however, mention integrating family planning with environmental programs, the benefits of which USAID-funded programs have amply demonstrated. He also did not delve into the emerging nexus of family planning, population growth, and climate change, a subject of much discussion at last month’s Women Deliver conference in Washington, D.C.
On the other hand, Shah did say that GHI’s emphasis on improving nutrition for the world’s poor will complement another major Obama administration outreach effort, the Feed the Future initiative—repeating a point he made at the recent launch of the food security effort.
Shah also highlighted the need for establishing benchmarks for measuring success that revolve around people, not diseases. He suggested one way of achieving this would be to ensure that clinics—particularly in rural areas—broaden their mandate to offer a variety of health-prevention services, rather than providing resources that treat primarily one type of illness.
For a full transcript of Shah’s speech, click here.
More analysis of Shah’s speech and USAID’s Global Health Initiative to come in the weeks ahead.
Photo Credit: “Statesman Forum: Dr. Rajiv Shah, USAID Administrator,” courtesy of flickr user CSIS: Center for Strategic & International Studies. -
Women Deliver in the Climate Change Debate
›One of the hottest topics at the “Women Deliver” conference earlier this month—where panels ran the gamut from HIV prevention and family planning to gender-based violence and maternal health—was the intersection of women’s reproductive health, global population growth, and climate change.
As panelists at three of the conference’s climate-focused events noted, women in poor, rural areas are especially vulnerable to the impacts of climate change. In many developing countries across Africa, Asia, and Latin America, women take on much of the burden of farming, gathering fuel, and supplying fresh water for their communities. As a result, they bear the brunt of hardships when climate change alters seasonal precipitation patterns, or increases scarcity of key natural resources.
In addition, “the more assets, the less vulnerable one person is,” said Lorena Aguilar of the International Union for Conservation of Nature. “Worldwide, compared to men, women tend to have more limited access to resources that would enhance their capacity to adapt to climate change—including land, credit, agricultural inputs, decision-making bodies, technology, and training services.”
Women’s hardship in the face of climate change can also have a negative effect on reproductive health. Aguilar remarked that during the dry season in parts of rural India and Africa, 30 percent or more of women’s daily caloric intake is spent on fetching water alone. The enormous physical strain placed on women’s bodies because of those tasks has resulted in higher miscarriage rates among those populations, she noted.
Educating Girls to Protect the Environment
Organizations like the United Nations and the Global Gender and Climate Alliance have been working in recent years to bridge the gap between women’s rights and climate change, and reframe climate change in terms of human development. But to date, women’s struggles with climate change have not translated into meaningful economic, educational, or healthcare support at the local government level, with women’s welfare “at the very bottom of the priority list” for most developing countries, according to Nickie Imanguli with Advocates for Youth.
The unmet need for family planning tools and services is perhaps the movement’s principal challenge going forward. With an estimated 200 million women having an unmet need for family planning, unintended pregnancies could be exacerbating environmental problems such as depletion of forests, water, and other finite resources. But most panelists expressed optimism that the growing recognition of a connection between climate change and women’s reproductive health might lead to a boost in funding for family planning initiatives in underserved areas of the world.
Speakers at Women Deliver emphasized that reproductive health can be bolstered by improving educational opportunities for girls in poor rural areas. Joy Nayiga with Uganda’s Ministry of Finance Planning Economic Development noted that “girls are more likely than boys to drop out of school to help their mothers gather fuel, wood, and water.” This trend, she said, robs females of an opportunity for educational advancement, and heightens the likelihood they will end up starting families of their own while very young.
Nayiga and other panelists asserted that empowering females through education leads them to take greater control over their own sexual health, making it easier for them to start their families later in life, or perhaps have a smaller number of children.
Encouraging women to take a more active role in family planning in this regard serves as “a win-win situation for women, their communities, and the nations of the world,” by “bending down the overall trajectory of population growth,” asserted the Worldwatch Institute’s Robert Engelman.
Some speakers also argued that enabling women to delay motherhood if they want could yield direct environmental benefits for nations of the Global South that are struggling to adapt to climate change. Since women are often responsible for overseeing agriculture and forest resource management practices in their communities, they help create localized carbon sinks across the developing world.
“Women pull carbon out of the atmosphere and bury it, in farm soils, in trees that they grow,” noted the Worldwatch Institute’s Engelman, who even suggested women’s aggregate impact removing carbon could be more effective than cap-and-trade plans.
Moving Slowly From Talk to Action
Given both their vulnerability to the effects of climate change—and their potential to help offset those same impacts—“women are critical stakeholders in climate change moving forward,” said Population Action International’s Kathleen Mogelgaard. So far, however, while there may be growing discussion about giving women a more prominent seat at the table when developing climate change adaptation and mitigation plans, that has not yet happened.
“We’re not seeing big government investment in empowering women on the issue of climate change,” remarked Leo Bryant, with Marie Stopes International, a U.K.-based NGO specializing in sexual and reproductive health. Instead, Bryant said, it has been NGOs that have been doing much of the heavy lifting of bringing women into the conversation.
But many panelists felt that, in time, governments will recognize it is in their enlightened self-interest to link issues of gender rights and climate change. “By upholding women’s rights,” concluded the IUCN’s Lorena Aguilar, “we are in fact making one of the most crucial preparations associated to climate change that any society can make.”
Click here for additional New Security Beat coverage of reproductive health talks at the Women Deliver conference, or here for more coverage of the interplay between traditional gender roles and family planning.
Sources: International Institute for Sustainable Development, International Union for the Conservation of Nature, Marie Stopes International, Population Action International, Population Reference Bureau, The Times (U.K.), United Nations Development Programme, Women Deliver, Worldwatch Institute.
Photo Credit: “Climate Change Canvas” courtesy of Amnesty International. -
Women Deliver: Real Solutions for Reproductive Health and Maternal Mortality
›The landmark Women Deliver conference, which concluded last week, reinvigorated the global health community’s commitment to improve reproductive health at both the grassroots and global levels. Providing a major boost was the Gates Foundation’s announcement that it will commit an additional $1.5 billion over the next five years to support maternal and child health, family planning, and nutrition programs in developing countries.
“We haven’t tried hard enough,” said Gates Foundation co-founder Melinda Gates. “Most maternal and newborn deaths can be prevented with existing, low-cost solutions.” Examples of these efficient and effective solutions were presented at the three-day conference’s dozens of panels on a wide range of issues, including climate change, contraceptive commodities, fistula, gender inequities, adolescent family planning, communications and technology, and much more.
Empowering Young Girls to Access Family Planning
“When we speak about adolescents we typically think of prevention. However, we must also think about providing access to safe abortions and supporting young women who want to be mothers and empower young women to make choices,” said Katie Chau, a consultant at International Planned Parenthood Federation.
In Nigeria, “there is not much attention on adolescent sexual and reproductive health, even though a majority of rapes occur before the age of 13, and the rate of teenage pregnancy and abortions is high,” said Bene Madunagu, chair of the Girls’ Power Initiative (GPI) in Nigeria. GPI teaches girls about their rights to make decisions, including those regarding sex and reproductive health, as well as improving their critical thinking skills, self-esteem, and body image. “Girls develop critical consciousness and question discriminatory practices, while also learning about the legal instruments to take up their concerns,” he said.
Sadaf Nasim of Rahnuma Family Planning said child marriages are common in his country, Pakistan. “Marriage is an easy solution for poor families. Once a girl is married she is no longer the responsibility of the family,” he explained.
While laws in Pakistan and other parts of the developing world condemn child marriage, the prevalence of child marriage remains high: 49 percent of girls are married by age 18 in South Asia, and 44 percent in West and Central Africa. Nasim said birth registration at the local and national levels should be improved to prevent parents from manipulating their daughter’s age.
In Kyrgyzstan, “community-based efforts worked to galvanize media attention and disseminate information to demonstrate the need for improved adolescent family planning,” said Tatiana Popovitskaya, a project coordinator with Reproductive Health Alliance of Kyrgyzstan. Such community-based approaches use grassroots education to mobilize community leaders, which is a critical step in overcoming child marriage and other harmful traditions.
Cell Phones and Maternal Health
“There is a lot of information being collected, but it is not necessarily going where it needs to because of fragmentation,” said Alison Bloch, program director at mHealth Alliance. In developing countries, the people most in need are often the most isolated, but mobile technology is emerging as a way to bridge the gaps.
According to a recent report by mHealth Alliance, 64 percent of mobile phone users live in developing countries and more than half of people living in remote areas will have mobile phones by 2012. The potential for improving global health with cell phones and PDAs is significant, and can address a wide range of health issues, such as human resource shortages and information sharing problems between clinics and hospitals.
“Mobile technology provides benefits to individuals, institutions, caregivers, and the community. It reduces travel time and costs for the individual, improves efficiency of health service delivery, and streamlines information to health workers to reduce maternal mortality,” said Elaine Weidman, vice president of sustainability and corporate responsibility at Ericsson.
“Mobile technology is the most rapidly adopted technology in history and represents an existing opportunity to reach the un-reached,” said Fabiano Teixeira da Cruz, a program manager for the Inter-American Development Bank, speaking of the benefits of using mobile technology to train field-based healthcare workers in Latin America.
While mobile phones are indeed reaching parts of the world not currently equipped with quality healthcare, the lack of systematic coordination and infrastructure at the district and regional levels must also be addressed, as highlighted during a recent Wilson Center event, Improving Transportation and Referral for Maternal Health.
Read about our first impressions of Women Deliver 2010 here.
Calyn Ostrowski is program associate with the Wilson Center’s Global Health Initiative
Photo credit: Woman and child in South African AIDS clinic, courtesy Flickr user tcd123usa. -
Women Deliver 2010: First Impressions
›Delivering Solutions for Girls and Women
“We know how to intervene; there does not need to be a magical solution,” said Søren Pind, Denmark’s minister for development cooperation, at the June 7 opening ceremony of Women Deliver 2010.
In its second year, the conference has gathered delegates from 146 countries representing hundreds of non-governmental organizations (NGOs), governments, and civil society organizations under the theme “Delivering Solutions for Girls and Women.” Delegates are working to share projects, policies, successes, and innovations in the field of maternal health and to develop strategies to meet Millennium Development Goal 5.
“Recent trends show great progress and this is very encouraging,” said Gamal Serour, president of the International Federation of Gynecology and Obstetrics (FIGO), speaking of a recent study by the Institute of Health Metrics and Evaluation (IHME). The study found that annual maternal mortality has dropped 34 percent–from 526,000 to 342,900–between 1980 and 2008. Nevertheless, Serour maintained that “we are far away from our goal for 2015.”
Overcoming Tradition and Religious Barriers
Investing in women’s health is not only the right thing to do, it is also economically advantageous. When women are healthy, they provide tremendous benefits to their families, communities, and countries. Women contribute to a majority of the small businesses and agricultural activities of developing countries and their unpaid work at home accounts for almost 33 percent of the world’s GDP. Unfortunately, over 215 million of these women do not have access to family planning services, resulting in unwanted pregnancies, childbirth, and maternal deaths.
There are many barriers to family planning in developing countries, not the least of which are cultural and social traditions that can uphold negative gender-based norms. Tailoring campaigns to address these gender inequities was the subject of discussion at the “Cultural Agents of Change Delivering for Women” session, where panelists acknowledged that collaboration and partnership with a wide-range of actors–from members of the local legislature to civil society organizations and actors in the health sector–are necessary to facilitate change.
Graciela Enciso of the Centro de Investigaciones y Estudios Superiores en Antropología Social-Sureste in Mexico, added that advocacy campaigns to increase support for family planning should be “linked with research.” In many traditional societies, strict interpretations of religion are used to control and disempower women; donors and NGOs “need to think outside the religious box at every point,” said Mary E. Hunt, co-director at the Women’s Alliance for Theology, Ethics, and Ritual.
Male Contraception, Gender Roles, and Family Planning
“I think it is important not to hide behind our cultures and religion,” said Ngozi Okonjo-Iweala, managing director of the World Bank. “We need to work with men and work together to overcome gender inequality.” “Male participation” has been a key theme echoed throughout Women Deliver and is often highlighted as a strategy for reducing maternal mortality.
At the “Men Deliver: Men’s Role in Family Planning” breakout session, experts addressed how new and existing technologies in male contraception and shifting gender roles can help to scale up family planning interventions. “Reducing unwanted pregnancies can also be carried out through male contraception,” said John Townsend, vice president of the reproductive health program at the Population Council.
Condoms are traditionally the main method of contraception for men, but usage rates quickly fall over time and to wear a condom “becomes the women’s responsibility,” said Townsend. To address issues around condom usage, development of alternative family planning technologies, such as gels and implants, is underway. As these technologies are being developed, however, it is important for program managers and donors to consider existing gender norms and the willingness of men to utilize new methods.
In researching gender roles in family planning in Zambia, Holo Hochanda, the chief technical administrator of the Planned Parenthood Association of Zambia, determined that there are many entry points for male intervention and increased family planning. “Men are clients, policymakers, and service providers. Each of these roles provides an opportunity to discuss utilization of male contraception and gender inequities in family planning,” he said. “Men can be key mobilizers and agents for change.”
For more coverage on Women Deliver 2010 click here and to learn more about the Wilson Center’s Maternal Health Dialogue Series visit the Global Health Initiative’s website here.
