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The Black Widows of Chechnya

February 24th, 2012

For most Islamic terrorist groups, using female suicide bombers is a relatively new phenomenon.  However, Chechnyans, Ingushetians, Dagestanis, and other Caucasians have long been recruiting women.

For a bit of a background, the Russian empire initially took over the Caucasian region during the 19th century.  At the time of the Russian Revolution, most of the Caucasus attempted to regain independence, and many ethnicities grouped together in solidarity.  However, the Soviet Union eventually recaptured the entire region.  During the USSR, the Caucasus was subject to a number of russofication campaigns, in addition to forced resettlements, land takeovers, and other far more serious human rights abuses.  Once the Soviet Union grew weaker in the late 1980s, nationalism rose and small rebellions started throughout the mountains.  Armenia, Azerbaijan, and Georgia became independent after the fall of the USSR, and other former Caucasian republics also clamored for independence (most notably, Chechnya, Ingushetia, North Ossetia, and Dagestan).  Fighting has continued throughout the 1990s and 2000s, with two official wars: the First Chechnyan War (1994-1996) and the Second Chechnyan War (1999-2000, with sporadic ongoing fighting).

The Caucasus has a strong nationalistic tradition, and is know for being one of the most ethnically, linguistically, religiously, and geographically diverse regions in the world.  Unofficially, they are also know for a more “macho” and paternalistic culture, and are often compared to southern Europeans by Russians.

“Black Widows” is the new nomenclature for the Caucasian female suicide bombers.  The name comes from the fact that many of them have seen their husbands, fathers, sons, and brothers die in the ongoing conflict with Russia.  It is popularly assumed that they choose to commit such a heinous act as a sort of “revenge killing”.  However, before jumping to conclusions as to their motivations, one must examine the demographics.

Out of the 26 female suicide bombers (or shahidka) from 2000-2005 only 5 (19.2%) were widows.  But, nearly all had lost close family members at the hands of the Russian forces, and as expected, they suffered from depression and other psychological conditions following these traumatic experiences.  So far, it is possible that these women were mainly motivated by a desire to seek revenge.  But still, the leap from anger at a death to a suicide attack is pretty wide.  I think there have to be other reasons.

Historically, Islamic Caucasians are more liberal than their counterparts in the Middle East.  For example, wine is enjoyed at many celebrations, and women were actually forbidden to wear hijabs during Soviet times.  In recent years, the region is become more “Islamicized” as a reaction to Russian aggression.  Although, even the Kemlin-backed President of Chechnya Ramzan Kadyrov has started to implement some aspects of sharia law, and even supports honor killings, polygamy, and shooting women who are dressed immodestly with rubber bullets (among far more horrifying ideas).  But, as previously mentioned, Caucasian Muslims have been rebelling against Russian rule for at least 150 years, and so I hypothesize that the issue is more one of ethnic pride than religious fervor.

Back to women, those from the region have traditionally been allowed to work outside the home and pursue higher education.  Sharia law was not enforced during the last century.  This has been posited as a possible reason why women too were on a more equal footing with men, and also expected to carry out attacks.

Other assert that most shahidkas were coerced, through violence, threats, and drugs into carrying out their attacks.  Most of these claims have been debunked however.  They stem from the testimony of failed bomber Zarema Muzhikhoyeva, a Chechnyan Ingush widow who in 2003 changed her mind and alerted authorities so as to not detonate her bomb.  She told authorities that she decided to become a Black Widow after her husband was killed by Russian forces, however it was later revealed that he actually died in a business dispute.  Afterwards, she testified that she was abused by his family and that they stole her daughter away from her.  She turned to suicide bombing as a last resort to regain some sort of respect, and provide financially for her daughter.  She also claimed that she was drugged throughout her training and upon her arrival in Moscow before she was sent on her mission.  Zarema’s statements have changed throughout her trial, so it is hard to know what to believe.  She and her lawyer ended up presenting a case of a woman suffering in a backwards culture who had no other option but a suicide attack.

Personally, I think there are multiple reasons why women make up nearly half of Caucasian suicide bombers.  It is true that women are freer to interact with men, which makes training easier to coordinate.  While recent attacks are changing this stereotype, women are not expected to be suicide bombers, so they can often slip in unnoticed.  It is also easier for women to hide bombs under layers of closing.  As for motivation, the fear of rape and economic devastation at the hands of the Russians coupled with experiencing the deaths of multiple family members and friends is a powerful galvanizing force.  I do not think though that these women are drugged or kidnapped by terrorist organizations. They have ample recruitment opportunities, so I do not think it is necessary for them to resort to force (but it may be true that bombers are given sedatives to relax before carrying out their mission).  I have concluded that the differential treatment or discrimination against women is not a reason why there are so many black widows.  Instead, they are simply seeking vengeance and some form of twisted justice after the many atrocities of the ongoing conflicts have killed many of their male counterparts.

Nota Bene:  Anna Politkovskaya, the celebrated journalist and human rights activist who was gunned down outside her apartment in Moscow, told CNN in 2003 “There is a line of (young women) hoping to be chosen as candidates for being suicide bombers … They say they want to force Russians to feel the same pain they have felt.”

 

A Positive Intervention in a Conflict Ridden Country: Iraq

February 24th, 2012

I mentioned this briefly in class, but this week’s readings were particularly difficult for me as we talked about women in war and refugee situations.  The reason it was so tough for me was because I could see no solution or protection for women aside from long term, insitutional or cultural shifts. But then, in class, Ben mentioned a thing he does when things get too be a little too saddening, look for positive interventions. So I decided to follow his advice and started by looking on a site he recommended called Insight on Conflict. [1] Seeing as I’m focusing on the Arab and Muslim world and those worlds are full of conflicts, it wasn’t too difficult to find a country to zero in on and look for positive interventions there. I decided to examine Iraq, since it was a country I had long been interested in blogging on, and which is fraught with conflict and challenges as the United States pulls troops out of the country.

Searching under gender on the Insight on Conflict site, I found just five organizations in Iraq, which is actually not too bad. But, as I was researching two of the organizations which the site recommended, I ended up running across another organization which caught my eye. Unlike the countrywide interventions I talked about in Tunisia, this group, called Al Mustaqbal Women’s Center, is just a small organization in the southern Iraqi city of Basra. What drew my attention to the organization was, first and foremost, the name of the group, Al Mustaqbal, which means The Future in Arabic. Something about the name just seemed very beautiful and promising to me. I was then drawn to the fact that the group is trying to educate on violence against women, a topic which has been at the center of our class the past few weeks.

Founded by a woman attorney named, Zainab Sadik Jaafar, Al Mustaqbal has launched a public education campaign which denounces violence against women. They also held symposiums to bring these issues not just to light, but into an open forum where they could be freely discussed. They also tried to brainstorm solutions and the underlying causes of violence against women in Iraqi society. In doing so, they were able to diminish fears that people felt about the local militia group called the Mahdi Army. [3]

The organization also raised money to fund the making of a documentary called “Be Tender with Flasks” which features women’s activists and Islamic leaders calling for the end of violence against women and “honor killings”. [4] Honor killings are ones in which a family kills a daughter for some sort of transgression, a premarital relationship, rape, and other things which supposedly bring dishonor to the family. The only way these families see to regain that honor, is to kill the daughter. This documentary, which appeared on local and regional satalittle channels, also really emphasized that the teachings of Islam promote peace and the “special status of women in society”. [3]

It was fascinating to read about this group, which one writer describes as having combined the non-profit model with innovation. That is to say, women are leveraging their education to lower violence and teach about recovery in their local area of residence. [5] Particularly in Iraq, I think it’s great this is a community run center which focuses on just one area of the country because Iraq is so divided. In looking at the country and the history of its formation, it is very fractured and often ruled over by tribal or sectarian groups rather than powerful local governments. So, in Iraq, it makes sense to have more local and specific organizations rather than countrywide interventions which are unlikely to be persuasive to people who live by local rule.

By doing a Google search of the group, I was also excited and fascinated to see that a group called the Open Society Foundations, a group which is dedicated to “building vibrant and tolerant democracies whose governments are accountable to their citizens”, had given a grant to Al Mustaqbal Women’s Center. The grant, given in 2010 was worth $49,800, a decent sum of money for a local community center, which makes me think that this organization has to be making an impact to merit such an award. [2]

Thus far, Al Mustaqbal Women’s Center has made significant gains in raising awareness about violence against women. It is by no means an end in itself, but it seems like a very good start to eradicating a practice which is so widespread in Iraq and often worsened by the tensions created by conflict in the county.

Works Cited

[1] Insight on Conflict: http://www.insightonconflict.org/
[2]Open Society Foundations: http://www.soros.org/initiatives/women/focus_areas/grantees/amcw_2010
[3] http://www.usip.org/events/women-fighting-peace-in-iraq
[4] http://web.peaceops.com/archives/1885#more-1885
[5] Female Entrepreneurship in Iraq: http://www.pitapolicy.com/?p=462

Food Security and Sexual Violence

February 24th, 2012

One thing that we read about in class this week briefly was food distribution in refugee camps and how sometimes those distributing food withhold the food from women in exchange for sex acts, or give women more than their ration in exchange for sex acts. I had a difficult time again this week in finding empirical evidence (or even qualitative evidence, for that matter) that a particular intervention against sexual violence has been transformative. There may be numbers out there on their success, but I was unable to find them — more research needs to be done on interventions in refugee camps. Nevertheless, several agencies have guidelines for reducing sexual violence against women, and several suggest that food distribution is very much related to sexual violence and other issues. While I didn’t find any articles specific to Somalian refugees, what I found can most likely be applicable to women refugees most anywhere.

Many articles I read discuss how in some cultures, before coming to a refugee camp, women are responsible for many/most aspects of food cultivation, production, and management. However, when they arrive in refugee camps, quite often the food ration card is given to a male member of a household (if there is one). Sometimes, men end up selling their food rations for luxury items like beer or cigarettes, and the women have no control. Many camps have attempted to give women control of their family’s nutrition by  making females the ones who are able to pick up their family’s food rations. While this is a good practice, it still doesn’t guarantee that women have control of the food.

Specifically related to sexual violence, many camps are having women distribute the actual food rations to other women, rather than having men do so (which puts women at risk when men demand sexual favors in exchange for food). One study in the late 80s in a refugee camp in Tanzania found that when women distributed the food, the rations were more equal and the outcomes more fair.

However, the use of females in distributing the rations does not fix every problem. For example, typically in refugee camps, food rations consist of only grains and oils. Thus, some reports have found that women perform sexual favors in exchange for other foods like fish, and sometimes don’t actually receive the food they were promised. I think a good intervention to solve this issue is to find ways for refugees to work and earn a livelihood, which will increase their agency and protect their dignity while providing them with funds to purchase more desirable and nutritious food.

Several groups have issued reports relating sexual violence and unequal access to nutrition to food distribution, and these groups have guidelines for female-controlled distribution of food. For example, the Inter-Agency Standing Committee, a non-profit focused on coordinating humanitarian assistance between UN and non-UN groups, has entire section devoted to food security and nutrition in its gender-based violence guidelines. Here are just a few examples:

  • women need to be involved in all decisions about food security and distribution
  • food must be distributed during the day with enough time for women to return home during daylight hours
  • food ration cards should be registered under the names of women and children
  • locations of distribution points should be far from areas where a lot of men congregate, especially in places where alcohol is used liberally
  • help women find access to cooking tools, firewood, etc. so they do not fall prey to gaining these things through sexual acts
  • encourage women to form collectives to collect their food
  • road to food distribution site must be well-lit and often used by other members of community, and also, not farther than nearest firewood or water site
  • secure funding for transportation for women who cannot travel from home to food distribution site
  • hold food distributions twice a month

This is just a start, but it seems several agencies and groups are recognizing women need to be in charge of their food sources as one way to potentially keep them safe.

 

References

1) Forbes Martin, Susan. Refugee Women. 2004 (book).

2 Inter-Agency Standing Committee. Guidelines for Gender-Based Violence Prevention Programs in Humanitarian Settings. September 2005 (http://www.ccsdpt.org/download/GBV_guidelines_Eng.pdf)

3) http://www.iiz-dvv.de/index.php?article_id=724&clang=1

4) http://fex.ennonline.net/3/role.aspx

5) http://www.unhcr.org/refworld/country,,HRW,,BTN,,3fe47e244,0.html

 

Holistic Change for Women: Venezuela and Banco de la Mujer

February 23rd, 2012

This week we will look at an absolutely incredible intervention that attacks the feminization poverty intelligently and compassionately. The Banco de la Mujer, or Banmujer, of Venezuela aims to empower women not only economically, but also politically and socially. Established on International Women’s Day in 2001, its goal was to target specifically the women who composed seventy percent of Venezuela’s impoverished through state-sponsored micro-credit programs (Embassy). However, Banmujer takes a holistic approach and uses not only financial, but also non-financial programs to make sure women are truly able to empower themselves beyond just material capital (Wagner).

Around the time of Banmujer’s founding, there had been an increasing trend of women in Venezuela’s work force. From 1990 to 2002, the percentage of employed women in Venezuela rose from 35.6% to 81.2%. While this is a vast improvement in terms of women entering the labor market, which as we have discussed is a key to ending the feminization of poverty, women also came to hold majority of informal sector, low-salary jobs. By 1998, 35% of women occupied informal sector jobs. Coupled with the fact that most government attempts to mitigate unemployment benefited men, Banmujer was an essential intervention for women. (Wagner)

Let us first look at financial empowerment through Banmujer. Financial help through Banmujer include “low-interest loans called micro-credits, consultancy in forming and developing projects, administrative training, and follow-up on the investments” (Wagner). By coupling financial education with resources, the ultimate goal is to help women establish sustainable, personal businesses. Unique to the Banmujer methodology is the use of promoters, rather than bank offices. Similar to what we have discussed with community health workers, Banmujer had a team of promoters who personally visit Venezuela’s most impoverished communities to discuss the resources and benefits of the bank. This is particularly crucial and commendable given how many communities are challenging to access. The promoters help women to plan promising economic projects and to apply to Banmujer. Should a project be approved, the promoters then help form cooperatives, which are then trained to manage their business plans. The idea of cooperatives is also key to Banmujer’s approach. The bank requires that loans be given to groups consisting of at least five women, or groups of five composed primarily of women. These groups, or cooperatives, are then incentivized to cooperate with one another rather than compete. Project plans are designed by the cooperatives themselves. The promoters do not design the projects, as they want the women to empower themselves. Multiple cooperatives are further encouraged to work together. For example, one group will raise chickens, another will kill them, and a third will sell them. This helps create further community solidarity. (Wagner)

Outside of financial resources and training, the bank also offers various workshops. These include courses on personal development, gender perspective, health, and self-esteem. These can also include workshops on preventing and reporting domestic violence or discrimination. Furthermore, they encourage women’s political participation. In cooperation with the Ministry of Health and Barrio Adentro community health clinics, Banmujer provides workshops in sexual and reproductive rights. Not only does Banmujer want to improve women’s financial situations, but they also want to improve their quality of life. (Wagner)

And Banmujer has had undeniable results. At its ten year anniversary, Banmujer had given 127,614 loans, of which ninety-seven percent were to women. They created 479,643 jobs and organized 16,159 workshops. Of the 207 networks established, 97% involved women. In terms of household changes, 49% became self-sufficient for food, there was a 6% decrease in households where children have to work, and the percentage of households where husbands and wives share earning power increased from 19% to 30%. (Embassy)

As the President of Banmujer Nora Castañeda said, “Banmujer tries to create a level playing field by empowering these women not just economically, but also politically and socially. It’s a social development bank that assesses the viability of projects, and provides training in citizenship, organization, leadership, education, health and self-esteem as well as personal development. We are not building a bank – we are building a different way of life” (Venezuela). As with so many issues we have discussed in this class, the feminization of poverty cannot be attacked simply through one lens. Change cannot simply be economic. As Banmujer demonstrates, phenomena change can occur through such a holistic approach.

Works Cited

Embassy of the Bolivarian Republic of Venezuela to the UK and Ireland. “Fact Sheet: Celebrating 10 Years of Venezuela’s Women’s Development Bank: Banmujer”. 16 February 2011. http://www.embavenez-uk.org/pdf/fs_Banmujer.pdf.

Venezuela Information Office. “Revolutionizing Women’s Roles in Venezuela”. 11 October 2008. http://www.womenandcuba.org/Documents/viowomen.pdf.

Wagner, Sarah. “The Bolivarian Response to the Feminization of Poverty in Venezuela”. 5 February 2005. http://venezuelanalysis.com/analysis/918.

“It felt like somebody took my body”: An Overview of Postpartum Depression

February 23rd, 2012

“ And it just worsened and 3 days after I was home … I didn’t want anything to do with him [the baby]/and he cried and cried” (5)

 

Outside of the course, my academic interest primarily focus on parental engagement and a child’s linguisitic competency. Mother-child physical and verbal interactions are crucial for a child’s development. Often, the quality and quantity of speech a child hears from a caretaker can serve as sufficient predictors of later language outcomes. This is the reason that I chose to focus this week on a mental health issue that can potentially disrupt such interactions between mothers and their children. While I initially intended the focus of my blog to be around acute traumatic experiences and mental health issues that subsequently arise, post partum depression is an mental health issue that affects women globally and is an important problem that needs to be touched upon at least once throughout my blog.

Post partum depression is a form of clinical depression which usually first manifests itself within the first four weeks after birth and generally lasts six months after giving birth to a child (1). During this period, great hormonal changes and psychosocial factors emerge to trigger the onset of the disorder. For the most part, rates of PPD in developed countries is consistent. There are three distinct stages of PPD (in order of increasing severity: PP blues, PP nonpsychotic depression, and PP psychotic depression) and data from the United States and Germany estimate this to be anywhere from 8 to 15 percent of pregnant women could be classified into one of the three stages (2). Although these figures are cause for concern, it is even more concerning given the fact that most instances of PPD are unreported, often because of stigma attached to mental illness and demonization of mothers who are suffering from the illness (i.e. PPD mothers who have harmed their children physically are often sensationalized in the media, creating social barriers for women who are depressed to seek help) (1).
This is especially problematic given that two risk factors of PPD (unhappiness about pregnancy and child mortality) would likely manifest itself disparately in developing countries. When family planning is unavailable or difficult to access, the likelihood of a woman having an unwanted child is increased, putting her at risk of devleoping PPD after giving birth. Additionally, the infant mortality rate in developing countries is often much higher than that of developing countries. An example of a country where women may be at a unique risk is Afghanistan. According to UNICEF, Afghanistan ranks second in the world in terms of under-5 child (infant mortality rate in 2009 was 134/1000 live births) and also relgious customs often make access to family planning difficult if not impossible (although there is some glimmer of hope that these religious customs are becoming less of a barrier to access, see referecne 4) (3, 4). Given the prevalence of both of these risk factors in the country, one would expect rates of PPD to be much higher in this country. However, one can only make inferences since data on the rate of PPD in Afghanistan is not readily available.
In looking for possible treatments and preventative measures, anti-depressants are often looked to as the answer. However, in resource poor countries, this is not always the best option financially (expense of anti-depressants) and logistically (distribution of the medication to women who need it). One Canadian study approached the issue with this in mind and sought to look at what mitigated some of the symptoms of PPD experienced by theses women. They found a negative correlation with the mother’s perception of the father’s involvement in the care of the child and severity of PPD symptoms. (5)
Overall, after researching this important issue in women’s mental health, I was disheartened by the seeming lack of data surrounding this issue in the developing world. One argument explaining the lack of data in these developing countries is that PPD is not distinctly recognized as a valid mental health issue. Another argument put forth is that the family unit is often stronger in non-Western cultures and thus PPD is prevented since this support system exists (2). Whatever the reason for this lack of information, future research should seek to provide more insight into the non-physical experience of new mothers.

References:
(1): http://jama.ama-assn.org/content/287/6/762.full
(2): http://www.aahperd.org/aahe/publications/iejhe/loader.cfm?csModule=security/getfile&pageid=39147
(3) http://www.unicef.org/infobycountry/afghanistan_statistics.html
(4) http://www.nytimes.com/2009/11/15/world/asia/15mazar.html?_r=1&hp
(5) http://www.biomedcentral.com/1472-6955/8/8

Visayan Forum Foundation, Inc. &the Fight Against Human Trafficking

February 23rd, 2012

After a variety of Google searches, I was able to find what one group called the Visayan Forum Foundation, Inc. (VF) in the Philippines was doing to help combat the trafficking of Filipinos that was founded by Cecilia Flores-Oebanda who I quoted in an earlier blog post in regards to what should be done to end human trafficking.

As written on their website, this NGO has a vision of “a world where vulnerable migrants are free, protected and empowered.”Their missions are as follows:

Mission 1: To develop and share models of interventions in source, transit and destination areas to reduce vulnerabilities to human trafficking, domestic servitude, slavery and other forms of exploitation.

Mission 2: To enhance core programs and specialized services to ensure the transformation of individuals from conditions of vulnerability to a state of empowerment.

Mission 3.To build and facilitate social movements that address root causes which perpetuate abuse and exploitation.

Mission 4: To advocate for the public and private sectors to adopt policies and effective measures that promote concrete, practical and sustainable solutions.

Mission 5: To promote international solidarity for awareness, action and resource sharing and mobilization  (Visayan Forum Foundation, Inc.).

VF has certainly done well on these missions through the work they do in the Philippines, as they are located in 20 provinces and cities with 11 offices, and they have been recognized internationally for their work:

VFFI’s work with child domestic workers has been cited by ILO-IPEC and the United Nations Girls Education Initiative (UNGEI) as an international best practice. Its anti-trafficking partnership with the Philippine government and private shipping companies was also hailed as one of the international best practices by the U.S. State Department in its 2005 Trafficking in Persons (TIP) Report.  (Visayan Forum Foundation, Inc.)

VF has three Migrant Empowerment Programs through which they are accomplishing their missions: the Anti-Trafficking Program, the Campaign for Decent Work for Domestic Workers, and the Community-Based Prevention &Protection Mechanism (Visayan Forum Foundation, Inc.).

The Anti-Trafficking Program fares well first and foremost because VF’s great knowledge of the geography of the Philippines and location of possible trafficking points. VF combats trafficking at these transit points such as shipping ports and airports across the country (HumanTrafficking.org).

Located at these seaports are a well-entrenched Anti-Trafficking Task Force, consisting of Port Police, the Philippine Coast Guard, and the managers and key personnel of Maritime and Shipping Companies, used to enforce laws, detect traffickers, and protect possible victims. They monitor and facilitate the rescue and interceptions of potential and actual trafficking cases in the area. They also help collect evidence needed for prosecution. This sustainable group also helps distribute informational materials and has developed television “infomercials” to warn passengers about trafficking (HumanTrafficking.org).

Near these seaports of interest, VF operates halfway houses run by a multi-disciplinary staff that provides integrative services to protect and heal trafficking victims. These services, mostly for women and children, include temporary shelter, counseling, legal assistance, skills training, and referral for aftercare services. These houses are also the “nerve centers” for information and advocacy inside the ports (HumanTrafficking.org).

There are many integrative services which VF offers to these trafficking victims as listen above. In more detail, they offer personality development seminars, counseling, processing activities, and other psychological interventions facilitated by registered Social Workers and Psychologists. Legal assistance is also provided for those who want to prosecute their traffickers. Skill training and IT training are provided to prepare those for alternative and sustainable work after their case is over and they are reintegrated with their famillies and communities. Education assistance is also provided (HumanTrafficking.org).

Bringing the issue of trafficking beyond the ports, VF has established the Multi-Sectoral Network Against Trafficking in Persons (MSNAT), a national civil society-led initiative whos purpose is to provide direct action, build capacities of partners, advocate for policy reforms and network with local and international agencies  (Visayan Forum Foundation, Inc.).

The Campaign for Decent Work for Domestic Workers is another great program that works well due to the active involvement of domestic workers themselves in its implementation. This migrant empowerment program provides specialized crisis services such as temporary shelter, hotline counseling and medico-legal services to reach out to abused domestic workers. VF does not do this on its own but works with a wide array of partners,  which allows them to build the capacities and mobilize to develop and implement their own programs to promote their rights and protection. Currently, VF is lobbying for the passage of a Magna Carta for Domestic Workers to better address the gaps in existing laws, and VF is also a leader in the campaign for the adoption of an International Convention on Decent Work for Domestic Workers  (Visayan Forum Foundation, Inc.).

Lastly, the Community-Based Prevention and Protection Mechanism were created to address the root causes of human trafficking and other modern forms of slavery. These programs are modeled with parents, children and youth in the urban poor communities of Paco and Pandacan in Manila and in the source region of Negros Occidental. It includes the provision of specialized community based services and genuine participation for and empowerment of parents and children. Bantay-Bata sa Kumunidad or Community Child Watch Network was established to monitor the condition of working children and cases of child abuse. In this network, parents play an important role by watching out for traffickers and ensuring that children go to school. The children and youth of the community also organize their own workshops, seminars and sports festival  (Visayan Forum Foundation, Inc.).

This intevention is very promising for human trafficking in the Philippines because it has been created so specifically for the Philippines, especially regarding the use of the Anti-Trafficking Task Force at the ports, knowing where to look for trafficking, and also having halfway houses closeby to help the victims through a tough transition period. This intervention not only finds the victims but helps them holistically. It also has aspects that reach further than the border of the nation and makes connections with locations where trafficked humans may be transported which is good because just as globalization makes trafficking easier, a global network can be just as useful in bringing an end to human trafficking. Other aspects of what this NGO is doing that I like is its work with domestic workers in helping those abused but now trying to lobby for laws to help protect these workers, and the community-based interventions are also very crucial to protecting whole communities against traffickers. The more vigilant communities are, hopefully the safer they will be from traffickers.

What is great about this intervention is that it can be tailored to do have similar effects in other countries where human trafficking is a problem. Hopefully these programs can serve as models for more interventions in other locations against human trafficking or even continue to be improved to better serve victims of human trafficking.

——————–

References

- HumanTrafficking.org. “Experts Corner: Cecilia Flores-Oebanda, Founder and Director, Visayan Forum Foundation (VFI)” Retrieved from http://humantrafficking.org/expert_corner/7

- Visayan Forum Foundation, Inc. Retrieved from http://www.visayanforum.org

 

The Cambodian User Fee Experience and Health Worker Incentives

February 23rd, 2012

The literature that I’ve explored in my blog series has focused on the variety of experiences that countries have had in changing their health policy as it relates to users fees. Typically, countries raise user fees on people in the health system to promote higher quality of service and  financial sustainability. Often this hits poor people particularly hard. On the other hand, some countries have reduced user fees in order to expand access to people. Both of these approaches have had positive results in certain contexts. However,in my last blog I emphasized how hard it is for countries with weak infrastructure to enforce health care policy in the rural periphery. People weren’t aware of the correct prices for users, and waivers were given on a clientelistic basis. In the article that I approach today, “Formalizing under-the-table payments to control out-of-pocket hospital expenditures in Cambodia”, Sarah Barber et al. describe how informal fees at a public hospital were displaced by formalizing user fees as government policy. In this particular case, it seems that user fees increased utilization by standardizing pricing.

I’ve focused insofar on African cases only, but the Cambodia applies because of the low health indicators and recent policy change regarding user fees. Cambodia has the lowest health indicators in Asia, and the footprint of devastating reign of the Khmer Rouge in the 1970’s is certainly partially responsible for this. Before the change in policy, under the table user fees comprised 45% of the hospital’s revenue. In 1996, the National Health Financing Charter was created and implemented by the Cambodian government with support from international donors. In this health center, focus on increasing and standardizing pay for health workers was prioritized, as well as the formalization of user fees with waiver exemptions. The results were remarkable, with an 30% increase in revenue, a severe drop in under the table payments, and utilization increased 50% over a year. This led to the eventual financial sustainability of the hospital, and donor support evaporated over a four year period.

Clearly, the user fee experience was helpful in this case. How and why under the table payments stopped was unclear though. Performance based payment for hospital workers was only implemented as a sanction for poor behavior, but health care worker payment was still low by any standard. This means that the incentive for corruption and coercing people for additional out of pocket funds still exists. Whether this change holds over time would be interesting to find out. Furthermore if I were designing a study, I would want to interview the health workers of this hospital to find out why they stopped seeking extra pay if their salaries didn’t dramatically increase. I don’t mean to pass judgment on the people working at this hospital — they have an extremely difficult job that doesn’t pay well. Corruption in this case isn’t surprising, they need to eat too. Understanding how to change the incentives of health care workers to address this issue could help undercut the problem of price instability in the health systems in the developing world.

This is reality… :(

February 23rd, 2012

I read an article that stated that,

“Gender inequity is the norm in Tanzania”.

Wow! I didn’t even know where to go from there.

The MKUKUTA (Swahili acronym for National Strategy for Growth and Reduction of Poverty) Status Report 2006 indicates that 60 percent of women believe that wife beating is acceptable as compared with 42 percent of men. 60% women compared to 42% men. This was shocking to me!

This week I decided to look at the issue of domestic violence in Tanzania. Given that I am Tanzanian and I’ve looked at two other countries sides my own, I thought that was a bit odd. Based on my life experiences, which I have shared with some members of the class, I decided to see what published work says about domestic violence in Tanzania.

This same article that I read that had this very gut-wrenching sentence (to me at least), went on to explain how many women in Tanzania do not have the same opportunities as men for education and economic independence, for example, in 2004, a Demographic and Health survey carried out in Tanzania revealed that 68% of men complete primary school education in comparison to 58% women.  Participants in this survey confirmed that, especially in poor families, educating men was more valued than educating women because women were often taken out of school to assist with domestic responsibilities or the fact that they were going to be married off meant that they would benefit another family so it was seen as a loss if they were educated.

The inequities in access to education and the social norms that obligate women to care for their families instead of working outside their homes in Tanzania results in women being financially dependent on men in the nation. This financial dependence makes them vulnerable, and in the case of Gender-Based Violence (GBV), unable to leave abusive situations.

To look at specific statistics on GBV in Tanzania, a study that was carried out by the World Health Organization (WHO) in 2005 of 1,820 women in Dar es Salaam and 1,450 women in Mbeya District found that “41% of ever-partnered women in Dar es Salaam and 87% in the Mbeya District had experienced physical or sexual violence at the hands of a partner at some point in their lives. In both areas, 29% of those experiencing physical intimate partner violence experienced injuries, with over a third of them having been injured in the past year [1].”

In a study conducted by USAID in Tanzania (2008) to get Tanzanian’s perspectives on issues of GBV in Tanzania, participants of focus groups conducted as part of the assessment affirmed that it was common for women to experience violence at the hands of their husbands or partners:

“There may be something the man does and hides it, for example, beating his wife. Still men today have the nature of beating their wives. It’s not something that is discussed openly.” - Adult male focus group participant

When asked why husbands beat their wives, one respondent gave the following answer:

“Men get very angry, and they will beat their wives for any reason. If she cooks or doesn’t cook, whatever, he has to beat her.” - Adult female focus group participant

Where the issue of sexual violence is concerned, the USAID assessment found that many in Tanzania view rape as acceptable behavior for men and boys under various circumstances. In the WHO, 2005 study conducted, 15% of women reported that their first sexual experience was rape. There were many reasons that were cited for rape including men not having enough money to convince women to marry or have sex with them, hormones, girl’s/women’s acceptance of gifts from men, and alcohol use (by both women and men).

One man in the focus group of the USAID (2008) assessment “justified” rape as follows:

“In our community if you approach a girl [for sex] and she refuses for more than three times,  you have to do any effort until you get her, be it by use of tricks or even raping her. You may even use another man to seduce and then do a rough game when she gets into a trap. This is known in our community as “mande,” that is, a number of men doing sex to one girl simultaneously. This is to give her a lesson.”  - Adolescent male focus group participant

YES! MY JAW DROPPED TOO! And I’m Tanzanian!

In addition, in Tanzania, forced sex within a marriage is not criminalize by the law and is not considered rape. One community leader stated that:

“It’s not rape because she went into the marriage. You see? The one who is in the marriage has already agreed. If you have a contract wither and go out of the contract, without a foundational reason, you as a man have been attacked with shame… it’s a shame.”

There is also a culture of blaming women for getting raped in Tanzania. For example, women who drink alcohol, wear revealing clothes, or accept money from men are seen as indulging in behaviors that provoke rape, and if raped are to blame for their demise.

“The girls in town wear clothes that are not worthy. They cause the men to look. So the man gets that lust, he rapes her.” – Adult female focus group participant.

For today, I end here. But this is to give a little insight on the situation of Gender-Based Violence in Tanzania. I read all this and I am so sad but this is the reality of the situation of women in my country.
:( :( :( :( :( :(

This is the reality…
:( :( :( :( :( :( :(

The Men's Story Project: Promoting "Healthy Masculinity" as a Means to Improve Women's Health

February 23rd, 2012

This week, to continue with my theme of men’s involvement in reproductive health interventions I decided to write about The Men’s Story Project (MSP). It may seem that because the project focuses on men and masculinity that it does not relate to this course on women’s health, but I believe that this project will ultimately have important implications for the treatment of women and thus for women’s health. I have learned in class and through research for my blog the extent to which our patriarchal society and unequal treatment of women is to blame for the health problems facing women. I wrote in previous blog posts about the importance of involving men in women’s reproductive health as a way to educate men on women’s health and rights, but there remains the question of whether education will alter men’s understanding of women’s rights and the value society places on women. I think that MSP has the potential to affect these deeper societal changes regarding the perceived value of women. While The Men’s Story Project does not have the improvement of women’s health and rights as a stated goal, the effect that it has on men’s understanding of themselves and of gender roles will have important implications for women’s rights and health.

The mission statement of The Men’s Story Project is: “To strengthen social norms that support healthy masculinities and gender equality, and to help eliminate gender-based violence, homophobia and other oppressions that are intertwined with masculinities, through ongoing events of men’s public story-sharing and community dialogue.” The project involves a diverse group of men presenting pieces that they have created about their own lives to their community. The ultimate goal of the project, which is replicable in any community, is to help increase the “presence of genuine self-expression, peace, health and justice in communities. According to the MSP website the project is intended for local implementation and evaluation around the world.

It is undeniable that gender norms play a large role in the health of women worldwide. Much discussion has been devoted to negative societal pressures on girls, but less attention is paid to pressures that are detrimental to boys. MSP aims to reverse the social training of men and the implications it has on communities. As Josie Lehrer, the founder of the Men’s Story Project stated “a lot of this social training that men receive can yield harm for their health and well-being and also in turn for the health and well-being of men and women and people of all genders around them.” Discussions about gender roles must extend to both women and men if widespread change is to be made. MSP addresses the side of gender and societal role issues that is often overlooked, avoided or ignored.

Another aspect of MSP that contributes to its effectiveness is that it is community-based. As we have encountered repeatedly in the study of global health, community interventions (community health workers, for example) are an extremely effective way to improve health and affect societal change. The men in this project are communicating and expressing their vulnerability to their own communities. They are educating their neighbors about what it means to be a man in this society and what they wish it meant to be a man in this society.

Overall MSP has been extremely well received and has been successful in changing people’s understandings of gender roles and the value of women. Audience members have described the project with words such as inspiring, transformative, freeing, and affirming. Women audience members have commented that witnessing this on stage has humanized men for them. The project has the potential to transform gender roles and gender relationships at a community level and ultimately affect the underlying issues defining the health status of women worldwide. I would be interested to see what sort of impact The Men Project could have in the developing world. It may be extremely difficult to get men to agree to participate in communities in developing countries, but if this barrier could be overcome I truly believe that this project could have an incredible impact on gender roles and ultimately women’s health worldwide.

 

 

Sources:

1. http://www.mensstoryproject.org/background.html

2. http://ultimatemenssummit.com/node/16021

3. CNN News Clip: http://www.youtube.com/watch?v=IIv_0qaFCTw&feature=player

4. http://www.darkhollowfilms.com/?p=462#more-462

5. http://www.ontheissuesmagazine.com/2009summer/cafe2/article/70

Mobile Medic – a technological solution for expanding healthcare access

February 23rd, 2012

For women in most of the developing world, poverty is plagued by disease and little access to medical care. The World Health organization estimates that there is a deficit of 4.3 million healthcare workers worldwide. Sub-Saharan Africa alone contains 36 countries with a deficit of health workers and adequate healthcare. Malawi is perhaps one of the worst in that region. Malawi, a small nation in eastern Africa, is considered one of the poorest countries in the world. In the 2009 Human Development Index, Malawi ranked 160 out of 182 countries, and an estimated 53% of the population lives below the poverty line. These devastating conditions have had a very significant impact on the well being of the women and children in Malawi. In fact, there are only 1.1 doctors for every 100,000 individuals in the country. These shortages are further exacerbated by the difficulties in travel.  Many clinics serve large areas without adequate transportation means or infrastructure leading to decreased patient-doctor interaction. Community Health Workers (CHW) are currently utilized to alleviate this problem. These community representatives are trained in primary care, but must travel large distances for replenishing medical supplies and reporting emergency situations.

It is these conditions that sparked the idea for a mobile healthcare platform in the mind of the founding developer, John Nesbit. In 2007, while completing his undergraduate degree at Stanford, he travelled to Malawi and was appalled to find that doctors would travel over 35 miles a week simply for patient records.  This became the basis for the mobile healthcare platform called Mobile Medic. The program focuses on increasing the communication between CHW and physicians to increase outcomes and access to healthcare for many patients. Cell phones are increasingly being used in Africa and therefore can be utilized as a communication mechanism for this program.

Mobile Medic is based on a free, open-source software in which doctors can remotely access patient records and send alerts to the CHWs. The platform has 5 main objectives: notify clinic of referrals, current status of patient, expand emergency care access, reminders for appointments, and drug information. The program was first test launched at St. Gabriel’s Hospital, which serves over 250,000 patients who are mostly rural farmers. 75 CHWs were given and trained to use inexpensive ($10), refurbished cell phones. In the six month pilot study, the program showed promising results with an estimated $3000 saved in fuel costs and approximately 2.048 hours of the workers time saved. The entire pilot study costed a mere $275.

In addition to the mobile platform, Mobile Medic has also begun partnering with the Ozcan Lab in UCLA for remote testing devices. The lab developed a $15 LED camera that can be hooked up to any cell phone and take a holographic image of a blood sample. This image can then be sent via text to the main clinic for blood diagnosis. While this device is still in the development stage, it holds a lot of promise for the future development of Mobile Medic and remote healthcare.

Mobile Medic has now been expanded to 70% of Malawi’s districts and twelve countries in Asia, Africa, and Latin America. The current results show a four-fold decrease in cost with a 112 time increase in efficiency.  The organization has been partnering with Hope Phones to donate inexpensive phones to these people in Africa. Despite the large advancements that Mobile Medic has made, its founders are aware that the problem of healthcare access is much larger. Yet, Mobile Medic is an effective solution to begin to increase healthcare access to most poor communities in this world, and through this decrease the gender disparity in access to healthcare  worldwide.

Bibliography

Asuncion, Kevin. “Text Messages That Save Lives with Josh Nesbit of Medic Mobile.” Care2 Causes. 2 Aug. 2011. Web. 24 Feb. 2012.

Bulkley, Kate. “Fast Mobile-based Messaging Service Boosts Healthcare and Cuts Costs | Activate.” Guardian. 18 June 2010. Web. 24 Feb. 2012.

Mahmud, Nadim, Joce Rodriguez, and Josh Nesbit. “A Text Message-based Intervention to Bridge the Healthcare Communication Gap in the Rural Developing World.” Technology and Health Care: Official Journal of the European Society for Engineering and Medicine 18.2 (2010): 137–144. Web. 24 Feb. 2012.

Pain, Parotima. “SMS Based Medic Mobile Helps Bridge Healthcare Communication Gap.” AudienceScapes. 2 Dec. 2011. Web. 24 Feb. 2012.

“Population Below Poverty Line.” CIA- World Factbook. Web. 24 Feb. 2012.

Sutila, Tamara. “Malawi Anual Report.” Unicef. Web. 24 Feb. 2012.