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“Water Poured Out”

January 31st, 2013

Feng Jianmei, a 23-year-old woman, lays unfurled on a dingy hospital cot in the Shaanxi province of northeastern China. The back of her head leans awkwardly against the bed’s metal frame. Her left arm splays out across the mattress, so as if to protect the blood-soaked fetus lying next to her.

Her face is covered by a swath of her hair, concealing her identity and any facial expression that might hint towards her thoughts at the time. The camera flashes, a couple of pictures are snapped. Her family posted the photos to Weibo, China’s most popular social networking site, akin to Facebook and Twitter. Soon, the graphic images of Feng Jianmei and her forcibly aborted baby went viral in June of 2012. [1]

Like India, China is also a culture enveloped within a widespread preference for males. Along with Feng, whose story captured the attention of the international community, Chinese women have more than 30 million abortions a year — all of them reinforced by both China’s Family Planning Police and the devaluation of girls, endemic to China. 35,000 abortions a day. 1,500 abortions every hour. [2]

But these high abortion rates cannot be pinned solely on the culture itself. This is the product of poverty, poor governance, and tradition — combined to place enormous amounts of pressure on Chinese women to bear sons, rather than unwanted daughters. Because as the proverb looms ominously, “You are only a girl. You are spilt water.”

"You are only a girl. You are spilt water."

Also similar to India, China is seen as a bastion for global economic innovation and political clout on the world front. Yet it also has the highest female suicide among countries. Every day, 500 women take their lives. [2] According to Rita Banerji of the Fifty Million Missing Campaign, “Women become inadvertent pawns in this material exchange of patriarchy.” China’s one-child policy has had unforeseeable consequences. One, China now has an unnaturally skewed gender ratio. [3] Two, there are 37 million fewer women for men to marry. Thus, 70,000 girls every year are kidnapped to provide brides for sons. [4]  This is accompanied by the rise in prostitution too, which is already a sizable industry among Chinese cities.

China is beginning to suffer the ramifications of its one-child policy and has no choice now but to confront them. However, abolishing the one-child policy will not alleviate the problem truly. In fact, the state policy has only exacerbated the already existing, underlying issues of pejorative attitudes towards girls and women in the country. Although human rights NGOs and other groups have denounced Feng’s forced abortion and scrutinized China’s one-child policy, it’s not about raising the number of children allowed in China or halting the practice of forced abortions, sterilizations, and exorbitant penalty fees. [5] Because if China’s preferences towards sones remain and no actions are taken to raise the value of daughters through economic incentives, prevention programs, awareness campaigns, etc., girls will continue to be trivialized, vulnerable to gendercide violence in all its forms as a result. Moreover, rural Chinese girls are at an even starker disadvantaged. [6]

So why did Feng Jianmei and her family choose to make her ordeal so public?

Perhaps the uncomfortably personal details of Feng Jianmei’s traumatic experience are meant to make the issues impossible to avoid. Although China’s government immediately took down the photos and banned its spread, forced abortions like Feng’s are difficult to cover up. So, by exposing her anguish, her helplessness, her fear, she effectively charged the Chinese people as well as the entire global community with the assumption of responsibility and their moral conscience to end such abuses. This was a bold move, particularly in a country where freedoms of speech and press are critically shaped by government censorship. However, with increasingly skewed gender ratios in China every year, Feng’s intrepidness has yet to be realized.

My next blog post will feature the issue of gendercide in Mexico.

————-

References 

[1] Barboza, David. “China Suspends Family Planning Workers After Forced Abortion.” The New York Times. 15 June 2012. <http://www.nytimes.com/2012/06/16/world/asia/china-suspends-family-planning-workers-after-forced-abortion.html>. 29 Jan 2013.

[2] “It’s a Girl!” Documentary Film (2012) by Director Evan Grae Davis

[3] Hitchens, Peter. “China’s shameful massacre of unborn girls means there will soon be 40m more men than women.” Dailymail.co.uk. 10 April 2010. <http://www.dailymail.co.uk/news/article-1265068/China-The-worlds-new-superpower-beginning-century-supremacy-alarming-surplus-males.html>. 29 Jan 2013.

[4] “It’s a Girl!” Documentary Film (2012) by Director Evan Grae Davis

[5] Wetzstein, Cheryl. “U.N. urged to probe China’s 1-child policy.” The Washington Times. 9 Aug 2012. <http://www.washingtontimes.com/news/2012/aug/9/un-urged-to-probe-chinas-1-child-policy/> 30 Jan 2013.

[6] Dulcimer, Marlyn and Laurie Nisonoff. “Abuses Against Women and Girls Under the One-Child Family Plan of the People’s Republic of China.” Abuses Against Women and Girls in China (p. 284-292)

Women's Healthcare in the Dutch Utopia

January 31st, 2013

Women’s Health Care in The Netherlands

Prior to the introduction of compulsory health insurance coverage, there existed many SES and geographic related differences in access to care in The Netherlands. Middle and upper classes relied on private practice while the lower and working classes were given an opportunity to obtain voluntary insurance plans. Maternal health care heavily emphasized child nutrition and proper hygiene to avoid primary infections. From the Health Care Insurance Act in the 1960’s to recent legislation, the basic requirement is that everyone must have health insurance and a general practitioner. Over the past twenty years, family planning has become a central component of primary care offered to women. Contraceptive use is commonly accepted and encouraged. Approximately 40% of women between the ages of 15 and 30 use the pill as their primary means of contraception; diaphragms and IUD’s are not popular among young women. In The Netherlands, abortions are legal, covered by all insurance companies, and are usually performed as outpatient surgery at many registered hospitals and clinics. It is interesting to note that The Netherlands has one of the lowest abortion rates. Routine check ups and pre-screening appointments are not normal components of primary care in The Netherlands. The two most common types of screenings include pap smears every five years and a mammography every two years for women who are over 35. While other screenings for HIV/AIDS, cervical cancer and other illnesses are covered by insurance providers, public practitioners perform screenings on a need-based basis.

 

Dutch Maternity System

Dutch maternity system emphasizes a natural approach to pregnancy – home births are very popular. Their perspective is that childbirth is not a medical condition and women who are expecting should not be considered as patients. The role of the gynecologist in dealing with normal pregnancy is very minor. Many women in The Netherlands typically select a midwife based on the referrals of their general practitioner or by word of mouth. While prenatal care is required, many women consult their midwives about their birth and labour process, the location of the birth, and any minor complications they experience. In addition, midwives recommend yoga and breathing exercises as natural means of pain management and relaxation. With 30 percent of births taking place in the home environment, The Netherlands has the highest rate of home births compared to other countries around the world. Insurance companies provide families with the medical items necessary for home delivery.

 

If planning for a hospital delivery, the woman must register directly with the hospital approximately five months ahead of the expected delivery date. Health insurance providers are very stringent in terms of hospital births, especially if the reason for hospital delivery is not medical. The hospital culture in The Netherlands discourages the use of drugs to diminish pain during labor; thus, less than ten percent of women elect to receive epidurals for pain relief. With an emphasis on natural pre- and post-natal care and home births, the Netherlands surprisingly has an infant mortality rate that is approximately 25% lower than the rate in the US.

 

Access to Reproductive Health Education

The primary and secondary school systems in The Netherlands embodies a “‘culture of openness’”, in which reproductive health is discussed with teenagers in the public domain and in family life. A unique feature to the Dutch education system is the greater participation of parents in school activities and curriculum. Educators encourage students to speak about reproductive health and sex with their parents. Schools provide sex education, including the physical and emotional components of sex, to children at young ages in primary school. The access to comprehensive and positive reproductive health and sex education has resulted in a low teenage pregnancy rate in The Netherlands. The low rate is due to the superior quality of education and the access/availability and adequate use of contraception. An alternative explanation for the low pregnancy rate is the belief that sex education contributes to increased knowledge about contraceptive practice and sexuality. Contrary to the popular critique that sex education results in increased sexual practice among young populations, the educational system in The Netherlands has had a positive impact on reducing risky sexual behavior among teenage populations. The educational system provides students with the educational tools about reproductive health necessary for them to make decisions that promote their health and emotional well-being. One lesson that can be taken away from their unique system and implemented in developing countries is the “‘culture of openness’” to increase communication and awareness about sexually transmitted disease, contraceptives, and HIV/AIDS.

 

Here is a quick video explaining the benefits of children receiving sex education as early as five years of age: http://www.rnw.nl/english/video/sex-education-starts-first-grade

 

Works Cited

Den Exter, Andre. “Access to Healthcare in The Netherlands.” Wiley. Journal of Law, 2005. Web. 31 Jan. 2013.

Hardon, Anita. “Reproductive Health Care in the Netherlands: Would Integration Improve It?” Reproductive Health Matters. N.p., May 2003. Web. 31 Jan. 2013.

Neighmond, Patti. “Netherlands’ Health Care Reflects National Values.” NPR. NPR, 17 July 2008. Web. 01 Feb. 2013.

Van Loon, Joost. “Deconstructing the Dutch Utopia: Sex Education and Teenage Pregnancy in The Netherlands.” Family Education Trust. Family Education Trust, 2003. Web. 31 Jan. 2013.

Van Mulligen, Amanda. “Maternity Matters: What to Expect in the Netherlands.” Expatica Communications. N.p., 21 Mar. 2009. Web. 01 Feb. 2013.

Confronting sexual abuse and rape in the aftermath of genocide: Justice served?

January 31st, 2013

This post will primarily focus on the legal proceedings,  specifically towards the victims of sexual abuse, in the aftermath of the Rwandan genocide. According to a 1996 Human Rights Watch report, of the nearly half a million women raped during the Rwandan genocide, 28 percent of the women were under the age of 18, 43.75 percent of the women were between the ages of 19 and 26, 17.1 percent between the ages of 27 and 35, 8.55 percent between 36 and 45 and 1.6 percent were over the age of 40. While this post will not focus on the violence that occurred during the genocide, the demographic of sexual violence victims is important to remember, when considering the interventions that were established following the genocide’s aftermath. Based on the data, the average age of the victims was 24, and 63.8 percent of the women were single.

LEGAL INTERVENTIONS

The international community, which largely ignored the genocide, attempted to help the country recover from the tragedy by establishing the International Criminal Tribunal for Rwanda (ICTR). According to Alison Des Forges and Timothy Longman’s “Legal Responses to Genocide,” published on Vassar College’s website, the ICTR was the international community’s effort to bring perpetrators to justice. However, the article cites that the ICTR’s initial prosecutions were “weak and disorganized..[and] relied too much on witnesses identified by the Rwandan government.” The Rwandan government viewed the ICTR as inconsequential, and treated the organization with hostility and little cooperation. The paper cites that the Rwandan government was frustrated that the international community chose to invest in the creation of the ICTR, as opposed to improving the Rwandan judicial system.

In spite of criticisms towards the ICTR legal structure, the Women Under Siege Project cites the 1998 ICTR trial of Jean-Paul Akayesu, a Rwandan mayor who did nothing to prevent the rape and sexual violence that took place in his village, as “the first case to define rape as a crime against humanity.” The Women Under Siege Project states that Akayesu’s trial was the first international legal proceeding to charge someone with rape outside the legal definition of rape.

Despite the ICTR’s presence in Rwanda, the Rwandan government largely took justice measures into its own hands.  In order to respond to the insurmountable number of criminal cases following the genocide, the Rwandan government established the gacaca court system. The gacaca court system essentially consisted of public trials, in which victims and perpetrators confronted one another. The “Survivors and Post-genocide Rwanda: Their Experiences, Perspectives and Hopes,” published by African Rights and REDRESS, cites  that “the yearning and search for justice, in so many ways, defines what a survivor is…the most common response by survivors of sexual violence was their sense of being somehow duped by the justice system…whilst many were intent on pursuing justice all had…explained how the process, whether domestically or internationally, left them feeling more vulnerable socially and psychologically.” Although victims of sexual violence were originally not intended to undergo the gacaca process, and, instead, would undergo private trials, the Rwandan government changed this policy. Lawmakers concluded that while rape, normally, would entail a private trial, since most of the rapes during the Rwandan genocide were “public in nature,” the victims could thus face their perpetrators in public. However, given the stigma associated with rape in Rwandan society, this situation did not bode well for the victims, many of whom refused to confront perpetrators in a public arena.

Thus, while victims of sexual violence emphasized the importance of achieving justice, the legal measures put in place were of little consequence in achieving this goal. While the law is often viewed as a key instrument to ensuring human rights are respected or maintained, it seems that for Rwanda, both the international and legal systems put in place, did not meet the needs of genocide victims, particularly victims of sexual violence. In the next post, I plan to write about other forms of intervention, designed to help rebuild the lives of Rwandan rape victims and their children.

Sex and the Ciudad 3: Designing Effective Interventions

January 31st, 2013

In class we have been proposing many interventions to combat a variety of women’s health issues, but, despite all of the great ideas and all of the enthusiasm, we are still left with some important questions: How do you ensure that you are making the right interventions? And, when we feel certain that the interventions will be effective and efficient without negative side effects, How do we actually implement these interventions?
In terms of urban design, this is particularly worrisome. When designing on a large scale and trying to understand the whole picture, it is easy to overlook the small details that have an intense impact on the lives of the city’s residents. Fast highways, gigantic stadiums and megamalls slice through cities, turning once-strong communities into isolated wastelands, clinging to the periphery of unconsidered super-projects. Without careful planning and cultural awareness, well-meaning public transport overhauls can leave women exposed to sexual harassment or assault, and can encroach on their right to move freely around their city. We can implement all the urban design theory and best practices we know, but once something is built, it is hard to go back. So how do we know that we are doing what is right?
In this post I will take a look at one example of carefully conducted research that looks to women themselves for the answers on how to improve their communities so that women have equal rights and equal opportunity in the city.
The Gender Inclusive Cities Program (GICP), funded by the UN and coordinated by Women in Cities International was a three year initiative that examined four cities around the world and proposed interventions and implementation processes that would help make these cities safer and more inclusive for women. Their report, “Learning from Women to Create Gender Inclusive Cities,” was presented at the 3rd International Conference on Women’s Safety in New Delhi in 2011, and it offers some interesting ideas of how to address the problem of making the right interventions.
As stated in the report, the purpose of the Safe Cities for Women Movement seeks to, “eliminate all forms of violence against women and girls by simultaneously targeting the systemic societal factors and empowering women and girls to make changes within their communities. At the core of the safe cities movement is the belief that violence and fear of violence restricts women’s and girls access to their cities, including to employment, health, education, political and recreational facilities.” What is most exciting about the group’s work is the commitment to listening to the opinions of local women and group’s ability to incorporate these opinions in a systematic and persuasive way.
In order to have a thorough understanding of the city before proposing any interventions, the GICP conducted a four-part investigation into the urban realities of the women living in the four chosen cities. (Rosario, Argentina; Delhi, India; Dar es Salaam, Tanzania; Petrozavodsk, Russia) First, the GICP reviewed policies and statistics that influenced the female experience of the city. Second, they spoke with focus groups of 8-12 women about their varying perceptions and worries about the city. Third, the GICP spoke with hundreds of local women in quick street surveys. And finally, they conducted “Women’s Safety Audits (WSA).” While all of these components were important for designing the most useful local interventions, the last component, the WSA is the most interesting.
In the Women’s Safety Audits, members of the GICP would join a handful of local women to walk around their communities together and discuss what they saw to be “unsafe spaces.” In Rosario, the city that is most important for this blog, the local women were able to point out many specific unsafe spots that an urban design team without local experience would overlook. For example, bus stops that were too isolated or, alternatively, too close to certain bars or parks were designated as unsafe. This is important because many participants in the surveys said that they would not allow their girls to ride the bus to school alone, and that if an adult (preferably male, as adult women suffer sexual harassment as well) were unable to accompany the girl, she would not go to school. Perhaps the most powerful result of this research was that 89% of participants in the street survey replied that “being a woman” was the greatest factor that put their safety at risk. Similar responses were recorded in the three other surveyed cities.
Based on the extensive research in Rosario and the other three cities, the GICP proposed interventions for each community. With this detailed process, based on local knowledge, there is hope that the proposed interventions will directly improve the safety and the lives of the women in these communities. When working to design cities across the world for gender equality, we should look to the careful, sensitive work of the Gender Inclusive Cities Program for inspiration.

To find out more about about the program and results, take a look at the report found here.

A Dangerous Secret: Abortion in the Philippines

January 31st, 2013

Abortion in the Philippines: An Overview

Another issue that impacts women’s reproductive health in the Philippines is access to abortion. Abortion has been illegal and criminalized in the Philippines since 1870 under Spain’s rule, with no exceptions to save the life of a pregnant woman or to protect her health.[i] Under the law, women may face imprisonment for two to six years if they receive an abortion for any reason.i This has led over 500,000 women in the Philippines to seek unsafe abortions in secret each year.i Women living in poverty, who already face barriers to receiving adequate reproductive health services, are especially at risk for undergoing unsafe abortions and complications such as hemorrhage, sepsis, and trauma to reproductive organs.i Women who experience complications from unsafe abortions end up facing harassment or delayed care from medical professionals as a result of the stigma surrounding abortion.i

Backstreet Abortions

Because of the stigma and the ban on abortions, many women obtain abortions through healers, called hilots, who perform ‘massages’ that involve pounding, rough strokes, and pincer-like grips on a woman’s stomach to trigger a miscarriage.[ii]

“I felt guilty but I thought it was better than having another child that will only suffer because we have no food. “I just prayed to God and asked for forgiveness.” 

 - Remy, a 44-year old woman who had no access to family planning. Remy bled for a week after her backstreet abortion, but refused to be taken to the hospital out of shame and an inability to pay medical bills.ii

Women also turn to using an abortifacient called Cytotec, a drug used for ulcers, which was banned from being sold over the counter.[iii] Now, Cytotec is sold to women on the black market, smuggled in from South Korea and Thailand.iii Women also obtain mixtures from street vendors, who concoct mixtures of herbs and roots that induce a miscarriage.iii

Impact of the Reproductive Health Care Act

            Last week, I talked about the Reproductive Health Care Act, and its aims to increase access to contraception for impoverished women and increase sex education in schools. While I don’t see women gaining access to safe and legal abortions in the near future due to a combination of strong opposition from the Catholic Church and the Philippine Constitutional Provision to protect the life of a fetus from the start of conception, I hope that the implementation of the Reproductive Health Care Act can help prevent unwanted pregnancies and reduce the need for abortions due to economic circumstances in impoverished communities. However, increasing access to contraception isn’t a cure-all solution to the lack of access to safe abortions, and until a solution is found, women may continue to suffer from health complications, stigma, and death due to unsafe abortions.


[i] Center for Reproductive Rights. “Facts on Abortion in the Philippines: Criminalization and a General Ban on Abortion.” http://reproductiverights.org/sites/crr.civicactions.net/files/documents/pub_fac_philippines_1%2010.pdf

[ii] Crimmins, Carmel. “Abortion in the Philippines: a national secret.” http://www.reuters.com/article/2007/09/05/us-philippines-abortion-idUSMAN29804620070905

[iii] Conde, Carlos. “Philippines abortion crisis. The New York Times. ”http://www.nytimes.com/2005/05/15/world/asia/15iht-phils.html?pagewanted=all

Cell Technology 3: A Case Study of M-PESA

January 31st, 2013

 

Last week’s post explored the scale and distribution of mobile phone use in sub-Saharan Africa, highlighting the significant, but not insurmountable, gender differential in cell phone ownership in the region. This week’s post will explore the story and impact of M-PESA, Kenya’s hallmark mobile services initiative and the most widely recognized mobile banking program in the developing world. Constrained access to credit and financial services is widely acknowledged as a huge issue for the world’s poor, particularly poor women. M-PESA, one of many initiatives attempting to broaden access to financial services, has scaled rapidly, leading the mobile banking movement. After discussing the development of this initiative as a positive intervention in access to financial services, this blog post will discuss M-PESA and female populations in Kenya in particular.

M-PESA

The M-PESA initiative began in response to a gap between the number of individuals in sub-Saharan Africa with access to financial services and the number of individuals with access to mobile phones. In 2011, Harvard Business School reported that over one billion individuals in the world had access to mobile phones but lacked access to financial services, or were, in other words, “unbanked.”[1] Cognizant of the potential impact, both financial and social, of providing banking services through mobile phones, Safaricom launched M-PESA in conjunction with Vodafone with the intention of providing financial services to unbanked mobile phone owners in Kenya. As HBS points out, rather than offer full, traditional bank accounts, M-PESA adapted to focus on the core need of its customers; the ability to send money between family members, often from urban centers back to rural areas, eliminating the expense and risk of hiring couriers or transferring money through personal travel.

Launched in 2007, M-PESA operates as a money-transfer application residing in the SIM card of mobile phones. Initially, the purpose of M-PESA was to facilitate microfinance loan payments; however, the initiatives core purpose quickly pivoted towards the concept “sending money home.”[2] M-PESA relies on a distribution network of mom-and-pop agents, allowing customers to transfer and cash money at mom-and-pop stores, using their phones. The conversion of cash to electronic money occurs through such agents, conveniently located in local stores. All transactions are authorized and recorded in real-time, using an SMS system.[3] With each transaction, Safaricom and Vodafone collect a small fee. By 2010, M-PESA had achieved scale, reporting close to nine million registered customers, and stating that more than $600 billion has been transferred using the service. Despite its scale, M-PESA focuses on affordability and small-value transactions; all transactions are capped at $500, emphasizing the service’s strong orientation towards low-income customers.[4] The World Bank reported that by the end of 2009, 40% of Kenyan adults were registered M-PESA users, and 10% of Kenya’s GDP was transferred monthly (on an annualized basis) using M-PESA. The Gates Foundation reported in March 2010 that as a next step, M-PESA began offering salary and bill-payment services as well. The initiative’s scale and impact is, certainly, substantial.

M-PESA and Gender: Female Usage

Given M-PESA’s overall impact, what can we ascertain regarding its relationship, if any, to female empowerment? On the one hand, as we discussed last week, a significant gender differential exists in mobile phone usage. Furthermore, the fact that a woman has a mobile phone, and even an M-PESA account, does not necessarily indicate that she has sole control over her own phone or any control over her or her family’s finances. Yet on the other hand, the expansion of female mobile phone use and female access to banking services through initiatives like M-PESA does seem to suggest the potential to bolster female empowerment. So what do the gender numbers look like for M-PESA use, as far as we know? In 2008, Georgetown and MIT researchers reported that 38% of M-PESA users were women; this number jumped to 44% by 2009. Amongst adults over the age of 18, the female share of M-PESA users jumped from 15% to 41% between 2008 and 2009, indicating substantial progress towards gender parity in usage of the mobile banking platform. The National Bureau of Economic Research agrees with this hypothesis, speculating in 2011 that “M-PESA could have the effect of empowering certain household members who traditionally have less bargaining power, particularly women.”[5] Given empirical evidence indicating that men and women exhibit different spending patterns and focus on different spending priorities at the household level, M-PESA could affect the allocation of household spending as well.[6] Anecdotal and survey evidence supports these hypotheses as well; initial findings from the University of Maryland and the Gates Foundation reported that women in rural areas in particular felt that M-PESA offered improved cash security from their husbands, giving them greater control over earnings and household finances.[7]

It is difficult to directly link mobile phone access, M-PESA, and female empowerment without hard empirical data exploring such linkages. However, evidence seems to suggest that the expansion of mobile phone use, paired with increased access to banking services and increased money security through M-PESA, has served as a positive step forward for previously unbanked women in East Africa.

 


[1] http://hbswk.hbs.edu/item/6729.html

[2] http://hbswk.hbs.edu/item/6729.html

[3] http://www.gsma.com/mobilefordevelopment/programmes/mobile-money-for-the-unbanked/mmu-examples/m-pesa

[4]http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/0,,contentMDK:22551641~pagePK:146736~piPK:146830~theSitePK:258644,00.html

[5] http://www.nber.org/papers/w16721.pdf

[6] http://www.nber.org/papers/w16721.pdf

[7] http://www.gsma.com/mobilefordevelopment/wp-content/uploads/2012/03/Community-Level-Economic-Effects-of-M-PESA-in-Kenya.pdf

Empowering Women through CARE

January 31st, 2013

Last week I discussed the need for increased preventative care in developing countries. When looking at the barriers to healthcare I recognized three components; economic restraints, insufficient education, and lack of empowerment. One without the others cannot be an effective approach to solving this problem. Increasing access and the economic infrastructure or education system is just a portion of the problem, in many cases it is increasing female empowerment that will induce the necessary changes to utilize the available resources. The problem of empowerment is a much larger and more difficult problem to address because it is often rooted in cultural and social traditions. I think this is a particularly relevant to our class discussion on Monday because we saw how important and more effective culturally sensitive interventions were with regards to AIDS education.

Week 2 I talked about the huge political push and economic investment made by the Niger government in the movement “Countdown to 2015 Maternal, Newborn & Child Mortality”. This was a combined effort of increasing medical education, infrastructure, and access that has resulted in huge success. The mortality rate in children younger than 5 years declined significantly from 226 deaths per 1000 live births (95% CI 207–246) in 1998 to 128 deaths (117–140) in 2009. For me, this is an encouraging statistic showing that with adequate political support and economic investment huge change can be implemented. However, when providing healthcare to females there are often issues that cannot be overcome by financial venture alone. This is why an organization such as CARE is an essential component to changing the broken system of healthcare.

CARE is an organization dedicated to fighting global poverty that, “[places] special focus on working alongside poor women because, equipped with the proper resources, women have the power to help whole families and entire communities escape poverty”.1 They have developed a process that allows positive and effective interventions through increasing the availability of resources and promoting the empowerment of women.

Case Study in Bangladesh (2002):

Sex workers in Bangladesh are at extremely high risk of contracting and spreading HIV/AIDS. CARE initially set out to “increase women’s knowledge of safe sex practices” but quickly realized the issues lay in much deeper engrained social stigmas and gender inequalities. CARE implemented a “rights-based strategy” using, “training (in literacy, vocational skills, microcredit group formation, human rights, leadership skills and self defense) and resources (school and board for the women’s children, drop-in centers where the women receive health care and counseling, find shelter, and meet and network)”.2 They also reached out to community leaders, police officers, and political channels to address harassment and to promote tolerance. After the program one woman was quoted, “We realized we are also human beings.” By reminding women of their human rights and empowering them as a community, CARE was able to increase condom use from 12% to 75% in brothel-based and to 51% in street-based sex work. 2 By tackling some of the fundamental injustices and empowering women and the community to recognize their own human rights, huge changes can be made towards implementing more preventative care measures.

Social Constructs and Poverty for Women in Chile

January 31st, 2013

In this post I will be discussing how social constructs for women in Chile affect their level of poverty, which as expert Jennifer Pribble describes, is a good indicator of the effects women’s social role has on their equality [1], as mentioned in the previous blog post.

“Overall poverty decreased 18 percentage points between 1990 and 2000” and the “share of female-headed households living in poverty decreased only 9.8%” [1]. However in a survey by the Chilean Ministry of Social Development it is shown that one-third of households surveyed are run by women, 43% among poor families and just under 48% among “the extremely poor” [2]. A former minister of women’s affairs in Chile says that most share the view that, “women must play certain roles in terms of domestic responsibilities and caring for their families” and as a result are not treated equally because men are seen as the “providers and workers” [2]. Women’s own lack of confidence may result from being assigned these gender roles [3] and contribute to their low socio-economic status. Many do not realize this brutal reality and social constructs also fail to acknowledge the fact that women hold a growing responsibility. Many women are unmarried, divorced or widowed, and/or have children and therefore are on their own. We will talk about the disparity between men and women and wages in my next post, but for right now, it is important to understand the changing structure of society and the fact that the cultural views in Chile are not able to catch up to reality. As a result, women are being left behind and confined to poverty.

As we have discussed in class women make up the poorest class in most societies. The IPS wrote an article called, “Women Make Up Majority of Chile’s Community Leaders”, and apparently 76% of the leaders are Chilean women, of which only 55% are married and 50% say their “main occupation” is as the head of the household [4]. Now, one question that struck my mind as I read the article was what is the definition of community leaders? And what sorts of communities are these because clearly community leader does not mean mayor or in Spanish alcalde. As I reread the information more closely, it became clear that these women lead the slum communities of Chile [4]. To put all of this in perspective, in 2007 a non-profit foundation called A Roof for Chile found in their survey that there still are 533 shanty towns with 29,000 families [4]. Now think about the fact that most of the families are run by women, struggling to find a way out of the shanty town life for the women and their children. Of the leaders, 80% have never used e-mail and 74% have never “surfed” the internet [4]. Considering the fact that these community leaders started a “national organization of the slums” and only about a fourth have finished primary school, it is pretty impressive that these women are banding together to make “concrete” proposals for presidential candidates this coming fall [4].

Who knows how many in the government will listen to the minority population of uneducated and poor women at the grassroots level and if those in power actually act on the injustices. However, community leaders mentioned in the IPS article claim that past president Michelle Bachelet listened to their opinions the most [4]. Michelle Bachelet will be able to run again this coming election year if she so desires and maybe this will give the women of Chile more hope for equality. One could say that single, unmarried women, divorced women, and widowed women seem to make up a new and growing division of Chilean society. They represent a new independence, voice, and hope. Even if there is only a small group of community leaders who also happen to be of the poorest populations, at least they are banding together.

Needless to say the current statistics do not bode well for Chilean women in poverty. From 1970 to 1987, the percentage of households under
poverty grew from 17 to 39 and the Gini index from 47.4 to 58.5 in 1971 to 1990 [1]. Of course, since then twenty years have gone by, and Chile has shifted from military rule and a dictatorship to a strong democratic nation. However, Veronica Silva from FOSIS, the Chilean government fund for solidarity and social investment, says that “there has been stagnation in extreme poverty reduction” [5]. Her reasoning stems from the fact that policies target the poor but do not impact the poorest populations because they do not know about the benefits they can apply for [5]. This comment echoes the reason the head of the national association of slums gives for forming the organization. She says they are massively misinformed of their options [4]. The fact that they are misinformed and cannot escape their low standards of living does not even touch on the
notion of their health. Under poverty, women have no money to eat well or to feed their children, have little access to healthcare, and are not living in the most sanitary conditions in the slums of Chile.

As the UN reports, “Women’s participation in power structures and in the decision-making process” is one of the main challenges in Chile as well as, “reducing poverty” [6], which is something to think about in the scheme of women’s health. Taking into consideration women’s socio-economic status is important because it influences access to healthcare, education, and almost every aspect of a women’s life. It is also crucial to consider cultural norms and values associated with the Latin American “machismo,” discussed in my last post. The “machismo” principles concerning the domination of men over women have an influential role on keeping the poorest women poor, without a voice, and chained by poverty in the slums of Chile.

[1] Pribble, J. (2006). Women and welfare: The politics of coping with new social risks in Chile and Uruguay. Latin American Research Review, 41(2), 84-111. Retrieved from http://www.jstor.org/stable/3874670

[2] Jarroud, M. (2012, August 02). Many Chilean women keep mum about unequal wages. Inter press service news agency. Retrieved from http://www.ipsnews.net/2012/08/many-chilean-women-keep-mum-about-unequal-wages/

[3] Murray, A. (2008). From outrage to courage. (1st ed.). Monroe, Maine: Common Courage Press.

[4] Women make up majority of chile’s community leaders. (2009, May 11). Huffington Post. Retrieved from http://www.huffingtonpost.com/2009/04/10/women-make-up-majority-of_n_185623.html

[5] Silva, V. Ministry of Planning, FOSIS. (2004). Reaching the poor (wb230924). Retrieved from World Bank website: info.worldbank.org/../Reaching the Poor/../Silva.doc

[6] Government of Chile, (2004). Report on implementation of the beijing platform for action presented by the government of chile to the united
nations division for the advancement of women
. Retrieved from United Nations website: http://www.un.org/womenwatch/daw/Review/responses/CHILE-English.pdf

What Is Your Mental Health Worth?

January 31st, 2013

What is your mental health worth? Have you put a number on it, or thought about how much you would spend to preserve it?  In the case of government spending and investment on mental health services, this is exactly the case.  The importance of mental health as a societal problem, the prevalence of mental illness, the impact of mental illness on quality of life, and the potential benefits to the government economically all play into the analysis of government spending on mental health care.

The assessment of government organizations and institutions aimed at treating mental health issues is becoming more prevalent in an effort to increase awareness of and infrastructure for treating mental health.  The World Health Organization formed a systematic tool for evaluating developing countries’ mental health programs, known as the World Health Organization Assessment Instrument for Mental Health Systems, or WHO-AIMS.  Published in 2009, an analysis of mental health systems via WHO-AIMS studied 42 developing countries, and the results were not exactly encouraging.

 

The State of Mental Health

While mental health is beginning to get recognition as an important aspect of health, seen both by the WHO’s holistic statement that health is, “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” and by the increasing number of governmental programs and support for mental health resources, more needs to be done.  As the WHO-AIMS report states, resources for mental health “are scarce, inequitably distributed and inefficiently used.” In addition, there is only one health professions per roughly 17,000 people on average, and the limited resources are more pronounced in lower income countries.  Upper-middle income countries spend 70 times more on mental health than lower income countries.  While the logical goal of mental health should be to increase the quality of life of all people, and to mediate and treat mental health issues, the majority of mental health spending globally focuses instead on funding mental hospitals.  While these places can facilitate healing and recovery, resources could be allocated much more cost effectively, such as through what the WHO-AIMS report calls “community care.”  This discrepancy only further highlights the need for increased attention to this issue of mental health.

 

Looking Closer

In Uganda, legislation and infrastructure exists to provide citizens with some access to mental health.  While the idea of this is a step forward, the health care in practice lacks some crucial elements.  As analyzed by Kigozi and colleagues in an International Journal of Mental Health Systems publication through a WHO-AIMS lens, the Ugandan system has the basic elements of mental health care, but is “outdated and offensive.”  While it addresses things like community services, decentralization of services, and “equity of access…across different groups,” it lacks financial structure, mention of poverty as an influence on mental health, research on policies, and improvement measures, among other things.  Uganda does have mental health outpatient facilities, one day treatment facility, community based inpatient clinics, a mental hospital, and a forensic facility.  While these facilities seem promising, the distribution of services is centered around main cities, which is a significant barrier for rural citizens seeking treatment.  The Ugandan system provides hope that national plans for mental health treatment are possible and sustainable, but definite improvements could be made to better serve the country.

What Can Be Done?

In the International Journal of Gynecology & Obstetrics, researchers made a series of eleven recommendations to improve the state of women’s mental health.  These include improving gender equality, supporting women’s choices in marriage, sex and reproduction, increasing education, and increasing health promotion in the context of women and girls across the life course, addressing basic human rights, education, employment, poverty, and discrimination.  While seemingly basic recommendations, these are all things that are consistently either unavailable to women entirely, or limited due to location, poverty, and lack of autonomy.

Sources:

http://www.who.int/about/definition/en/print.html

“Mental health systems in selected low- and middle-income countries: a WHO-AIMS crossnational analysis.”  http://whqlibdoc.who.int/publications/2009/9789241547741_eng.pdf

Kigozi, Fred, et al.  ”An Overview of Uganda’s mental health care system.” http://www.ijmhs.com/content/4/1/1

“Women’s Mental Health: A silent cause of mortality and morbidity.” http://www.sciencedirect.com/science/article/pii/S0020729206001883

Domestic Violence Worldwide

January 31st, 2013

This week I would like to take a step back from exploring the issue of rape in India to look at another prevalent and complicated form of violence against women—domestic violence.

How prevalent is it? Approximately 1 in 3 women worldwide have been victims of domestic violence.[1]

Why is it complicated? A few years ago when the celebrity gossip magazines were delving into every detail of Chris Brown and Rhianna’s relationship, including the assault issues, I was in a class at Stanford and we were discussing the topic. My teaching assistant was furious that Rhianna was still with Chris Brown, and she finally summed up her thoughts by saying, “if a man ever hits you, you leave him. It’s that simple.” However, the reality is that it is rarely if ever that simple. When factors such as poverty and cultural values are thrown into the mix, it is absolutely never that simple.

Unfortunately, this behavior is accepted in many cases or at least tolerated when women are economically and socially limited. According the The Population Bureau’s The World’s Women and Girls 2011 Data Sheet, up to 40% of women in Uganda, and 30% of women in India believe that wife beating is acceptable.[2] Men were actually reported to hold this attitude slightly less, with 36% and 26% respectively. In both of these countries, the women are likely to have been married before age 18 and be living in poverty. Their husbands are likely older and making all the decisions and their relatively low status inhibits their ability to express agency.

In addition to cultural and individual views that allow domestic violence to occur, policies and programs may also create barriers to women’s safety. A study conducted in rural Bangladesh in 2002 distributed surveys and gave in-depth interviews and small group discussions to married women in villages to examine the local domestic violence and the factors that contribute to a woman’s exposure to violence in marriage.[3] Of the women surveyed, 67% had experienced domestic violence. The study found that woman’s level of education significantly reduced odds of violence, and a marriage with a dowry agreement increased the odds, likely because the practice of dowry often affects the socioeconomically disadvantaged. Interestingly, marriage registration increased a woman’s risk as well. Although marriage registration legally gives a woman long term economic security, it may affect the husband’s sense of control and contribute to his issues of asserting his authority through violence. Additionally, women who participated in microcredit programs were at an increased risk. According to the researchers, questions on domestic violence seemed “not to be troublesome to most participants.”

The World Health Organization’s study on Women’s Health and Domestic Violence surveyed women in 10 countries and found that between one-third and three-quarters of women surveyed had been physically or sexually assaulted by someone since the age of 15.[4] More than one-fifth of the women reporting had never told anyone of their partner’s violence. Interestingly, the lowest prevalence of ongoing domestic violence was found in urban Japan, Serbia, and Montenegro. This may be reflective of different levels of economic development and a woman’s increased ability to leave an abusive partner.

Although this is a complex social problem, the WHO study emphasizes the need for women to change their attitudes that abuse is justifiable. Unfortunately, as a complex social problem, there is no easy solution and it is politically a low priority issue. Hopefully, as our knowledge of domestic violence grows and we understand more of the factors that contribute to it, the prevalence will decrease enough for it to become uncommon and abnormal. Possible interventions may include policies that promote social awareness to change the norms that condone violence, policies that give women access to economic, social, and supportive services, and policies for health services to integrate prevention programs and identifying victims.


[1]  “Domestic Violence Statistics.” Domestic Violence Statistics. N.p., 2013. Web. 31 Jan. 2013.

[2] “The World’s Women and Girls 2011 Data Sheet.” Population Reference Bureau, 2011. Web. 31 Jan. 2013.

[3] Bates, Lisa M. “Socioeconomic Factors and Processes Associated With Domestic Violence in Rural Bangladesh.” International Family Planning Perspectives 30.4 (2004): n. pag. Guttmacher Institute. Dec. 2004. Web. 31 Jan. 2013.

[4] Garcia-Moreno, Claudia. “Violence Against Women.” Science 310 (2005): n. pag. Science. AAAS, Nov. 2005. Web. 31 Jan. 2013.