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The Life of a Sex Slave

January 30th, 2011

Forced to drink a male client’s urine. Bitten by fire ants. Whipped with an electric cable. Burned with hot metal rods. Stuffed with hot chili pepper flakes. Deprived of basic medical care.

Because she dared to ask for a rest from clients. Because she was bleeding and vomiting. Because she is female.

According to the Human Rights Task Force on Cambodia’s 2001 report, “the inadequacies in the law and legal system and the serious violations to the health and human rights of women in sex work” stem from three main social factors:

  1. stereotyping of women as providers of pleasures to men, a role that is reinforced by the media’s depiction of women as sex objects
  2. unequal access of women to education, resulting in the marginalization of women to work such as prostitution, where educational qualification is not necessary of pleasure to men
  3. societal ostracism of commercial sex workers, make it difficult for them to seek assistance for their health and security needs

Even though prostitution and human trafficking are illegal in Cambodia, “officials are often paid to look the other way” (Marie Claire). Sreypov Chan was 7-years-old when her mother sold her to a brothel in Phnom Penh. If she didn’t meet her quota of men for the day, she was shocked with a loose wire from a socket in the wall. This horrendous physical abuse was coupled with verbal and emotional harassment, which have permanently scarred Sreypov, leaving her terrified and skeptical of men. Sreypov escaped at age 10, after living a slave in Phnom Penh’s most notorious sex district, the “White Building.”  She succeeded in fleeing from the brothel on her third attempt; she ran into a man on the street who brought her to the police station. Often, police officers return girls to the brothels. Luckily this time, they called Somaly Mam.

Sreypov was relatively fortunate, in that she was only enslaves for 3 years. For many girls and women, a brothel is their permanent residence, because they feel they cannot escape, or they are too physically weak or hopeless to try. Most sex workers start under the full control of the brothel operator, which means they are treated as slaves. They are not paid for their labor. When girls first arrive at the brothel, they are often given more food, clothing, and freedom of movement than they will ever enjoy again. Many girls start out doing household chores or cleaning when they first arrive at the brothel; this deception allows brothel owners to lock up the girls before they think to escape, especially if they are young and particularly unaware of the reality of their situation. Once a girl has serviced her first client, she becomes a prisoner to the brothel owner, and is forbidden from leaving the building unless guarded by someone. Some women gain back a little bit of this freedom when they have earned back their “purchasing price.” However, since there is no official accounting of how much a woman has earned (since most of the money goes directly to the pimp), women are “at the complete mercy of the operator as to when they can be “freed” from the purchasing bondage” (HRTFC).

Not only do sex slaves risk contracting STIs and HIV/AIDS, but they are also frequently beaten by their pimps, forced to live in cramped quarters with minimal sanitation, insufficient nourishment, and crippling psychological distress. Every day for these girls and women is filled with violations of human and health rights. Many women are forced to engage in unprotected sex, even when condoms are available, because clients often refuse to use them. Luckily, several condom interventions have been successful. Sreypov now distributes condoms and soap to sex workers. So much blame is placed on the sex slaves for spreading HIV, but “what is usually forgotten is that it is not the women sex workers themselves nor their work but the high risk behavior of their clients that has caused the spread of HIV/AIDS and other STDs” (HRTFC). A client who didn’t use a condom infected a sex worker in the first place, and the epidemic spread throughout Cambodia’s cities. Here’s a another great example of the dangerous intersection between education, health, and human rights.

Please watch the following clip for a vivid picture of the brothels: http://www.youtube.com/watch?v=aSDiMIgrd9A

The more I research, the clearer it becomes: the life of a sex slave is isolated, injurious, and paralyzing. The sex workers both depend on one another for support and compete against one another for favorable treatment by brothel owner. According to HRTFC, 84% of sex workers interviewed wanted to stop working in prostitution. It surprised me to learn that not everyone says they want to escape. They feel they have no other alternative, or have given up hope. Additionally, a woman’s status is forever tainted by her work as a sex slave, so they may never be able to marry. Women often feel that they have no other skills and have a better chance of earning a living as a prostitute than as a free woman. HOW can we CHANGE this attitude so that women feel empowered to believe in their worth as contributing members of society?

Works Cited:

Human Rights Task Force on Cambodia. “Cambodia: Prostitution and Sex Trafficking.” Human Rights Solidarity. 13 Aug. 2001. Web. 20 Jan. 2011. <hrsolidarity.net>.

Pesta, Abigail. “Diary of an Escaped Sex Slave.” Marie Claire. Web. 26 Jan. 2011. <marieclaire.com/world-reports/news/international/diary-escaped-sex-slave>.

Microcredit Finance

January 28th, 2011

Grameen Bank and Dr. Muhammad Yunus

When Anne mentioned in class that she wanted us to blog about positive interventions to balance out all the negative facts and figures with which we’re being inundated, I knew immediately what I would blog about. In 2004, I spent a day with Dr. Muhammad Yunus in some villages on the outskirts of the Bangladeshi capital, Dhaka. Though the godfather of the microcredit revolution and well known among those in global finance, he had yet to win his Nobel Prize and was not quite a household name. As the South Asia bureau chief for The Associated Press, I had heard so much about his Grameen Bank and thought he would be a wonderful man to profile – a man who had done so much for women.

I learned that Yunus, a U.S.-educated Ph.D. in economics, had given up his cushy life in the United States to return home and teach at Chittagong University on the Bay of Bengal. It was here that he witnessed the incredible poverty surrounding his campus and learned that so many of the impoverished women were beholden to loan sharks. So no matter how much the women earned, most of the profits went back to these middlemen for the materials they needed to buy to produce the goods they sold at market, so they rarely got ahead. Yunus started a project with his economic students at the university, tracking some 42 families in a small village, Jobra. He gave them small loans, told them to pay it back when they could, little by little. They all did, one by one, over a year.

Today, Grameen Bank is considered the prototype for microcredit finance institutes. It has helped some 9.4 million of the world’s poor with small loans to start small businesses, such as buying cell phones to sell calls in villages with no telephone systems; a cow to produce cheese and milk; new plots to expand their rice paddies or mustard fields.

“Mr. Yunus has done more for the poor people of Bangladesh than anything our government has ever done,” said Anju Monwara, one of the so-called “telephone ladies” I had interviewed. Spending a few hours in that village, the telephone ladies showed me how they had were making enough money with the purchase of their cellphones to sell telephone calls for the farmers in the village to find out the price of crops in neighboring villages, make calls to their loved ones overseas about new babies, marriages or banking issues. One woman I interviewed was making $50 a month from her phone calls – about double the average annual income at the time.

As I would write two years later, on the day he won his Nobel in 2006, traveling with Yunus to the villages outside Dhaka is like being on the road with a rock star. Both men and women flock to him, want to touch him and share his easy laugh. They love to regale him with their latest achievements, push their girls forward to explain how they’re now in school for the first time and getting good grades.

Here are links to the two stories I did on Yunus and the “telephone ladies.”

http://articles.latimes.com/2004/apr/04/news/adfg-banker4

http://www.usatoday.com/tech/wireless/phones/2004-04-05-telephone-ladies_x.htm

But not everyone is so taken with Yunus, his bank or the microcredit philosophy. I interviewed several economists who say the small loans go after vulnerable women and get them hooked on credit and that the system does little to eradicate poverty.

“Microcredit has many flaws,” said M.M. Akash, an economics professor at Dhaka University. It does not reach the extreme poor, who account for 20 percent of the population, he said. They have no homestead or land to cultivate and fear banking and investment. “It’s a low-level poverty equilibrium trap.”

A recent article by The New York Times spelled out the growing flaws in the system, including possible corruption among the lending institutions and recipients of the micro loans not using the money to invest in items that will earn them money:

In December, the prime minister of Bangladesh, Sheik Hasina Wazed, who had championed microloans alongside President Clinton at talks in Washington in 1997, turned her back on them. She said microlenders were “sucking blood from the poor in the name of poverty alleviation,” and she ordered an investigation into Grameen Bank, which had pioneered microcredit and, with its founder, was awarded the Nobel Peace Prize in 2006.

http://www.nytimes.com/2011/01/06/business/global/06micro.html?scp=1&sq=India%20microcredit%20finance&st=cse

http://nytimes.com/2010/11/18/world/asia/18micro.html?scp=1&sq=microcredit%20India&st=Search

I’ll be very curious to see how it all shakes out. It seems to be such a credible and life-saving tool for so many women.

PEPFAR under W.

January 28th, 2011
"Is abstinence only sex education more politics than public health?"

"Is abstinence only sex education more politics than public health?"

Those who have followed the global response to the HIV/AIDS pandemic will be familiar with the President’s Emergency Plan for AIDS Relief, or PEPFAR.  PEPFAR, started under President George W. Bush in 2003, is the U.S. governments initiative to help those suffering with HIV/AIDS worldwide (see the current website: http://www.pepfar.gov/press/88332.htm).  According to the U.S. Government Office of U.S. Global AIDS Coordinator, the $15 billion the U.S. earmarked for PEPFAR for 2003-2008 is the largest commitment by any nation to combat a single disease (http://www.pepfar.gov/press/88332.htm).  PEPFAR was re-authorized in 2008; Congress authorized up to $48 billion over the next five years  for HIV/AIDS, TB, and malaria.  Since Obama took office, PEPFAR’s strategy has changed considerably.  I will begin by documenting how PEPFAR affected sex education under George Bush, then I will very briefly explain the education-related changes since 2008.

The original goal of PEPFAR was largely treatment-oriented.  The program aimed to provide antiretroviral treatment (ART) to several million individuals living with HIV in low-resource settings.  By 2008, PEPFAR increased the number of Africans receiving ART from about 50,000 at the start of the program in 2004 to upwards of 1.2 million in 2008 (Stolberg, 2008).  Upwards of 70% of PEPFAR money under Bush was designated for treatment and care (55% for treatment programs, 15% for palliative care, and 10% for care of orphans and vulnerable children), with just 20% earmarked for prevention, including education (see Health GAP 2004).  Of this 20%, one-third (or 6.7% of the total budget) was mandated to be spent on abstinence-only programs (see the original bill summary here: http://thomas.loc.gov/cgi-bin/bdquery/z?d108:h.r.01298:).  Further, in 2005, PEPFAR introduced a new rule that at least 2/3 of all money spent to prevent the sexual transmission of HIV must be spent on “AB” strategies – those that promote abstinence and being faithful.  The remaining third could be spent on condoms and other activities, generally for “high-risk” groups such as commercial sex workers and drug users (http://www.avert.org/pepfar.htm).

The focus on abstinence-only programs (and more recently on AB programs) has been the source of much controversy.  The New York Times and other major newspapers have come out against the policy (See an NYT Editorial from 2007, citation below)  High-ranking officials, such as Stephen Lewis, former UN Secretary General’s Special Envoy for HIV/AIDS in Africa, have spoken out against the funding restrictions of the first phase of PEPFAR (sometimes called “PEPFAR-I”).  In a press conference regarding a condom shortage in Ugana, Lewis said:

“There is no question in my mind that the condom crisis in Uganda is being driven and exacerbated by PEPFAR and by the extreme policies that the administration in the United States is now pursuing in the emphasis on abstinence, far and away beyond that of condoms.”

(The transcript of this press conference can be found here: http://www.healthgap.org/press_releases/05/082905_HGAP_Uganda_call_transcript.html)

PEPFAR-I did not promote condoms to young people.  Funds could be used to support ABC (Abstinence, Be Faithful, Condoms) for young people as long as these programs informed youth about the failure rates of condoms and presented condom use and abstinence as equally viable choices.  Many have criticized PEPFAR for degrading public trust in condoms (see, e.g., PEPFAR Watch: http://www.pepfarwatch.org/the_issues/abstinence_and_fidelity/).

As a result of these restrictions on funding, many youth (and others) in Africa have been denied their right to full information on HIV prevention.  In 2006, the Government Accountability Office (GAO) released the results of their investigation of PEPFAR programs and policies around preventing HIV transmission through sex.  Of the 20 country teams GAO interviewed, 17 said that meeting PEPFAR’s funding requirements presented “challenges to their ability to respond to local prevention needs ” (Government Accountability Office, 2006).  The report also notes that some countries were forced to scale down their efforts to prevent mother-to-child transmission or their efforts to ensure a clean blood supply.  Funding also cannot go to organizations that provide abortions or abortion information and counseling.  Again, the result is that young people are getting only partial knowledge of HIV, and a dismal sliver of the comprehensive sexual health information they need.

Other restrictions on funding mean some of the groups most in need.  Under PEPFAR-I, organizations receiving funding had to follow a so-called “Gag Rule.”  In order to receive funding, organizations had to make a “loyalty oath” stating that they opposed prostitution.  The exact wording is as follows:

“No funds made available to carry out this Act, or any amendment made by this Act, may be used to provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking.”

(see the bill here: http://thomas.loc.gov/cgi-bin/bdquery/z?d108:h.r.01298:)

This restriction has lead to many organizations refusing funding, including Brazil refusing $40 million in PEPFAR funds in May 2005.  The stipulation means that some of the most vulnerable women in the world – commercial sex workers – are not worthy of U.S. tax dollars.

A bigger issue is that the politics surrounding PEPFAR meant that young people not only lacked access to comprehensive HIV knowledge, but that the fear of losing funding causes many organizations to stop discussing condoms, family planning, abortion, and sexual and reproductive health at all (e.g. Center for Strategic Studies, 2006).  Organizations, dependent on this money, may become extremely cautious in their day-to-day operations.  Regardless of whether organizations’ particular fears of losing funding are grounded, the climate PEPFAR has created around meeting spending requirements has severely limited what sexual health information organizations throughout Africa provide.

Since 2008

PEPFAR was re-authorized in 2008.  The new phase, PEPFAR-II, included a number of notable changes.  The 20% cap on funding for prevention efforts was eliminated, as was the requirement for 1/3 of efforts to be abstinence programs (Moss 2008).  However, the 2008 re-authorization does state that in countries with generalized HIV epidemics (that is, not confined solely to high risk groups), at least half of all money directed towards preventing sexual HIV transmission must go to programs that promote abstinence, be faithful, and general partner reduction (see avert.org/pepfar.htm).  It’s not yet clear what the consequences of not following this recommendation will be.  PEPFAR’s current website (http://www.pepfar.gov/press/88332.htm) writes that PEPFAR supports prevention efforts that use the full “ABC” approach.

Additionally, the new phase of PEPFAR shifts focus to working with local and state governments rather than relying on U.S. based NGOs.  This may help countries and organizations have more autonomy over how PEPFAR money is spent, hopefully with an eye toward more comprehensive sexual health information.  Further, a new stated goal of PEPFAR is to address HIV/AIDS in a broader health and development  context.  How these new goals will pan out remains to be seen.

References

Stolberg, SG.  “In Global Battle on AIDS, Bush Creates Legacy.” New York Times, Jan 5, 2008.  Accessed from:
http://www.nytimes.com/2008/01/05/washington/05aids.html?_r=2&oref=slogin&oref=slogin

Health GAP Briefing Paper, March 22, 2004.  “U.S. Emergency Plan for AIDS Relief (PEPFAR): Facts and Critical Issues”. Health GAP Global Access Project. Accessed from www.healthgap.org.

Editorial: Shackles on the AIDS Program. New York Times, April 4, 2007. Accessed at: http://www.nytimes.com/2007/04/04/opinion/04weds3.html?scp=7&sq=pepfar&st=nyt

Government Accountability Office.  “Global Health: Spending Requirement Presents Challenges for Allocating Prevention Funding under the President’s Emergency Plan for AIDS Relief.”  GAO-06-306.  April 4, 2006. Accessed at: http://www.gao.gov/products/GAO-06-395

Morrison, SJ and Fleishman, J.  Integrating Reproductive Health and HIV/AIDS Programs. Center for Strategic and International Studies (2006, July).  Accessed from: http://csis.org/publication/integrating-reproductive-health-and-hivaids-programs

Moss, K.  (Aug 25, 2008) International HIV/AIDS, Tuberculosis, and Malaria: Key Changes to U.S. Programs and Funding.  Congressional Research Service Report for Congress.

The Opportunity Cost of Water

January 28th, 2011

As I raised in my first blog post, water scarcity in the developing world forces women to devote a large portion of their day to collecting enough water for their family each day; this task comprises a huge percentage of a woman’s total household chores and thus effectively curtails her ability to participate in other activities.  In this blog entry, I will focus on the theory that improved water infrastructure can act as an empowerment tool for women, effectively freeing up the amount of time they can devote to participating in income-generating activities.

In Africa, only 4% of the population has access to improved water sources, which requires women to spend between 1 and 8 hours a day carrying water to and from wells, pumps, or rivers (1) (2).  In addition to this physically-draining task, women are still expected to perform other domestic chores, such as gathering firewood, cooking, cleaning, and caring for children.  Thus, the brunt of household chores falls disproportionately on women, while men are typically assigned the role of “family breadwinner” and participate in money-making work.  In theory, then, one would suspect that providing better access to water could allow women to devote the amount of time they would have spent participating in non-income generating chores to economically-viable activities.  This newfound financial independent would, in turn, empower women with a greater say in their household and community.

At first blush, the theory sounds foolproof.  Yet, empirical data is murky, at best, as to the correlation between improved water access and women’s empowerment (3)  Most benefits to women come in the form of improved quality of life, as opposed to shrinking the gender inequality divide.  For example, by decreasing the amount of time women spend collecting water, they are less prone to gender-based violence, water-borne diseases, and physical ailments associated with carrying such heavy quantities of water (4).  However, when surveyed, most women do not seem to view these health risks as their primary concern; rather, most women just cannot afford the time it takes to actually get the water and transport it back to their homes in the first place.  This, of course, begs the question: what would women be doing with their time if they weren’t required to get water?

Unfortunately, the issue isn’t that simple, as with most problems.  A study conducted on countries such as Madagascar, Uganda, and Rwanda suggests that there is no correlation between increased women’s empowerment and improved water access (5).  There are simply too many other intervening variables that come between free time and the choice to pursue income-generating activities in this free time.  Although women might be more likely to devote time to leisure activities and caring for their children, water projects must be accompanied by parallel activities in order to increase women’s power in the house and the community (6).  For example, even with free time, social taboos or distance might prevent women from actually pursuing economic opportunities.  Some women might engage in more work on their own farms, but this would not give them greater economic independence, since agriculture is still under the primary aegis of men (7).

One study does suggest that improved water access does improve children’s access to education, especially young girls (8).  Thus, the benefits of increased water access might extend more to the young generation, and provide a potential solution to improving female primary education by freeing them up from certain household chores.

In order for water infrastructure to provide a viable form of women’s empowerment, it must be accompanied by other simultaneous projects.  As long as women are still chained by gender roles, very few initiatives will empower them with a greater voice in their communities and homes.

Works Cited:

1) Gender, Water, and Development: An Introduction

2) Does Increased Water Access Empower Women?

3) Access to Water, Women’s Work, and Child Outcomes

4) Time Savings from Easy Access to Clean Water: Implications for Rural Men and Women’s Well-Being

5) Access to Water, Women’s Work, and Child Outcomes

6) Time Savings from Easy Access to Clean Water: Implications for Rural Men and Women’s Well-Being

7) Access to Water, Women’s Work, and Child Outcomes
8) Access to Water, Women’s Work, and Child Outcomes

Traditional Birthing Assistants

January 27th, 2011

Last October, the president of Malawi lifted a 2007 ban on Traditional Birth Attendants. Traditional Birth Attendants are unlicensed helpers who have learned about the birthing process through informal apprenticeships or observation, and come to the aid of mothers in their communities. They usually have other, regular jobs or duties in the community, but can be called upon for assistance when a woman goes into labor. They are not midwives, because they have not undergone the same rigourous training that midwives do. Traditional Birth Attendants are very common in rural areas of developing countries, as this has often been the model of care for centuries before the emergence of more modern health care workers. President Mutharika’s decision is an encouraging sign that developing nations recognize the importance of empowering and educating TBAs rather than suppressing them if they want to improve maternal health. It is estimated that 47% of all births are assisted by TBAs. [1]
The World Health Organization has been encouraging TBA training  since the 1970s as one of the primary single interventions to address maternal mortality. Educational programs to give TBAs better obstetrical knowledge and training in modern methods of perinatal care and hygienic procedures have been put in place in many developing regions, from South Asia to Central America. Evidence shows that these trainings can have a pretty large impact: a trial of trained TBAs in Pakistan showed a 30% reduction in maternal mortality. [2]
Nevertheless, governments and health ministries often regard TBAs with mistrust– and not without good reason, as there is much to be improved. Malawi’s ban was originally instated in 2007 because of the concern that low-skilled TBAs could not identify obstetric emergencies clearly enough. A Malawi spokesman for UNICEF said that many TBAs in the country had only two weeks of training, when ideally they would have about three months–enough time to teach them to recognize all the kinds of complication that might emerge and require hospitalization. [3]
Nevertheless, the lifting of the ban puts women who are not able to afford hospitalization in urban centers back into more able hands. And it might also spur the development of new policies and programs for TBA education. “We need to train traditional birth attendants in safer delivery methods,” said the President after returning from a UN Summit on the MDGs. “We should not completely stop them because their work is very important. We should train them to assist us in addressing the health challenges that we are facing.”

1. http://eprints.qut.edu.au/19234/
2.http://apps.who.int/rhl/pregnancy_childbirth/antenatal_care/general/cmacom/en/index.html
3.http://irinnews.org/Report.aspx?ReportID=90732

Ukraine’s Maternal and Infant Health Project— lessons learned.

January 27th, 2011

Ukraine’s Maternal and Infant Health Project— lessons learned.

Although Ukraine has a universal health coverage plan that ensures pregnant women’s access to prenatal care, health outcomes for these women and their babies are not always positive. Studies demonstrate that improvements in health outcomes for mother and child are related not just the availability of care, but the quality of care they receive (Barber and Gertler, 2002). Indeed research also shows that access to low quality providers contributes to higher child morbidity and mortality (Sodemann et all., 1997). This issue can also be viewed from the Emergency Obstetric Care 3-delays framework introduced in the first blog, in which case women in the Ukraine may have a delay in receiving appropriate care. This can be thought of as appropriate care (including prepared health workers, quality care, access to medications and interventions) not only during delivery but also during prenatal care.

In Ukraine, the maternal and Infant Health Project (MIHP) is a USAID-funded initiative whose aim is to improve the quality of maternal and child health in order to reduce maternal and infant mortality and morbidity. The program was launched in January 2003 and developed standards of care and clinical guidelines for MCH (maternal and child health) services and practices which were implemented in maternity hospitals and eight obgyn outpatient clinics, four oblasts. Of these last four, two were in rural regions and the other two in industrial regions.

A recent evaluation by Nizalova and Vyshnya from the Kyv School of Economics and the National University of Kyiv has shown, through program evaluation methods, that the administrative units in MIHP have “exhibited greater improvements in both maternal and infant health compared to the control ones” (Nizalova and Vyshnya). The program seems to have best benefited in reductions of stillbirths and infant mortality. In regards to maternal health, MIHP seems to have been very effecting at reducing anemia, blood circulation and urinary-genital system complications, and late toxicosis. The researchers suggest based on the analysis that the improvements are due to “early attendance of antenatal clinics, lower share of C-sections, and greater share of normal deliveries. Furthermore, MIHP also seems to be a cost effective initiative. Preliminary analysis shows  benefit per dollar spent on the project, with the cost to benefit ratio to be one to 97, including maternal and infant lives saved and the costs savings due to changes in labor and delivery practices.

What is very interesting about studying this intervention is that, unlike the situation of developing countries where health initiatives usually involve creating infrastructure and health facilities, participation in the MIHP exclusively focuses on the quality of the services since prenatal and obstetric care are universally available. Thus it is easier to evaluate the importance of quality of and not just quantity or availability of services. One of the points I wanted to highlight about what worked in this intervention was the earlier attendance of prenatal care visits and the increased rate of normal deliveries. Previous literature I had read hadn’t really emphasized these to factors as ways to improve MCH. Nizalova and Vyshnya suggest that Ukraine’s MIHP has helped reduce the maternal mortality ratio by 63 per 100 thousand live births and infant mortality by 280 for every 100,000 pregnancies. This could be a potential model for developing countries.

Sources

Nizalova, O Y. “Evaluation of the impact of the Mother and Infant Health Project in Ukraine.” Health economics 19.S1 (2010):107.

Sodemann, M., Jakobson, M.S., Mølbak, I.C., Alvarenga Jr., I.C., Aaby, P., 1997. High mortality despite

good care-seeking behavior: a community study of childhood deaths in Guinea-Bissau. Bulletin of the

World Health Organization 75 (3), 205-12.

Bangladesh: Planting the seeds of change

January 27th, 2011

Araceli Y. Flores

In last week’s blog, I presented Bangladesh as a case study in examining the difficulties women confront in accessing the “rights” guaranteed to them. Despite being a democracy with the “promise” of equal rights written into its laws, Bangladesh still faces many challenges in translating these laws into tenable action— as seen by the culturally prevalent subjugation of women to extreme violence, human trafficking, and forced early marriage.

Thankfully, these harsh realties paint only one side of the picture: Bangladeshi civil society has made significant strides in empowering women in both economic and social life [1].

Economic: Bangladesh has made extraordinary progress in advancing human and economic development in recent years. Started by Muhammad Yunus in 1976, the Grameen Bank has served as the pioneer lending institution for the poor in Bangladesh through its elimination of collateral as a credit prerequisite.  Yunus reasoned that extending financial resources to the poor would allow them to break the poverty cycle and “create the biggest development wonder.” With 2,565 branches, the Grameen Bank provides services to 81,376 villages, covering more than 97 percent of the total villages in Bangladesh. As the birthplace of Grameen Bank, Bangladesh has long internalized the concept of microcredit, which has given Bangladeshi women almost unprecedented access this financial resource. As of December 2010, the Grameen Bank reported 8.34 million borrowers, 97 percent of whom are women. [2]

Social: The triumphs of the women’s rights movement in Bangladesh can be most readily observed in the vibrancy of Bangladesh’s nongovernmental organization. The United Nations High Commissioner for Refugees (UNCHR) recently published the findings of a Refugee Review Tribunal on Bangladeshi women’s rights organization. The report states “Bangladesh has a long tradition of women’s organizations… Women’s groups include the women’s wings of political parties as well as independent non- government organizations, professional bodies, student associations and trade unions… These have traditionally been focused on issues such welfare, education, skills, income generation and childcare.” [3]

Despite being often targeted by Islamic fundamentalist groups, these women’s organizations remain firmly planted in Bangladeshi society, demonstrating their resilience and determination in championing women’s rights. One such organization is Naripokkho, an NGO involved in research, lobbying and advocacy campaigns regarding gender justice and equal rights. [4] Founded in 1983, Naripokkho focuses on four pressing issues facing Bangladeshi women:

  • Violence against women and human rights
  • Reproductive rights and women’s health
  • Gender issues in environment and development
  • Representation of women in media and cultural politics

Naripokkho works at the grassroots level to create issue-based campaigns and bring this content to national awareness. Among their varied programs and activities– such as targeted public protests– Naripokkho also convenes an “International Women’s Day Committee” that works in conjunction with other Bangaldeshi NGOs to discuss women’s issues.

Steps Toward Development, established in 1993, is another Bangladeshi nongovernmental organization that campaigns and advocates for “policy interventions to establish gender equality and mainstreaming women into development”. [5] Steps Toward Development focuses on creating accountability measures for equality and respect for human rights in Bangladesh. Like many other grassroots organizations in Bangladesh, Steps Toward Development networks with other NGOs to build solidarity in the women’s rights movement and to present a united front when advocating these rights on local and national policy levels.

These two organizations provide a glimpse into the dynamic response that nongovernmental organizations have adopted to bring women’s issues to the forefront of Bangladeshi political life. Next week, I plan to look at other solutions – both governmental and civil sector based— that have been pursued in order to remedy and rectify the disregard for Bangladeshi law in practice, as well promote gender equity in society.

————————————————————————————————

Citations:

[1] “Bangladesh: Human Rights and the Rule of Law in Crisis?” United States Institute of Peace, May 2005: http://www.usip.org/publications/bangladesh-human-rights-and-rule-law-crisis

[2] Grameen Bank, Bank for the Poor: http://www.grameen-info.org/index.php?option=com_content&task=view&id=16&Itemid=112

[3] “Bangladesh— Women’s rights organizations”, United Nations High Commissioner fore Refugees, 2007: www.unhcr.org/refworld/pdfid/4b6fe12d0.pdf

[4] “Naripokkho (Women Activists Group in Bangladesh), People’s Solidarity for Participatory Democracy, 2002: http://blog.peoplepower21.org/English/5763

[5] “Bangladesh— Women’s rights organizations”, United Nations High Commissioner fore Refugees, 2007: www.unhcr.org/refworld/pdfid/4b6fe12d0.pdf

Two Children are Enough

January 27th, 2011

“A baby is like a guest in our house, and when we have one, we have to have it for all our life,” Esfanidyari said. “We ask mothers to think about this before they have children.” Soghra Esfanidyari is a community volunteer in Kian Shahr, Iran that is working to try and make mothers think about their future before they decide to have a child.(1) Iran is a prime example of effective family planning implemented in the Middle East. A quarter of a decade ago, however, this was not the case. In 1976 Iran implemented its first family planning policy, acknowledging it as a human right and aimed at improving the status of women. Before the Islamic Revolution, some family planning facilities did exist, however they were dismantled by order of the Supreme Leader, Ayatollah Khomeini, at the beginning of the Iran-Iraq War in 1980.  He urged procreation as a way to gain the upper hand in war and increase the number of “soldiers for Islam”. National growth rate grew to over 3%, and the population doubled from 27 million in 1968 to 55 million in 1988.(2) After the war, and under a flailing economy, the country began to realize the impact that the growth rate was having economically as well as socially. At the beginning of the new decade, family planning was re-implemented, and in 1993 Parliament passed new legislation that restricted or completely withdrew many social and financial programs for families with more than three children. Money that was saved on restricted maternity leave funded a media campaign by the Ministry of Islamic Culture and Guidance that raised awareness of population issues in Iran and promoted family planning services. The idea spread that “two children are enough”.

The fertility rate plummeted from 3.2% in 1986 to 1.2% in 2001, one of the fastest drops ever recorded in history. At that time, the UN projected the birth rate from 2005 to 2010 to be fewer than 2, or replacement-level fertility.(2)  In 2008 Iran’s total fertility rate exceeded this goal, dropping down to 1.71.(3) This is despite President Ahmadinejad’s announcement in 2006 that he would like to see the population rise from 70 to 120 million. “I am against saying that two children are enough. Our country has a lot of capacity. … for many children to grow in it. … Westerners have got problems. Because their population growth is negative, they are worried and fear that if our population increases, we will triumph over them.”(4) After this he was heavily criticized by the media, especially since at the time unemployment was high and there was (and is) a limited supply of clean water. Fortunately the President’s words seem to have little effect on the people of Iran, as the growth rate is still hovering at 1.2%.(5)

There are still many gains to be made in women’s reproductive rights in Iran. Currently, abortion is legal, however only if the pregnancy puts the mother’s life in jeopardy. In 2005, Parliament approved a bill that conceded more allowances for women to terminate pregnancy, such as instances where the child had a detrimental birth defect.(6) However, a month after it was passed, it was rejected by the Council of Guardians.(7) Despite legislation, there is a large backdoor market that puts many women at a great health risk every year.

(1) Iran Promoting Birth Control In Policy Switch, Washington Post. http://www.highbeam.com/doc/1P2-1004654.html

(2) Janet Larsen, Iran’s Birth Rate Plummeting at Record Pace: Success Provides a Model for Other Developing Countries. http://www.earth-policy.org/index.php?/plan_b_updates/2001/update4ss

(2) http://www.nationmaster.com/graph/peo_tot_fer_rat-people-total-fertility-rate

(3)Guardian: Ahmadinejad urges Iranian baby boom to challenge west. http://www.guardian.co.uk/world/2006/oct/23/iran.roberttait

(4) CIA World Factbook: Iraq. https://www.cia.gov/library/publications/the-world-factbook/geos/ir.html

(5) Iran’s Parliament eases abortion law. http://www.dailystar.com.lb/article.asp?edition_id=10&categ_id=2&article_id=14225#axzz1CJUsrKGm

(6) Iran Rejects Easing of Abortion Law. http://www.lifesitenews.com/news/archive/ldn/2005/may/05050909

photo: http://www.payvand.com/news/09/apr/1183.html

What is the situation for schools in refugee settlements?

January 27th, 2011

After researching and writing the last blog entries, I realized that I didn’t have a good idea of what a school in a refugee settlement would be like or what issues a school would face. So this week’s post will include some facts about refugee schools in general, and then take a closer look at Bhutanese refugee schools in eastern Nepal as examples of success stories of refugee settlement schools.

According to the UNHCR (United Nations High Commissioner for Refugees), refugee education is fraught with many difficulties, and in general this causes “generally low standards in refugee education” (1, p. 111).  Firstly, many refugee settlements are in developing countries that are trying to build or improve education systems for their citizens, not to mention any refugees that may also be living in the country (1, p. 111). As our guest speaker last week mentioned, even if access to school is provided, it doesn’t necessarily mean adequate education, and often most girls, and many boys, don’t make it to secondary school (1, p. 111).

Availability and training of teachers is a big issue for schools in refugee settlements. While teachers may be committed and driven to make a difference, they often don’t have the necessary experience or training when they are first hired. The UNHCR recognizes this problem and has instituted teacher training programs that emphasize on the job learning in order to help teachers that are already teaching (1, p. 7).

Money is also a problem for refugee schools. Learning and teaching supplies, school fees, physical school buildings, and many other things necessary for a school to function all cost money. The UNHCR funds schools that support thousands of children, often through on-the-ground partners who deal with the practical, everyday running of schools and training of teachers (2, p. 9). As of 2002, over 40% of children registered as refugees were of an age to be in school. In Uganda alone, the UNHCR supports about 50,000 children in 84 different schools (2, p. 8). Often the UNHCR is the main funder of refugee schools. Without funding, schools may have to close, leaving refugee children without possibility of education.

However difficult the school situations may be in refugee settlements, many refugees list education as one of their top priorities, after basic survival needs (3).  In fact, in some developing countries refugee school communities appear to be more motivated and organized than schools outside of refugee settlements (1, p. 7) because securing a future for themselves and their children despite their hardships is such a priority (3). It has been shown that in Nepal and Uganda, students from some refugee schools perform better than the students at national schools in the same area (1, p. 7).

One success story comes from Nepal: refugee schools in the east of the country have been able to achieve very strong programs at a relatively low cost, and can serve as good models for effective management of other schools.  This success stems from many reasons: extensive participation of the refugee community in the school (for example, many of the teachers are parents, and the teachers themselves are refugees), a sharing, committed environment, continued curriculum development, textbooks produced in the settlements that cost far less than the alternatives, and exams that are recognized by the Nepalese government. According to the “Learning for a Future: Refugee Education in Developing Countries” report by the UNHCR, the three most important qualities for success in both this refugee camp and others are: “positive attitudes, recognition of the importance of the teacher, and good organization” (1, pp. 139-147).

Positive attitudes seem not to be a rare occurrence in refugee settlements, as far as education is concerned. To end with a quote from Ruud Lubbers, the UN High Commissioner for Refugees,

“Contrary to popular opinion, visiting a refugee camp or settlement is frequently an inspiring experience. For while refugees undoubtedly suffer a great deal of hardship and trauma, they also show tremendous determination to make the best of a bad situation and to prepare for the day when they can resume a normal way of life. This determination is to be seen most clearly in the very high value which refugees place on all forms of education” (3).

1. http://www.unhcr.org/3b8a1b484.pdf

2. http://www.refugeelawproject.org/working_papers/RLP.WP09.pdf

3. http://www.unhcr.org/cgi-bin/texis/vtx/search?page=search&docid=4a1d5ba36&query=refugee%20education

♫ If you wanna be happy for the rest of your life/Never make a pretty woman your wife/So from my personal point of view/Get an ugly girl to marry you ♫

January 27th, 2011

When Jimmy Soul sang these lyrics in 1963, I am sure he had the best of intentions. He wanted every girl who was ever told that they weren’t pretty enough or who ever cried herself to sleep because someone had brazenly told her she was downright ugly to know that they shouldn’t be worried. At the end of the day she was a better catch than a pretty girl. The reason being she would never cheat, and certainly she was bound to be a good cook. Yes, his 1963-gender-biased song is easily retrospectively criticized, but how different is it from the current mantra we often tell our young girls in the hopes of deterring them from mental illnesses such as depression, eating disorders and anxiety disorders?

Don’t worry you don’t really want huge boobs anyways; yours will grow soon.

God gave you brains instead of beauty just use what you’ve got.

One day those girls will all be working for you.

Just like the well-meaning Jimmy Soul, we are ignoring the fact that a little girl, most likely on the cusp of puberty (which is arguably the most traumatic event in every girls’ life, where chaos is the norm with her body) is dealing with some difficult emotions and is basically being told to swallow them. Furthermore, we are completely ignoring the fact that even the pretty girls may have maladaptive issues with their changing bodies, and no one even bothers to consider that they too may be in turmoil. This is the well-meaning, but hazardous way we treat youth and adolescent girls that keeps them from addressing their mental illness early and thereby quickly abating the illness.

Keeping this in mind and after hearing Piya Sorcar’s guest lecture about the success of TeachAIDS it seemed that my blog post last week needed to be revisited. I decided to research interventions in mental health for youth and adolescent girls. Not just any interventions, but successful ones that were actually making a difference for young girls. I was hoping to bring about something positive perhaps even enlightening to a topic that when discussed seems to only thrive when we see images of the most depraved consequences of mental illness. We have been lambasted by images of eating disorders, depression, and other mental illness, as a way of promoting their awareness, but it is to the extent that we have become inured to these images and their shock value is no longer effective. It is about time we took a different approach to mental illness in general, but it is even more important that we take a different approach to mental illness in youth and adolescent girls because more often than not it affects the women they become and we lose their potential influence on the world.

The first article I encountered immediately began by restating much of what I have said and a bit more. “Most mental disorders begin during youth (12-24 years of age), although they are often first detected later in life.” (Patel et al., 2007) Furthermore [mental illness in youth and adolescents] is often correlated with other health and development discrepancies, including lower educational achievement, substance abuse, violence, and poor reproductive and sexual health. (Patel et al., 2007) Incidences of self-harm and suicide increase at these ages as well.

Patel et. al argued that despite there being several interventions to prevent mental illness available, even in developed countries, the rate at which the related mental-health care they receive fails to meet their needs is nearly 100%. Basically, these youth and adolescent are being ineffectively treated nearly 100% of the time. Yes, 100%. This is shameful especially in developed countries where access is less of an issue than in developing countries, and it is often because we tend to deliver healthcare in general for young adults in outpatient settings for adults. We need to be revise our interventions to have a youth-focused model and we also need to integrate mental health disorders into the spectrum of young adulthood diseases.

Subsequently, in Computers in talk-based mental health interventions I found a likely candidate for a youth-focused intervention. We are the generation of laptops iPhones, iPads, and digitized and hand-held everything. Why not use the object we use most as a assistive tool for mental health? Previous research, while limited, has shown the potential of technology in mental health settings. (Coyle, 2007) Current interventions including drug interventions are clearly not working as the majority of people suffering from mental illness do not receive the required or even adequate treatment. Therapists and psychiatrist on the other hand argue that this is an issue of access, but research has also shown that often patients with access do not want to open up with their doctors and thus fail to get adequate treatment. (Coyle) Selfishly, mental health workers are also worried that trying computer-based interventions will damage the patient-doctor relationship and even make it obsolete. However technological interventions and patient-doctor interactions are not mutually exclusive and instead computer based interventions should be seen as a tool to help adolescents open up more easily. This will certainly decrease the preponderance of adult mental illnesses and unnecessary drug interventions.

Technology and computer based interventions still needs much research, but anyone truly familiar with our youth and adolescents will know that they are often more prone to interactions when they are in an environment that is normal and replicates their everyday existence. So what’s the harm in trying?

Works Cited

Coyle, D., Doherty, G., Matthews, M., Sharry, J. (2007). Computes in talk-based mental health interventions. Interacting with Computers 19, 545-562.

Patel, V., Flisher, AJ., Hetrick, S., McGorry, P. (2007). Mental health of young people: a global public-health challenge. Lancet 269, 1302-1313.