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Archive for October, 2012

The Madrid International Plan of Action on Ageing

October 31st, 2012

This act calls for all governments to ensure that the advantages and conveniences of new technologies (especially information and communication technologies) are available to older women.  Since technology such as the internet, cell phones, computers etc. has rapidly increased in the past twenty years, the world is now more connected than ever.  Social media has expanded to the point where people of all ages use Facebook, Twitter, or other forms of communication.  Mail can now be sent and received in a matter of seconds via Email and traditional phone calls are replaced with text messaging.

The worldwide expansion of technology introduces a unique opportunity for “expanding the economic, social, and political condition for women of all ages.”  Older women are typically out of the loop with the current forms of technology and most don’t own computers.  The knowledge of computers and other type of technologies can increase their participation in the current information based society. (Sub Committee on Older Women NGO Committee On The Status of Women)

With access and knowledge to computers, older women can be linked to resources that offer information including employment, the most up to date ways of agricultural, use of natural resources, as well as market their own products.  Older women from the developed and developing countries can benefit from the ability to use informational and communication technologies.  Women from developing countries are often isolated in a rural area where they are bound to their homes because of children or disability.  These women can utilize computers to “maintain contact with individuals and groups for mutual support and to build vital links to the outside world.”  Exposure to the internet may offer women the pathway to health care access that they wouldn’t have known about before.  (Information Communication Technology and  Older Women)

Older women are usually less informed about politics and world news.  Their participation in information and communication technology can help them learn about different perspectives and be more aware about their country.  Not only will the older women be more politically aware, their input and experiences could be shared with the rest of the community or world.  This input from older women can help voice their needs and gain more public awareness, which in turn will help end some of the disparities surrounding older women.  Including older women in the loop of current techologies can increase their quality of life.  With the power to help themselves, the “feminization of poverty at an older age” can be reversed.

Citation
Position Statement on Information Communication Technology and Older Women
http://www.ngocsw.org/blog/about/older-women/scow-documents/position-statement-on-information-communication-technology-and-older-women/

No need to reinvent the wheel – Venture Strategies Innovations

October 27th, 2012

Since we had the pleasure of having Ndola Prata as a speaker in class this week, I thought it would be fitting to highlight her role as Medical Director of Venture Strategies Innovations (VSI), and the numerous endeavors she had referred to in her talk. Ndola provided much statistical information about the state of maternal health today, and cited the successes of programs and research that she had conducted. I was inspired to take a closer look into her work when she answered one of the questions brought up in class. Ndola was asked how her organization was able to convince physicians to provide safe abortions to women in need when the laws of that country did not allow the procedure. Ndola then described how emergency treatment of incomplete abortion is an international right, regardless of the law of abortion in the country. Thus, VSI utilizes this loophole in a creative approach to promote safe abortion.

VSI offers training of physicians for this procedure, but in the training process begins a dialogue with the physician about the importance of women’s access to safe abortions. They discuss how the law of the country can be interpreted to assist these women and how physicians can work around the country’s restrictions. Ndola used the example of Angola, her home country, and how physicians were taught to ‘maximize’ the law by utilizing the financial clause in the country’s abortion law. This innovative approach to increasing access to safe abortion caught my attention and impelled me to further investigate VSI.

Venture Strategies Innovations has numerous other interventions that have original resolutions to issues of maternal health. Under the values of equity, respect, collaboration, expediency, and accountability, VSI utilizes partnerships with existing infrastructure, resources, and markets [1] .VSI differs from the NGOs we have looked at previously, Tostan and Marie Stopes International, because it works with existing organizations, and is not an intervention all on its own. Interestingly enough, Marie Stopes International is a partner of VSI. The aforementioned strategy of teaching physicians how to interpret abortion restrictions is also an example of these partnerships. Additional examples of improving efforts of existing infrastructures are given below:

Task shifting is one way that VSI works with existing providers and clinics to increase access to products, information or treatments regarding women’s health. VSI recognizes the lack of properly trained physicians, therefore outlines tasks that are appropriate for nurses, health workers, and volunteers. There is not only an emphasis on the increased accountability of lower level providers, but there is also an increased responsibility of the woman herself for her own health. [2]

Another approach that Ndola had mentioned in her talk was the use of Misprostol. This simple tablet is an example of the low-tech, inexpensive interventions that have huge potential impacts. VSI works mainly with country governments to ensure availability and negotiate lower prices for this drug. The drug itself stops post-partum hemorrhage, which is one of the leading causes of maternal deaths. Additionally the drug can help induce abortion or expel remnants after physical abortion procedures. [3] VSI has trained over 500 antenatal care providers and community midwives on the use of Misoprostol tablets and as a results 3,800 pregnant women have been enrolled in the Misoprostal program. [2]

Often, when we think about NGOs, we believe that they are implementing an entirely new service or resource. Yet, as Venture Strategies Innovations demonstrates, much impact can come from enhancing the efforts of existing organizations. One of the purposes of this blog was to analyze the tactics of successful NGOs and how other organizations can emulate their success. In essence, this is what VSI has done. VSI embodies the phrase “don’t reinvent the wheel”, and maximizes the effectiveness of their partners.

  1. “Saving Women’s Lives, Strengthening Communities.” VSI. Venture Strategies Innovations, 2012. Web. 27 Oct. 2012.
  2. “Venture Strategies Innovations (VSI).” Center for Health Market Innovations. Results for Development Institute, 2012. Web. 27 Oct. 2012
  3. “Misoprostol.” Medline Plus: Trusted Health Information for You. The American Society of Health-System Pharmacists, 01 Sept. 2010. Web. 27 Oct. 2012.

A Mother's Burden

October 26th, 2012

“Born into their own country they face persecution

And live their lives full of confusion

Oh little boy playing with sand

Shot dead from snipers in your own land

Mother’s tears fall like razor sharp

Penetrating down deep with permanent scars

Oh world wake up his mother screams

Another atrocity with holocaust fears

Peace has been written in Rainbow colors

And doves are praying for all the mothers”

Laila Yaghi, Palestinian Poet,Mother of Zaid Yaghi (in prison) ,Exert from “Tears of Blood”

My last post focused on the physical complications aspect of being a Mother in a Palestinian Refugee Camp, this week I would like to examine another difficult aspect of being a mother in a difficult, dangerous environment: the stress and worry for one’s children. I was curious to look into the relationship a mother has with her children and the impact on her own health as a stress factor after the continuous emphasis that empowering a woman will empower her children and begin a trend of empowerment. There have been examples in the readings from anecdotes and viable data trends showing that investing in women is an automatic investment in the well-being of her children as well. Why? Because in spite of tremendous hardship and suffering, most mothers worry, care, and want the best for their children, so I wanted to examine this relationship and see what are the psychological consequences of such a worry and how could this possibly be used as a tool in mental health interventions? Mental health interventions need to be thought about from all possible angles because mental health care is heavily needed for women in unstable settings due to suffering, poverty, conflict, and/or violence. However, in the same societies mental health is often a difficult and sensitive topic within the community.

As I have described in previous posts, life in refugee camps/conflict zones is extremely unstable and dangerous, especially for children. Hence, children’s well being and future are primary causes of stress for women. I will specifically share trauma/environment related statistics as they pertain to children to give a brief window into the types of issues that trouble the mothers:

Approximately 65% of children suffer from moderate to severe PTSD, the majority of children are reported to suffer from nightmares, bedwetting, frequent crying, and severe anxiety in response to their volatile and unstable environment (not necessarily diagnosed as PTSD). Furthermore, studies range indicating that 80-90% of children in the Occupied Palestinian Territories have been exposed to conflict, violence, or some form of trauma.

There are many other saddening statistics regarding Palestinian children including lack of education, poverty, malnutrition, and likelihood to be imprisoned during their adolescent/young adult period. However, I wanted to focus on PTSD/mental health issues to introduce a fascinating study I came across in the World Psychiatry Journal.

The study examined Palestinian mothers’ perceptions of child mental health problems and services. Essentially using a diagnostic interview, a scale of emotional and behavioral problems exhibited by the child, and a providing a checklist range of emotional, cognitive, and behavioral manifestations of mental health issues, the mother stated whether the manifestation/symptom was “undesirable”/mental health problem or was normal/expected. The mothers also disclosed whether the problem demanded help/treatment and if so which type. What I appreciated about the study was that it provided a data set of how keenly aware and tuned in Mothers were too their children’s’ needs. While I have read in anecdotes/interviews about a Mother’s fear and concern for her children in dismal situations, this offered an actual quantitative and qualitative analysis to show the actual correlation for a “Mother’s concern”. The findings about types of treatment they desire for their insight also gives insight onto which mental health interventions/solutions they themselves trust the most.

The interviews and surveys were done in the El-Nusirate refugee camp in Gaza with 249 families each with children under the age of 16 and an average family size of 6 children. Briefly, the results were that 42.6% of mothers knew there were child mental health centers/services offered in the Gaza region, and 92.7% stated the community’s children had a huge need for mental health services. 70% of mothers said they would take their children to service centers even if it  meant travel. In regards to types of treatment: 84.7% favored “talking treatment” (psycho therapy), 63.1% favored medication, 61% were also in favor of treatment by reciting the Quran, and 38% favored traditional healing methods with healers.

What the findings showed about perspective towards manifestations presented in these two tables:

How frequently mothers perceived various emotional and cognitive manifestations as mental health problems (N=249)

  N %
Phobias (excessive fears) 165 66.0
Somatic complaints 108 43.2
Depression 107 42.8
School refusal 75 30.0
Day time wetting of clothes 52 20.8
Suicidal thoughts 56 22.4
Suicidal behavior 49 19.6
Inattention 146 58.4
Hallucinations 107 42.8
False beliefs 69 27.6

How frequently mothers perceived various behavioral manifestations as mental health problems (N=249)

  N %
Disobedience 174 69.9
Sleep problems 82 32.8
Fighting 123 49.2
Destructive behaviour 102 40.8
Outburst of anger 157 63.2
Verbal abuse of others 139 55.6
Lying 117 46.8
Physical abuse of others 119 47.8
Fire setting 76 30.4
Escape from home 71 28.4
Truancy from school 60 24.1
Drug use 39 15.6

 

Interesting trends to notice: The vast majority of mothers are highly willing to employ mental health services, specialists, and professionals far more than traditional methods. The stigma of the “mental health” label does not seem to apply to the children’s age group. Also, mothers rated “positively” on opportunities to learn more about mental health issues via meetings, talks, and information provided by “professionals”. There was a clear sign of trust to “professionals” and specialists with regards to mental health. Furthermore, the majority were not aware of available services nor about what symptoms could be a sign of mental health problems. Over 90% of women after being told a certain manifestation could be a mental health symptom, were willing to change their responses. What comes across as key issues amongst these mothers is lack of knowledge about mental health, and the frequency of mental health issues in children thus not understanding that even though a problem might be a “norm”in the refugee community, it is not a “norm” in children’s behavior.

The next question is, so what? How can we relate these findings to the women’s well being themselves? Well, I actually found this study extremely encouraging in terms of what can be done in mental health interventions for women. The main take-away detail is that mothers are more than willing to put in the time, energy, and resources to take care of their children’s mental health issues. And, most importantly, they trust and would seek out if available professional advice and services. This knowledge can permeate into a powerful tool for mental health interventions.

The current status of most mental health interventions as described by the Palestinian Medical Relief Society and UNRWA, the two largest groups operating in the territories, focus on the establishment of permanent community centers where mental health services might be offered. They focus on a decentralization of mental-health services from the main health care system in hospitals due to lack of immobility for people in the various refugee camps (I discussed implications of lack of mobility on maternal health in my last post). Also, being separate from governmental services allows the clinics to continue to operate in the face of political instability. And unlike the use of mobile clinics often used for primary healthcare needs and physical exams, it allows for a continuity and sense of stability with treatments. Also, both local and foreign services are provided, in fact Doctors Without Borders’ mental health specialists have found that people are more willing to talk to “Western” professionals because they feel a greater sense of trust that their personal details will not be spread around the community and they will not be judged.

This brings me to mention some further complications to mental health interventions besides basic lack of resources. As in many conservative, developing societies mental health is extremely stigmatized. Often, women will choose not to seek psychiatric help out of fear of being labeled “mentally unstable” and often turn to religious or traditional modes of healing if any. This also leads to lack of incentive to learn about mental health, thus while women describe themselves as constantly “stressed and sick from worry”, very rarely due they classify their state as symptoms of mental health problems. And, in traditional, Arab societies where family and family protection is extremely important, often the causes of stress might be “too personal” to share with others and cause “shame” for their families. Thus the “talking treatment” women desired for children they would not seek for themselves if it meant being open and sharing information about domestic abuse, financial burden, and other problems within their families.

What is critical to note is that worry about children, is not considered a “source of shame”. In fact, alongside lack of resources (a universal burden in the camps), it might be considered one of the few issues that women would be able to speak candidly and openly about. The doctors from the psychiatry study were able to find a plethora of participating families to discuss children unlike other studies that struggle to accumulate interviews and data  on issues such as relationship problems.

Another interesting detail that can help create a successful intervention is the overall success of creating a “sense of community” to overcome challenges. Many  interventions on a variety of topics such as HIV/AIDS in developing countries focus on bringing victims together to discuss their own stories. The empowering and de-stressing factor of feeling “you are not alone” can be a powerful tool in mental health interventions.

Thus, what about using child services as a tool to bring in mothers to mental health centers? A successful intervention would have to realize that perhaps the best way to encourage women to utilize available mental health services would be to offer assistance for a major cause of stress in their lives as well as a part of their lives they are more than willing to seek mental health attention for. The centers can then offer resources for Mothers as a greater space to discuss with professionals or in a group setting. Being a mother is a universal topic that many women can share with each other and feel a sense of community in discussing the challenges in raising children within refugee camps or other causes of worry. While any basic mental health intervention would be provision of services, especially permanent, local services taking away the need to pass through check points or extensive travel, a key component are strategies to encourage use of such services when the issue is a sensitive one. Most women have in these camps will frequently visit physical care services, yet never step foot once in a mental health service center.

Thus,I believe that employing what is actually a wonderful, intimate, and genuine component of mother-children relationships, the concern a mother has for her children, can be used as an intervention strategy to encourage the use of mental health services for themselves.

And as a person anecdote,I actually had the privilege to see a variation of this type of strategy in interventions for mothers first hand this past summer. On the outskirts of Jerash, Jordan, I had the privilege of visiting the UNRWA women’s community center, run by local NGO’s, in the Jerash Refugee camp which consists primarily of Palestinian refugees from Gaza.  In the center, one will immediately notice the children running around the courtyard and toys/activities available to them. Noora, the local head of the center, who grew up in the camp stated that perhaps the most successful tool in encouraging women to come and use the center’s resources such as legal services and counseling was to market the center as a sort of daycare/play-area for children. Safe spaces for children to run around and play under supervision are rare in the camp, thus many women eagerly approached the center under that motivation and from there have remained permanent members of the community naturally built as a result of the center. Noora remarked upon the definite sense of community, while not officially or even intentionally created by the center, that started as a result of the mothers coming to the same place and discussing their children. Those discussions eventually have manifested into other important topics in their lives besides children but came as a result of the initial, secure topic of being able to relate to one another’s motherhood.

I thought the story touching in that the women seeking the best for their children were then able to receive help themselves from the community created and by being in an area where services are available to them.

In conclusion, perhaps a potential strategy for women’s health interventions are to use multi-faceted interventions offering and focusing on other aspects of community development such as their children’s well being as a way to motivate women to utilize existing services and resources. Perhaps it’s an idealistic or even naive approach to intervention strategies, yet it could be one worth exploring.

*And for anyone interested- here is s a great link of photos and a brief description from the UNRWA website of the Jerash camp I worked with during the summer: (This is not a refugee camp in Palestine, but rather a Palestinian refugee camp in Jerash, Jordan)  http://www.flickr.com/photos/einkarem1948/sets/72157620424425144/

 

Works Cited:

http://www.unicef.org/health/index_maternalhealth.html

http://www.pratiquesciencessociales.net/upload/thabet.pdf

http://www.unrwa.org/userfiles/20100119141655.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525116/

http://www.springerlink.com/content/n00m1pu8qd2knw3x/

http://www.doctorswithoutborders.org/news/article.cfm?id=4139&cat=voice-from-the-field

Pre-eclampsia: risk for maternal death

October 26th, 2012

This week I’d like to focus on a specific health condition pregnant women are at risk for that can be addressed with antenatal care: pre-eclampsia and eclampsia.

What is pre-eclampsia? 

Pre-eclampsia is a condition pregnant women may experience, characterized by hypertension and proteinuria. Secondary symptoms include the swelling of the face, feet, legs, and hands. Left untreated, the condition may progress to eclampsia, an acute severe case involving seizures; it may cause a coma or even lead to death.

Prevalence and role in maternal death

Eclampsia is one of the leading causes of maternal death, as an average of 12% of maternal deaths are caused by eclampsia.[i] Though there has been an overall decline around the world, prevalence remains significant in the developing world. For example, in some parts of Latin America such as Brazil, Colombia, or Mexico, estimates indicate that pre-eclampsia is involved in 22%-35% of maternal deaths.[ii] This poses as a concern when considering the risk factors of becoming pregnant and carrying out a full term. According to a study of risk factors for pre-eclampsia among a large cohort of Latin American and Caribbean women, risk factors associated with experiencing pre-eclampsia include nulliparity (having a child for the first time), multiple pregnancy, a history of chronic hypertension, and diabetes mellitus.[iii] These risk factors could possibly affect a woman in any country, but the higher prevalence internationally shows that there must be a difference in either risk or access to care.

Role of ANC

For any disparity, risk or access to care plays a significant role, and I would like to propose that access to antenatal care could be a reason for the difference. A woman that regularly attends ANC would benefit from early detection of this condition—this comes from routine urine analysis and checking the blood pressure of an expecting woman. Prescreening could be done and a special watch could be put on women that are at higher risk—those with chronic hypertension or diabetes mellitus. Onset is around after 20 weeks of gestation[iv] and less severe cases can be treated with magnesium sulfate. The WHO, as a part of their initiative to decrease maternal mortality, recommends screening for this condition at the 32 weeks.[v] Early detection is key to prevent the development to eclampsia, which in severe cases leads directly to death.

In the developing world

Studies show that the reason for this disparity between the developed and the developing world can be attributed to the need for antenatal care. The WHO estimates that the incidence is up to 7 times higher in developing countries.[vi] An article about maternal mortality and pre-eclampsia emphasizes this point here: “these differences are mainly due to universal access to prenatal care, access to timely care, and proper management of patients with preeclampsia–eclampsia in the developed countries.”[vii] Awareness is also important, as a challenge in management of preeclampsia could begin with a delay in the decision to seek health care and/or subsequently reaching a health facility. Overall, a push for awareness towards these maternal health diseases and increased access to ANC seems to be the solution. Early detection is key and receiving the magnesium sulfate early is needed to prevent death from this condition of pregnancy. Researching this conditions reminds me that being a woman anywhere a becoming pregnant results in a set of risks towards healthcare, and no one anywhere should be subject to simple surrender against this maternal disease due to lack of ANC services.


[i] Walker. “Pre-eclampsia.” The Lancet 356 (2000):1260-1265. Web.

[ii] Pan American Health Organization. Health in the Americas. PAHO Scientific Publication No. 569. Washington DC: PAHO, 1998; II:210–220

[iii] Conde-Agudelo and José Belizán. “Risk factors for pre-eclampsia in a large cohort of Latin American and Carribbean Women.” BJOG: An Internationl Jouranl of Obstetrics and Gynecology 107.1 (2000):75-83. Web.

[iv] http://www.sciencedirect.com/science/article/pii/S0146000511001571

[v] WHO, Antenatal Care, in Report of a Technical Working Group, World Health Organisation, Geneva, Switzerland, 1994.

[vi] Osugbade et al. “Public Health Perspectives of Preeclampsia in Developing Countries: Implication for Health System Strengthening.” Journal of Pregnancy 2011 (2011):1-6. Web.

[vii] Ghulmiyyah, Labib et al. “Maternal Mortality from Preeclampsia and eclampsia.” Seminars in Perinatology 36.1 (2012): 56-59. Web.

 

 

Up for Interpretation

October 26th, 2012

There is comfort in knowing that religion is a fluid thing, changing to adapt to the nuances of the times in which the current adherents of a particular religion are living. On the other hand, this poses a struggle between central faith tenants and the cultural changes of a society. This struggle is trying for those caught in their ways of thinking, as they forget that religious texts were written with a future generation in mind. One must analyze religious texts  carefully with these things in mind: the time it was written, the setting/context, the original intent of the author, the applicability to today, etc… That said, there are times that central tenants do not change, where cultural shifts do not necessarily require the religion to follow. Such is the thinking of many pro-life groups, I encourage you to look into the arguments these people are making!

However, today I’ll take a look at Hinduism, a religion that adopts this fluid structure and allows many different points of view to inform their thinking. (Caveat: I am not an expert on Hinduism, so if I fail in any way, feel free to comment and correct me!)

There are 3 central tenents of Hinduism:

  • dharma: the law of life, the moral or natural law. This includes a belief that morality is consistent but adaptive.
  • karma: what individuals and society sow, they will reap.
  • ahisma: nonviolence and compassion to all beings
I’d like to take a look at the first point, dharma, especially the point that morality is consistent but adaptive. It is through this thinking that the state of India was able to pass the very liberal Medical Termination of Pregnancy Act in 1971 without widespread outcry from religious leaders. Though the argument could be made that ahisma, because of its tenent of non-violence towards all beings, does not allow for abortion of a fetus, it is overcome by the fluidity of dharma. In addition, ahisma says that compassion to the mother may be more beneficial for society.
Interestingly, the most progressive city in India, (with an HDI index of 0.79) Kerala, provides family planning and contraceptives for its women and believes in social justice as a means of fertility management. It also has the highest literacy rate in all of India, 86.3% vs. 39% for the whole nation. The female age of marriage is 4 years older than the rest of India. Most of the inhabitants of this city are Hindu.
See: Sacred choices, The Right to Contraception and Abortion in Ten World Religions.

Comprehensive Sexual Education

October 25th, 2012

“Does sex education encourage sex? Many parents are afraid that talking about sex with their teenagers will be taken as permission for the teen to have sex. Nothing could be further from the truth. If anything, the more children learn about sexuality from talking with their parents and teachers and reading accurate books, the less they feel compelled to find out for themselves.” –Dr. Spock, Baby and Child Care author

Given all the information we have about the conditions of sexual education and it’s importance, we must now gather information on effective interventions. What constitutes a good sexual education program and when should it begin? While there is no one approach that would eradicate the problems we so often see, there are various approaches that have proved to be effective. While the abstinence approach has had some positive effects, it should not be the sole approach designated to prevent the negative consequences of early sex. There should be various options available because every individual is different and “sex is inevitable and unavoidable, and society must accept this reality and concentrate on helping adolescents…”[1] While I believe that early sexual education should be tailored to the place where it is being given, for example incorporating culture specific information so that children can actually relate to what they are learning, there are certain characteristics that most effective programs possess. The most effective form of sexual education has proven to be comprehensive sexual education. I will present characteristics of these effective approaches and some evidence of their efficacy.

Characteristics of Effective Sex Education

“Experts have identified critical characteristics of highly effective sex education and HIV/STI prevention education programs. Such programs:

  1. Offer age- and culturally appropriate sexual health information in a safe environment for participants;
  2. Are developed in cooperation with members of the target community, especially young people;
  3. Assist youth to clarify their individual, family, and community values;
  4. Assist youth to develop skills in communication, refusal, and negotiation;
  5. Provide medically accurate information about both abstinence and also contraception, including condoms;
  6. Have clear goals for preventing HIV, other STIs, and/or teen pregnancy;
  7. Focus on specific health behaviors related to the goals, with clear messages about these behaviors;
  8. Address psychosocial risk and protective factors with activities to change each targeted risk and to promote each protective factor;
  9. Respect community values and respond to community needs;
  10. Rely on participatory teaching methods, implemented by trained educators and using all the activities as designed.”[2]

 

“5. Provide medically accurate information about both abstinence and also contraception, including condoms;”The thought that teaching this sensitive subject at such a young age might trigger the initiation of sex is a worry for many, yet “no study of comprehensive programs to date has found evidence that providing young people with sexual and reproductive health information and education results in increased sexual risk-taking. These studies also demonstrate that it is possible, within the same programs, to delay sexual intercourse and to increase the use of condoms or other forms of contraception.”[1] According to the United Nations Educational, Scientific, and Cultural Organization, “[A] dual emphasis on abstinence together with use of protection for those who are sexually active is not confusing to young people. Rather, it can be both realistic and effective.”[1]

Positive evidence for comprehensive approaches have been documented, “according to a rigorous 2008 review of the evidence of comprehensive sexuality education’s impact on sexual behavior, effective programs can not only reduce misinformation, but also increase young people’s skills to make informed decisions about their health.”[1] This review included “87 studies from around the world with experimental or quasi experimental designs: 29 from developing countries, 47 from the United States and 11 from other developed countries. Nearly all of the programs increased knowledge, and two-thirds had a positive impact on behavior: Many delayed sexual debut, reduced the frequency of sex and number of sexual partners, increased condom or contraceptive use, or reduced sexual risk-taking. More than one-quarter of programs improved two or more of these behaviors.”[1]

All of these benefits though, would be reaped under ideal situations, where children stay in school long enough to get the information they need. The unfortunate reality though, is that most girls don’t stay in school long enough to receive these lessons.“…it is crucial to make sexuality education available to girls at younger ages, reaching them in primary schools before they drop out of school.”[3] How then, can these young girls be reached? In my next blog entry, I will explore the ways to reach those who are so often forgotten; the one’s who live in rural areas and who have dropped out of school.

1) http://www.guttmacher.org/pubs/gpr/14/3/gpr140317.html

2)http://www.advocatesforyouth.org/publications450

3)http://www.unfpa.org/webdav/site/global/groups/youth/public/Comprehensive%20Sexuality%20Education%20Advancing%20Human%20Rights%20Gender%20Equality%20and%20Improved%20SRH-1.pdf

Access to Ultrasound: Part 3 – Efforts to Save the Lost Girls

October 25th, 2012

Every sixth girl child’s death is due to gender discrimination.[1]

Last week, I covered the destructive application of ultrasound for sex-selective abortion (a growing epidemic in rural areas worldwide). In cases such as India and China, we’re seeing millions and millions of girls “disappearing” because of sex-selection.  To combat this, there have been interventions at the governmental, non-governmental, and societal levels mobilized to address this misuse of ultrasound.  This misuse of ultrasound has become such an issue that GE, the maker of a majority of these machines, has even put out a public derision of ultrasound use for sex-selective abortion.[2] A pattern emerges from my research on the study of various interventions focused on addressing these issues. Efforts (esp. governmental ones) that outlaw the practice itself – such countries that have done so include China, India, Nepal, Vietnam, and South Korea [3],[4],[5] – are by no means effective, and often the governments have little to no resources to implement the laws.  The successful campaigns and organizations have been those that attack the heart of the problem and focus on increasing the status and rights of the female so that a daughter becomes more and more valuable. In fact, five UN agencies – the United Nations Children’s Fund (UNICEF), Office of the High Commissioner for Human Rights, UN Women, United Nations Population Fund (UNFPA), and World Health Organization (WHO) – have released five categorical action recommendations to address this growing issue: guidelines on technology use in obstetric services that don’t infringe upon equities to access; laws to enhance gender equality (esp. in areas such as inheritance and economic resources); more data on this problem and the effects; supportive measures for females thru means such as education and health services; and advocacy and media support to change behavior and societal perceptions. [6]

Efforts in action to address this issue:

- Preconception and Prenatal Diagnostic Techniques (PCPNDT) Act 1994 (in India): As a timeline for the inception of this act: The Forum against Sex Determination and Sex Pre-selection (FASDSP) began its efforts against discriminatory abortion in 1986; In 1991, the central government of India formed a committee and the act came into action in 1994.  The act allowed for more strict punishments of clinics providing the sex-selection options, empowered authorities to search and seize the machines of violators, and mandated a compulsory registration of all clinics and diagnostic laboratories. However, the financial allocations and local-level political support the implementation of this act was incredibly faulty. [7] In 2001, CEHAT in Mum- bai and MASUM in Pune (both NGOs) took successful legal action against the Union of India and its state governments to enforce the implementation of the 1994 act.

- More successful legislation:

1.       Hindu Succession (Amendment) Act of 2005 – This law mandated that sons and daughters have equal inheritance, thus improving the value of having a daughter.

2.       In addition to this, Maintenance and Welfare of Parents and Senior Citizens Act (MWPSCA) in 2007 stipulated the equal respon­sibility of sons and daughters in the care and support of elderly parents, thus increasing the parents’ want of having a daughter [8]

3.       The Ladli scheme in Delhi, India, added financial incentives to having a daughter. The government would deposit money in the new parents’ bank account when a girl was born, and more deposits would be made as the girls go through school (to promotes girls’ education).  These funds were then made available to the girls upon her 18th birthday if she has remained unmarried and finished secondary school: Standard 10.  Started in 2008, this effort helped 135,645 girls in the first year and 140,006 in the second, and has done a great deal to increase registration of birth and promote parents’ investment in girls.

- Atmajaa (“Born from the Soul”): This was a television series (fictional) that aired in India in 2004. It dramatized the problem of sex-selective abortion in both urban and rural areas.  A study on audience impact found that young women were actually very receptive to the messages of the show.  [9]

- Doctors for Daughters: United Nations Population Fund (UNFPA) teamed up with various medical professional’s associations and the Indian Medical Association (IMA) in 2006 to build up the campaign, “Doctors for Daughters”.  This effort focused on helping doctors understand the laws against sex-selective abortions, fight for girls’ rights within the medical community, and challenge the gender/societal norms in India.

- Incredibly successful case study: South Korea.  Their approach was to focus on altering the social norms surrounding a women’s role in society. By using economic, legal, and social means, the country significantly increased the status of women by including more women in labor market, by passing laws to improve gender equality, and mobilized media campaigns to raise awareness of equality. (6)

Some might argue, why not get rid of ultrasound or regulate it even more strictly? The consequences of these actions would dire as ultrasound plays such a vital part in fighting maternal mortality (see Part 1 of my blog “Access to Ultrasound: Part 1 – The Good”), and as mentioned above such policies are not as effective.  In addition, one issue we do need to consider in all these efforts is the major challenge of fighting against use of pre-selection techniques for gender selection without infringing upon a women’s right to abortion. That’s why efforts to change societal perception of females are more likely to be effective and sustainable in the long run.  The solution really needs to start further back than this physical technology. Similar the sentiments expressed by the NGO’s, at the fundamental root of this problem is a lack of respect for the worth of a female. No matter how well intending the medical technology, if the cultural sentiments are “better two scorpions [in the house] than two daughters” (West Saharan proverb) or “a house of girls is a house of ruin”  (Arabic proverb), the practice will follow. Any technology is a tool; like fire or stone, this tool can be used for good or bad depending on the characteristics and objective of the user.

For more information, the United Nations Population Fund discusses this issue in depth and put out a recommendation for action. Visit their publication at http://www.unfpa.org/webdav/site/global/shared/documents/publications/2010/guidenote_prenatal_sexselection.pdf

 


[1] Child Rights and You. (2012). Statistics : Indian children. Retrieved from http://uk.cry.org/knowus/statisticsindiachildren.html

[2]GE. (2009, January). Promoting ethical ultrasound use in India. Retrieved from http://files.gecompany.com/gecom/citizenship/pdfs/ge_ethical_ultrasound_use_india_casestudy.pdf

[3] Jing-Bao Nie. Limits of state intervention in sex-selective abortion: the case of China Culture, Health & Sexuality. Vol. 12, No. 2, February 2010, 205–219

[4] Barot, S. (2012, Spring). A problem-and-solution mismatch: Son preference and sex-selective abortion bans. Retrieved from http://www.guttmacher.org/pubs/gpr/15/2/gpr150218.html

[5] Patel, V. (2011, May 21). A long battle for the girl child. Retrieved from http://www.unfpa.org/gender/docs/sexselection/indiapublishedpapers/UNFPA_Publication-39860.pdf

[6] Barot, S. (2012, Spring).

[7] Patel, V. (2011, May 21).

[8] Gilles, K., & Feldman-Jacobs, C. (2012, September). When technology and tradition collide: From gender bias to sex selection. Retrieved from http://www.prb.org/pdf12/gender-bias-sex-selection.pdf

[9] Gilles, K., & Feldman-Jacobs, C. (2012, September).

What Is All the Talk About NGOs?

October 25th, 2012

Non-governmental organizations are independently run groups created and designed with a specific interest in mind.  These organizations can be partially funded by government, as long as no government representatives have membership, but are mostly funded by outside interest groups and individuals.  There is no doubt that the issues involved in international women’s health have been greatly affect by the existence of such NGOs.  But with all the hype surrounding these organizations, I have begun to wonder to what extent these groups make a positive and longstanding impact on female healthcare worldwide.

I think we all agree that without NGOs, women’s healthcare in many areas of the world would not be as advanced and, to say quite honestly, even exist.  NGOs are estimated to account for approximately 15 percent of the development growth in developing countries and contribute billions of dollars each year to various causes and movements (1).  Historically, these organizations have been at the roots of developing new ideas and influencing governments, along with providing funding and training to implement policies to do so.  Many have targeted minority groups, which is why their influence on women’s health rights have been so profound; in many areas of the world women receive no healthcare from government organizations in the manner that most men do.  A major benefit of NGOs is that they do not have to work through governments, and can reach areas of the world which other forms of aid may not extend to (2).  In regards to women’s health, NGOs have the challenge to not only use funding to implement change, but also convince decision makers and leaders, along with the general public that women’s health is important and no longer should take a backseat to men’s healthcare in public health programs.

A major goal of non-governmental organizations in improving the lives of individuals through advocacy.  There have been many successful groups such as Global Alliance for Women’s Health and the International Women’s Health Coalition which advocate for a more gender approach to health care (3).  NGOs have also been found to work together to have a greater influence on policy makers and government to improve the status of females and encourage state departments to become more concerned about women’s health.  It is easy to see why there is great support surrounding NGO’s as they attempt to make change by influencing governments to alter policies to improve women’s health and implement training programs to educate both males and females in the health profession.

However, it appears to me that due to the nature of working closely with the government, and the concept of an outside organization leads me to believe that these organizations are not as effective as they could be with the resources and funding they are given.  Over the past few years, funding for healthcare has more or less been taken away from the government, and given to other organizations.  With this comes the burden that these organizations must continue to stay afloat.  If funding runs out, it is more or less an “oh well” approach, and people are left probably in a worse state than before the NGO made its presence known (4).  Many people argue that the creation of NGOs eliminates the government as providers, therefore, preventing them from being able to do its job, and requesting the help of an NGO is a backwards direction to move towards.  When funding does in fact run out, the approach to healthcare may also return to its original state of a male dominated system.

Additionally a majority of NGOs are outside institutions and some may fail due to the lack of influence and agency granted by the individuals in power in a particular area of the world.  Many outside workers have different cultural beliefs and often expatriates and their healthcare views are not welcomed by all locals, especially those in power (4).  There is also the argument that these non-governmental organizations are merely special interest groups funded partially or completely by the government, with the same level of corruption as the government itself.  A final disadvantage of NGOs is that many are centered around small scale solutions with overlapping ideals, and this can be a waste of resources(1).

I think that many NGOs have proved to be quite successful, but I’m still not thoroughly convinced that these organizations are the way to impact women’s international to the fullest extent.  Many of them are too closely linked to  various governments and special interests play a much larger role than I think the public wants to believe.  Without them, however, I do not believe women’s healthcare would not be as advanced as it is today, and they prove to be much more effective than government systems, assuming they are long lasting.

http://library.duke.edu/research/subject/guides/ngo_guide/igo_ngo_coop/ngo_wb.html
http://www.un.org/womenwatch/daw/csw/role_ngo.htm
http://www.gawh.org/home.php5
depts.washington.edu/ihg/conference/orgs.doc

Support Groups for Immigrant Women

October 25th, 2012

Video: Immigrant Services Society of BC (ISSBC) – Cross Cultural Peer Support Program

Last week I wrote about how immigrant women around the world struggle with many issues having to do with the situations from which they immigrated, financial, physical, emotional and mental stresses. Many of these women suffer through it alone, unaware that there are support groups out there to help them. However there are support groups that exist for immigrant women. For example, in Canada the Cross Cultural Peer Support Program is a free program offered to women who come from different immigrant backgrounds that provides support and peer support training. The 14 week program was originally developed to help women find support in other immigrant women that have experienced and survived through many of the same struggles. The CCPSP  also provides immigrant women who complete the program, support to make support groups of their own in their respective communities for 10 weeks. CCPSP candidates include immigrant women from countries around the world and all walks of life (3).

Similarly to Canada, the United States has the National Coalition for Immigrant Women’s Rights, an organization that compiles 40+ grassroots and national advocacy organizations from IPAS to individual Planned Parenthood branches (2). Though the focus is based more on policy and justice, the program publicly recognizes the struggles immigrant women face in terms of health and tries to bring those issues to the forefront for policy. Many of the supporting members of the NCIWR share the same strategies to help and support immigrant through their struggles. For example, the ways in which NCIWR member National Asian Pacific American Women’s Forum tries to address immigrant women’s issues included the following strategies:

- Promote culturally and linguistically competent, gender-sensitive health care as well as increased research on women’s health through formal relationships and coalitions with other national women’s health organizations, especially women of color organizations (e.g. Black Women’s Health Project, National Women’s Health Network, Healthy Mothers-Healthy Babies, etc.)

- Advocate for improved health care access and disaggregated health data collection on API women through formal relationships and coalitions with other national, statewide, and local Asian and Pacific Islander health advocacy organizations (e.g. APIAHF, AAPCHO, APIRH, NAWHO, NAPAFASA).

- Develop and strengthen strategic relationships with the federal Offices for Women’s Health and for Minority Health as well as with the Regional Directors of Women’s Health to improve public health funding for API women and to promote educational forums on API women’s health issues.

- Develop and implement a legislative education and advocacy campaign aimed at local government bodies and legislative health committees to ensure that API women’s health needs are adequately addressed. Protect abortion access and broaden the definition of reproductive choice to include API women’s perspectives through coalition work with national, statewide and local reproductive freedom groups (e.g. Planned Parenthood and National Abortion and Reproductive Rights Action League). (1)

While, again these strategies highlight advocacy through relationships with national groups, I believe a combination of groups like Canada’s CCPSP on the ground program and larger groups (like members of the NCIWR) are the best way to ensure immigrant women’s issues are being brought to the forefront and that individual women are finding the support they need. The two videos embedded are short clips that highlight issues faced by women immigrants. The video at the beginning of the post is about the CCPSP program and the link below highlights immigrant women in the United States.

Video:  Immigrant Women: Stewards of the 21st Century Family

 

References:

(1) Leung, Yin Ling. “NAPAWF Platform Paper on Health.” National Asian Pacific American Women’s Forum. N.p., 1999. Web.

(2) “The National Coalition for Immigrant Women’s Rights.” The National Coalition for Immigrant Women’s Rights. N.p., n.d. Web. 22 Oct. 2012. <http://nciwr.wordpress.com/>.

(3) “SWIS Resource – Immigrant Support Groups.” Cross Cultural Peer Support Program for Immigrant and Refugee Women (CCPSP). Burnaby Intercultural Planning Table, n.d. Web. 22 Oct. 2012. <http://www.bipt.ca/node/449>.

 

The Chipko Movement

October 25th, 2012

Contractor:

“You foolish village women, do you know what these forest bear?
Resin, timber, and therefore foreign exchange!”

Women:

“Yes, we know. What do the forests bear?
Soil, water, and pure air,
Soil, water, and pure air.” [1]

This is a cry, or slogan, that evolved from the Chipko movement which began in India in 1970s. For many decades the Himalayan forests had been disappearing. Deforestation had been wide spread in India to meet foreign demands for lumbar resources and grow India’s economy. This deforestation led to widespread desertification and erosion on the Himalayan hill slopes. Forests are important on the steep slopes to absorb water and prevent flooding of communities, to prevent erosion of top soils needed for agriculture and to prevent destructive landslides. Deforestation also made it harder for women to find basic resources, fuel for fires, water. As forests are cleared the soil dries quicker and the ground retains less water.

“Women, being solely in charge of cultivation, livestock and children, lost all they had because of recurring floods and landslides… sheer survival made women support the movement.” [2]

This movement, Chipko, was a cry to end deforestation originating in a district of Uttar Pradesh, India. Cipko literally means ‘to embrace.’ [3] Although the founding leaders of this movement were all men, the movement quickly became feminist as women had much more investment in the land and resources and could see the direct connection to their welfare. One early Chipko leader stated 90% of women were with him and 90% of men opposed him.

A big takeoff point in the movement happened in 1973. A contractor had gotten the rights from the State Forest Department to cut down 2500 trees for a sporting goods store. Many of these northern communities of Uttar Pradesh were demographically more women than men and during the day men leave the villages to work while women take up agricultural work. When the contractor arrived in the village of Lata, whose river had flooded in recent years, they were expecting to take advantage of the fact that all the men were gone and the women were occupied. However, Gaura Devi, had organized the women of her village to peacefully resist the contractor’s men by embracing the trees that were to be cut down. They were threatened with words and guns and held their ground until the contractor’s men left.

This form of protest by women spread to other districts. Women had proved their political power in the community and were more often being invited to village meetings and having a greater impact on their community’s actions. “The Chipko Movement can indeed be considered an important success story in the fight to secure women’s rights, in the process of local community development through forestry and in environmental protection.” [2] These mounting protests resulted in a huge victory in 1980 when the Prime Minister of India signed a 15 year ban on cutting down trees in Uttar Pradesh.

Women in one district created a cooperative, Mahila Mandal, which created forest guard positions for women that was paid. The coop also regulates the communities own resource extraction to maintain sustainability.

This movement is an amazing example of a successful bottom-up model of social change. While it was men in the community that started ‘Chipko’ it was women who took up the efforts of the movement in their absence and used their success to gain political clout in their communities. They are using their own ecological knowledge and gaining the respect in their communities to have some political power. At the same time they are preserving their ability to maintain a healthy livelihood and not become subjugated by outside corporations. They were also able to reveal the economic value of the environment which at the time was not often accounted for and still is not. It is sometimes looked down on when women fight so hard for their positions in agriculture and resource gathering when outsiders want women to move into higher political positions. Chipko women were able to accomplish this upward social movement at their community level while keeping their feminie roles in society. They were some of the first to challenge the meaning of ‘modern development’ to help the world realize it does not necessarily equate to social improvement. I leave another slogan that resulted from the Chipko Movement below, it is something that I believe communities in direct use of their resources value that the disconnected world forgets.

“Ecology is permanent economy.” - Sunderlal Bahuguna [3]

___________________________________________

[1] http://www.womeninworldhistory.com/contemporary-04.html

[2] http://www.fao.org/docrep/R0465E/R0465E03.HTM

[3] http://www.apnauttarakhand.com/chipko-movement/