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Al-TAAWUN: Building A Savings Reserve On The Basis Of Justice And Cooperation

March 9th, 2011

To: The Islamic Development Bank

From: Neha Tahir, Class of 2012, Stanford University

Subject: A New Group-based Microfinance Model Catering to Women

Executive Summary:

The Islamic Microfinance industry, a consequence of the union between the Islamic Finance and the Microfinance industries, might be the answer to the recent failures that the Microfinance industry has been facing. Islamic Microfinance has been modeled upon the strength of the conventional Microfinance industry, with the scope to correct some of the inherent problems and inefficiencies that exist within the conventional system, while still adhering to the common goals of an Islamic Economic System, such as justice and equality, and a proper distribution of income and wealth.

However, the Islamic Finance system does not offer any significant form of finance that caters to individual financial needs (particularly cash needs), and the Retail/Consumer Banking sector in the industry has a lot of scope for the research and development of new products and services. The relatively new industry also suffers from a very limited outreach; the findings of a global survey on Islamic Microfinance carried out by CGAP in 2007 show that “Islamic Microfinance has a total estimated global outreach of only 380,000 customers”, this meager figure being representative of an estimated one-half of one-percent of total Microfinance outreach (Karim, Nimrah).  This is owing to the narrow range of products and services that the industry currently has to offer; While the Islamic Financial Services Industry has made great strides in recent years, it has not adequately addressed poverty alleviation. This must be remedied, as diverse approaches are needed to provide poor Muslims with access to financial services (Islamic Research Training Institute). The lack of sufficient and diverse products and services in the industry leaves the common man who is in need of an immediate interest-free loan, but is unqualified to receive this money from banks, to resort to pawnshops, despite their high rates of interest.

Proposal:

I would like to propose the model of a new Islamic Microfinance service that will be offered by Banks and/or Microfinance Institutions worldwide. It is particularly suited to the needs of women entrepreneurs looking for an interest-free way to finance their enterprise. There are various discrepancies between Microfinance products that are targeted towards men and women; the characteristics of this model, as will be discussed below, make it more functional for aspiring female entrepreneurs.

The product, “Al Taawun” (which translates: “helping one another”), will be practically experimented in Dubai, UAE, with the city’s expansive Islamic Finance background and expertise. Having been researching the theory and mechanism of this product since June 2010 in Dubai, I have been successful in building a supervisory board of patrons in the city, inclusive of technocrats, senior government officials, ministers, CEOs, and Heads of Islamic Finance in Banks and other Financial Institutions.

The model is built on the foundation of a ‘cooperating with and helping one another’ motto. Al Taawun is basically a cluster of networks that generate money for its members. Every individual member of the group contributes a sum of money to the group, the collective amount of which, every member gets to benefit from at different time periods during the year. Due to the fact that this model works on the basis of group cooperation, with every member of the group being a motivating factor for the other members to not default, and because the model is a savings model that is contingent on its members repaying on time, it is more likely to receive better results if it was specifically targeted towards women. Women entrepreneurs essentially reflect feminine values and the characteristic developmental qualities of women such as relationship, interdependence and cooperation; this is contrary to the management styles of men, which include autonomy, independence, and competition (Mahmood, Ahmed).

Conclusion

Al Taawun is a step in the direction of diversifying the current spectrum of products offered by the industry, without paying very high rates of interest; it is an attempt to contribute towards a fair and just economic system that caters to every individual’s needs, and helps alleviate poverty by providing the poor population, in desperate need of an access to basic finance, with a refuge to relieve its financial problems.

Sources:

Tarazi, Michael. Reille Xavier. Karim, Nimrah. Islamic Microfinance: An Emerging Market Niche. CGAP Focus Note. August 2008.

Islamic Financial Services Board and Islamic Research Training Institute. Islamic Microfinance Development: Challenges and Initiatives. Working Paper for Islamic Financial Services Board Forum Framework and Strategies for Development of Islamic Microfinance Services, Dakar, Senegal, May 27, 2007, 81p.

Ahmed, Mahmood. “The role of RDS in the development of women entrepreneurship under Islamic Microfinance: A case study of Bangladesh.” In: Islamic Finance for Micro and Medium Enterprises by Mohammed Obaidullah and Hajah Salma Haji Abdul Latiff. Islamic Research Training Institute, Islamic Development Bank and Centre for Islamic Banking, Finance and Management, University of Brunei Darussalam, Jeddah/Brunei, 2008

The “Women-Only” Approach Versus the “Family Empowerment Approach”: Egypt as a Case-Study

March 7th, 2011

The access to basic financial services that Islamic Microfinance offers empowers Muslim women in giving them a new dimension in life and feeling of self-worth. However, while this ability of Microfinance to provide rural women with micro-loans in gender-segregated societies is laudable, working with Muslim women in particular raises the issue of interfering with social, cultural and religious codes. The Qur’an encourages men and women to play their respective roles in society, by ensuring the economic and social wellbeing of the family: “Men shall have a share of that which they have earned, and women a share of which they have earned” (Qur’an, VI, 32).

Hence, the “women-only” approach typical of conventional microfinance is not always followed by Islamic Microfinance Institutions (IMFIs) that try to adhere to Islamic principles and values while providing customers with loans. IMFIs overcome this problem by shifting their focus from “women empowerment” to “family empowerment”, which is also promoted by the Qur’an. While this kind of an approach might be met by criticism, it must be understood that it is a very culture-specific approach that mostly caters to male-dominated societies.

The “women-only” approach does weaken the institution of the family by sending both the male and the female out to work, giving them both the feeling of being the breadwinner for their family. But besides this, this approach is also prone to many risks posed by traditional male-dominated societies. In these societies, the funds provided to women for investment in their enterprises are often usurped by the male members of the family, while the women consequently end up carrying the burden of repayment and of their business independently.

In a Muslim country like Egypt, which was the first MENA country to sign the UN Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), Microfinance has had a great impact on women’s empowerment in the country. In 2008, a national survey carried out by Planet Finance (NGO) evaluated the impact of microcredit as well as the perception of this impact: “During the focus group discussions, women unanimously stated that the loan had had a positive effect in terms of their image in their communities; they are also more self-confident and their children appreciate what they do. Their projects have allowed them to have a better life in general (“National Impact Survey” 86)”. Despite being a male-dominated Muslim society, Islamic Microfinance accentuates women empowerment.

47 percent of Egypt’s microentrepreneurs are women; 88 percent of these women operate home-based businesses and only 28 percent operate non home-based businesses. Despite these circumstances wherein women are allowed to realize their entrepreneurial skills and abilities out of their home, 45 percent of women have noticed a positive change in their life, in terms of education and economic possibilities, whereas 86 percent of women have experienced a positive impact in terms of personal autonomy (V. COSTA – H. MAKHLOUF – P. MAZAUD).

Sources:

Costa, Valentina. Makhlouf, Hala. Mazaud, Perrine. “Women’s Empowerment through Islamic Microfinance in Egypt”. MESCI 2009-2010.

The Role of the Rural Development Scheme (RDS) in the Development of Women Entrepreneurship Under Islamic Microfinance

March 7th, 2011

Looking at the RDS as a case study in the development of women entrepreneurship in Bangladesh by means of Islamic Microfinance, we can analyze the role of the burgeoning industry in poverty alleviation, and women empowerment in particular. The RDS is a provider of Microfinance services in Bangladesh, following the rules set by the Islamic Shari’ah. The RDS caters to the investment needs of the agriculture and rural sector; its target market segment include destitute women and distressed people. The RDS is an investment project that conforms to social responsibility fort he downtrodden in the rural areas as its prime priority. It uses depositors’ funds in interest-free ways in rural areas where downtrodden people are susceptible to interest-based groups.

90 per cent of the RDS’ customers are women; the project is currently being operated in about 2200 villages in 45 districts through 21 branches, with a recovery rate of approximately 99.7 per cent.

The cardinal principle of the Scheme is the ‘Group Approach’, Allah loves those ‘who conduct their affairs by mutual consultation’ (Al-Quran 42:38). For all decision-making activities, this mutual consultation is given high priority. The scheme works with each member of the group guaranteeing other members’ investments, and once the investment is approved, the investment (along with a percentage of the profit earned by the business) needs to be paid back by the client in 45 equal weekly installments.

This model has worked really well in terms of the scheme serving as a great source of empowerment for its women customers (who are also the majority of its borrowers). Since the establishment of the RDS, there has been a positive impact on women’s income, decision-making skills, and in reducing overall gender disparity in Bangladesh. Moreover, the group approach adopted by the RDS works really well with women because women in general find it easier to identify with organizations that essentially reflect feminine qualities such as relationships, interdependence and cooperation. An article written by Mahmood Ahmed on the RDS also points out that that scheme has seen a really high repayment rate because women are more likely to repay loans than men, owing to their “mother-hood” skills that they have developed while looking after their husbands, children, and families at home. This hypothesis particularly applies to the women and culture of Bangladesh.

RDS is therefore one out of the many Islamic Microfinance models that has proven successful in alleviating poverty and empowering women by means of granting them interest-free loans.

Legitimacy of Islamic Microfinance as a Viable and Feasible Alternative to Conventional Microfinance

March 7th, 2011

Why is there a need for Islamic Microfinance?

We know that the prime motive of every government and every country’s Finance Minister is to account for a sound and stable financial system in the economy, and try to alleviate poverty. However, factually speaking, there is no evidence of a system that has succeeded in the above-mentioned attempts. With the emergence, instant success, and exponential growth of the Microfinance industry, Microfinance has been claimed to be the mechanism that has the potential to eradicate global poverty. This claim obviously comes with its share of criticism and debate; how does Microfinance aim to defeat poverty, if it charges its high-risk, poor customers, excessive rates of interest that in some cases soar as high as 60%? The industry is getting carried away by its potential to generate profits; there is an increasing number of MFIs that have started operating under the business objectives of the commercial world, with profits and expansion being their main aim. MFIs have started to go public, when the only beneficiaries of this industry, as stated by Mohamed Yunus, should be the poor population it was initially created for. Of course, other social benefits such as justice and equality, and a proper distribution of income and wealth, remain just as unattainable and untouched with the industry moving farther away from its actual goals.

Looking at Different Countries as Case-Studies of a Global Need for Islamic Microfinance

In such a global situation, Islamic Microfinance could be the savior that the Microfinance industry needs to remind it of its original motivations. Like Muhammad Yunus pointed out, the Microfinance industry was created to protect the poor from loan sharks, not create more loan sharks. Looking at the global Microfinance industry, and the cost of borrowing money, the countries that are most shocking are Nigeria and Mexico (NYTimes). The demand in these countries for micro loans is very expansive. In this classic case of an excess demand being met by a high price, these countries charge their poor excessive rates of interest.

In Mexico, the average rate of interest for a micro loan is 70 percent, compared to a global average of about 37 percent (NYTimes). Uzbekistan also boasts a whopping 80 percent average in interest rates per annum, with Uganda, Kenya and Ghana following at approximately 55 percent, 55 percent and 50 percent (respectively) (CGAP).

In such a situation, where the global average itself is at 35 percent, would it help to have an industry serving the same purpose of providing the poor with basic financial access, WITHOUT charging interest? Islamic Microfinance is definitely an alternative to the problem of high rates of interest; although Islamic Microfinance does not mean that money is lent absolutely free cost (since the industry needs to make its profits in accordance with the Islamic Shar’iah), its compliance with Islamic rules and the Islamic goal of an Economic System with values such as justice and equality, the industry is obviously bounded by moral values that hinder it from getting carried away or trying to make profits at the expense of the poor.

Sources:

Rosenberg, Richard. Kneiding, Christoph. 2008. “Variations in Microcredit Interest Rates” Brief Note. Washington, D.C.: CGAP, June.

<http://www.responsability.com/domains/responsability_ch/data/free_docs/1_0807_CGAP_Variations_in_Microcredit_Interest_Rates_2.pdf>

MacFarquhar, Neil. “Banks Making Big Profits From Tiny Loans”. NYTimes. April 13 2010.

<http://www.nytimes.com/2010/04/14/world/14microfinance.html?_r=1

Sex Trafficking In Vietnam: The Sustainable Solution

March 4th, 2011

Date: March 3, 2011

To: The Vietnam Women’s Union

From: Tania Tran, Stanford University

Dear The Vietnam Women’s Union,

My name is Tania Tran and I am a student at Stanford University.  In my studies in women’s health during the past quarter, I have become very interested in the issue of sex trafficking in Vietnam.  Prior to the class, my knowledge on the issue of sex trafficking and prostitution came from the discussions within my family and the Vietnamese-American community around us.  I learned that sex trafficking is a largely prevalent and growing problem in Vietnam, with hundreds of thousands of women and girls victim to trafficking for prostitution and forced-marriage only within the past few decades.  The stories that I’ve heard gave me the impression that this practice is fundamentally the buying and selling of women into slavery.

My research within the past quarter has informed me that the Vietnamese government, especially through The Vietnam Women’s Union, has taken many steps to reduce sex trafficking.  There is no doubt that sex trafficking is an increasing problem in Vietnam.  From the United States perspective through the Trafficking In Persons (TIP) Report, Vietnam’s standing has dropped from Tier 2 in 2009 to Tier 2 Watch List in 2010 [1], suggesting many problems that the Vietnamese government has insufficiently addressed.  Some of these issues include lack of funding for victim protection resources, education of law enforcement officials, legal framework for addressing trafficking crimes, and prevention methods.  In light of these problems, I am writing to you with regards to solutions to ending sex-trafficking.  I would like to address key problems I see in existing solutions to end sex-trafficking and propose new ways to combat this issue that could be more effective and sustainable.

Key Issue #1: Community Involvement

According to the National Plan of Action To Combat Crimes of Trafficking in Women and Children in 2004-2010, it was reported that only 12 of 63 Vietnamese provinces had strategies to prevent trafficking linked to the national plan [2].  This suggests an enormous gap in communication and knowledge that could be vital to stopping sex trafficking.  I believe that if the government does not have enough resources to reach out to the provinces, change could also start from the local level.  As evident in the work of ActionAid International Vietnam, providing information and education to poor communities is a very effective way to effect change on a larger scale, especially because women and children who are poor and less educated are most likely to be trafficked [3].  By providing education through monthly meetings in these communities, we can not only provide these women the awareness of the dangers of sex trafficking, but also a sense of community and empowerment.

Key Issue #2: Respecting Women

I have observed that The Vietnam Women’s Union has focused a large portion of its money and efforts on education services designed for women and girls.  I would like to propose that awareness campaigns should address male members of the community as well.  Sex-trafficking, prostitution, and sex-tourism are all activities that flourish due to increasing demand.  In order to combat these issues, we must recognize that the root of the problem lies within the hands of men and leaders in our communities.  If there wasn’t a demand, sex-trafficking would not occur.  Education on sex-trafficking must happen at all levels of society and must target all age-groups.  It must be known that sex-trafficking is prevalent because it is a practice that operates on the belief that women are commodities.  To address sex-trafficking appropriately, we must also address the way society objectifies women and come up with a way to stop it.

Key Issue #3: Government Responsibility

Through public education and awareness campaigns, The Vietnam Women’s Union must pressure the government to be more accountable and diligent in the prosecution of sex-trafficking crimes.  Education programs should specifically target state officials and those in positions of power.  At the most basic level, criminals of sex-trafficking must be punished in order to set a precedent for the respect of human rights at both the national and international level.  The government must be persuaded to focus on the bigger picture – it must seek to improve the status of women in society and protect them from the dangers of trafficking.  The government should not worry itself about the formation of a State Run Bridal Agency [4] or Red Light Districts to limit “illegal” exploitation of women, for these solutions will only temporarily address sex-trafficking and fail to address the human rights of women and the freedom from slavery.  Even when regulated, these practices fundamentally treat women as objects, easily sold and exploited for a profit.  The public must become informed about the Criminal Code in Vietnam and demand for a more uniform legal code for punishment of sex-trafficking crimes.  Currently, article 119 states that perpetrators could be imprisoned for 20 years for this crime, yet does not indicate any punishment for perpetrators who are government officials [5].  Education must seek to educate citizens not only of their rights, but also for insisting that state officials must be educated and responsible in the fight for human rights for trafficked victims.

I hope that The Vietnam Women’s Union will take these suggestions into consideration. I believe that approaching the issue of sex-trafficking systematically by educating all levels of society will contribute greatly to both the prevention and treatment of this injustice.

Sincerely,

Tania Tran

[1] Trafficking in Persons Report 2010: http://www.state.gov/g/tip/rls/tiprpt/2010/

[2] “Trafficking Fight Lacks Political Will” http://www.rfa.org/english/news/vietnam/trafficking-12062010172500.html

[3] ActionAid International Vietnam: www.actionaid.org.uk/100192/Vietnam.html

[4] BBC News: Vietnam State to Run Bride Agency: http://news.bbc.co.uk/2/hi/7817818.stm

[5] General Assembly WOM/1593, Committee on Elimination of Discrimination against Women: www.un.org/News/Press/docs/2007/wom1593.doc.htm

What Does It Mean For Women To Be “Empowered” And Does Empowerment Compromise The Viability of Microfinance Institutions Worldwide?

March 3rd, 2011

Microfinance has had a positive impact on the status of women globally. What does it mean for women to be “empowered”?

According to the State of the Microcredit Summit Campaign 2001 Report, 14.2 million of the world’s poorest women how have access to financial services through bank, Microfinance Institutions (MFIs), NGOs, and other such institutions. These women belong to the 74 percent of the approximately 20 million of the world’s poorest people that are now being catered to by MFIs. This means that most of these women have access to the ‘loan’ they need to start or invest in their own enterprise; also, most of these women have great repayment records despite the financial problems they run into on a regular basis. So then, is it a good idea to lend money to the poor, and more specifically to poor women? What does this money do for them in terms of their ‘empowerment’?

The word empowerment is difficult to define precisely; yet, it is easy to pin-point an example of empowerment when we see one:

Snapshots of Empowerment:

  • Nury, an illiterate Trust Bank client at AGAPE in Colombia, formerly too shy to speak to strangers, became the treasurer for her Trust Bank.
  • A group of widows in Bali received loans from WKP to start simple projects raising pigs. Over time, they grew in confidence and solidarity and expanded to form a pig-feed cooperative that became the major supplier for their village.
  • Hanufa, a member of CODEC in Bangladesh, defends her rights against an illegal divorce but ultimately decides that she is better off on her own. “I can walk on my own shoes now.”

A lot of different terms have been associated with empowerment: self-reliance, self-respect, self-enabling to reach potential, development of self-worth, and so forth. Empowerment is definitely the goal of many MFIs worldwide; these institutions help women that have previously experienced little or no power, make choices that impact their lives forever. By providing these women with basic financial services, and a loan to become an entrepreneur, they have a tremendous impact on this empowerment process.

Even though MFIs with a strong focus on empowerment have been criticized to have lose their operational viability and sustainability in the process, this has been proved wrong by many MFIs with the same women-empowerment focus. Working Women’s Forum (WWF) in India, for example, is fully financially sustainable and offers a range of nonfinancial services, including organizing women in the informal sector to achieve better wages and working conditions. WWF also empowers poor women through its institutional structure by training them to act as health promoters and credit officers in their neighborhoods. Therefore, MFIs with a strong focus on empowerment maintain very high levels of operational and financial sustainability, suggesting that a great deal can be done to enhance women’s empowerment even within the constraints of financial sustainability.

Reducing Maternal Mortality by Investing in Midwives: A Policy Brief to the UNFPA

March 3rd, 2011

To: The United Nation Population Fund (UNFPA)

To Whom It May Concern:

The unacceptably high rates of maternal mortality that exist in developing countries remain a source of shame for this agency and the global medical community. The situation can be summed up in a few statistics: first, 529,000 women die annually due to complications from pregnancy or childbirth—that’s one woman per minute. Moreover, some 10 million women a year suffer from disease, injury, or infection as a result of pregnancy or childbirth (1). However, these numbers become much more meaningful with another number: by UN estimates, 80% of maternal deaths are preventable (2). Unfortunately, despite substantial opportunities for reduction, maternal mortality rates have barely changed in the past 20 years (3). I understand that you and many other UN agencies have established the Millennium Development Goals, among them MDG 5: reduce maternal mortality. This MDG sets the target reduction of MMR at 5.5% per year, but the actual annual rates of decline were less than 1% between 1990 and 2005 (4).

How can we shrink the enormous gap between goal and reality? It is well known that we have the necessary technologies to reduce to maternal mortality to extremely low levels—simply take any wealthy, Western country as an example. Given this fact, as the WHO wrote in a 2005 report, “The challenge that remains is therefore not technological, but strategic and organizational.”

A 2006 Lancet article identified the provision of intra-partum services, including emergency care, as the single biggest priority to getting on with what works and reducing maternal mortality in a meaningful way (5). Specifically, it is time to shift the focus towards providing regional maternal healthcare centers in areas with high maternal mortality. Most maternal deaths happen between labor and the first 24 hours after delivery. Because most complications related to childbirth arise as emergencies, it is simply not feasible to rely on hospitals located hours away. However, that is often what happens. A recent study found that in rural Zambia, “half of all mothers lived more than 25 km from a health facility that provided basic emergency obstetric care” (6). This is particularly unacceptable when one considers that “all five of the major causes of maternal mortality – hemorrhage, sepsis, unsafe abortion, hypertensive disorders and obstructed labor – can be treated at a well-staffed, well-equipped health facility” (7). This policy brief focuses on ways to make the facility mentioned above a reality.

In order to do this, the most critical area to build is human capacity. Indeed, “The most crucial impediment [to reaching MDG 5] is the large deficit of human resources for maternal survival” (9). By increasing the number of skilled birth attendants, placing them in regional intra-partum care centers, and providing them with a sustainable and well-organized referral system, we can ensure that women have basic emergency obstetric care (BEOC) immediately available and comprehensive emergency obstetric care (CEOC) when needed. My suggestions for increasing human capacity are threefold: First, increase training of midwives while focusing on quality. Second, provide the necessary human resource networks to function on a regional and national level. Third, implement Mozambique’s successful surgical-midwife program to increase the comprehensive care options in rural areas.

In 1989, the Indonesian government launched a massive national village-base midwife program. They trained and deployed some 54,000 midwives in 7 years, and continued to scale up from there. Ultimately, from the time of implementation to 2003, they saw a reduction in maternal mortality from 400 deaths to 307 deaths per 100,000 live births (8). There are many lessons to be learned from Indonesia’s example—first, that drastically increasing the number of midwives does result in a substantial reduction in mortality—and moreover, that by correcting their mistakes in the future, reductions can be greater. A major lesson from the outcome in Indonesia is that a high priority must be quality, so that women receive thorough and excellent training before they’re deployed to rural posts. The WHO has also emphasized the need for “a considerable investment in high-level basic training” for aspiring midwives, who do best in training with a 10 year base of general education (7). Despite the urgent need for more midwives, quality must not be skimped on in training programs.

After studying Indonesia’s example, another crucial factor is evident: supervision and support of midwives on a local and regional level (8). It’s necessary that sufficient supervision and mentoring programs are put in place to provide support to midwives, established at the beginning of their post and occurring at regular intervals. This kind of support will increase retention and can also continue the training process once midwives are established in villages. Overall, “Implementation at scale needs a sound human resource plan: a health workforce framework that considers planning, recruitment, education, deployment, and performance support of health workers” (5). While this is a bit of an overwhelming requirement, it is nevertheless essential to devote the resources to a human resource strategy to ensure sustainable, effective healthcare provision.

The final major lesson from Indonesia is the need for “access and financial support for referral to emergency obstetric-care centers” (8). Indeed, this is absolutely crucial for a midwife and intra-partum care model to work. While midwives are able to provide basic emergency obstetric care, which is sufficient for the majority of women giving birth, there are a few services out of their range, which fall under the category of comprehensive emergency obstetric care, and include c-section and blood transfusions. This agency has recommended that for every 500,000 people, there be 4 facilities offering BEOC, and 1 offering CEOC. Aiming for these ratios should be a major priority, as well as ensuring open communication and transportation between facilities. Finally, an exciting possibility to increase the number of midwives who can offer comprehensive emergency obstetric care comes from Mozambique, where a training program has been implemented to train midwives in surgical techniques. These workers, called técnicos de cirurgia, or TCs, receive at least 3 years of surgical training, with an emphasis on quality and self-sufficiency. Many go on to work in district hospitals, where they provide 92% of surgeries and have largely identical outcomes to those of medical doctors. Moreover, their retention rate was 88%, while that of doctors was 0%. The incredibly successful example of Mozambique can be mimicked in terms of quality and content to provide sustainable increases in provision of CEOC in rural areas. (9)

We have the technologies to prevent most maternal death. The focus must be on building regional personnel capacity to handle maternal health, particularly obstetric emergencies, so that all women have access to these technologies. I would also like to emphasize, as many others have, the importance of writing policy with an emphasis on immediacy and practicality. The current maternal mortality figures are shameful, and policy and implementation need to have increased support, money, and urgency behind them. A major strength in the fight to reduce maternal mortality is that we have the techniques to almost completely reduce maternal mortality and morbidity. This confers an advantage not present in many other global health problems. However, it also indicates a responsibility to do much more than what we’re doing—there is no excuse.

In Solidarity,

Jenna Wixon-Genack

Stanford University

  1. World Health Organization: “Why do so many women still die in pregnancy and childbirth?”
  2. United Nations Summit. September 20-22, 2010. New York.
  3. http://www.unifem.org/attachments/products/MDGsAndGenderEquality_1_MakingChangeHappen.pdf
  4. “What Will it Take to Achieve the Millennium Development Goals?—An International Assessment.” UNDP. June 2010. http://content.undp.org/go/cms-service/stream/asset/?asset_id=2620072
  5. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)69381-1/fulltext
  6. http://biomedme.com/general/emergency-care-for-childbirth-complications-out-of-reach-for-rural-women-in-zambia_31570.html
  7. http://www.who.int/whr/2005/chap4-en.pdf
  8. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60538-3/fulltext
  9. http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2007.01489.x/full

Policy memo: Where to go from here

March 3rd, 2011

To: The UNHCR

Over the past few weeks, I have written a blog on women’s education in refugee situations for a class on critical issues in international women’s health. Time and again in our class we learned that women in many places in the world fare worse than their male counterparts in most areas of life. We have learned that women struggle to achieve the same levels of education as men almost everywhere in the world, and that it looks as though if more women received more education, it would go a long way towards ameliorating many of the world’s issues, for example, population growth. We have also learned that women in refugee settlements suffer even more abuse and violence than usual, and that their situation can often be truly dire.

Education for women in refugee situations is an enormous topic, and a short series of blogs like this one could never begin to touch on all the issues that fall under that heading. However, since starting this blog several themes have come up again and again:

  • Education is key. The importance of education in refugee situations cannot be stressed enough. It may seem less important than other issues, but after basic survival, education is among the top priorities of refugee families (1). In addition to being a basic right of every human being, education brings countless benefits to settlements and individuals. It’s helpful as a stabilizing force in the lives of children who may have suffered from traumatizing events (2), and is vital to those same children when they’ve grown up and are looking for jobs, because it can mean reintegration into society and the economy (3). Vocational training can take the place of traditional education and prepare refugees for re-entering the job market, as well as providing many women with the opportunity to generate valuable income and work toward economic independence (3).
  • Health education is hugely beneficial to women. Health education is a specific area of education that can have an enormous effect on women living in refugee settlements and help keep them safe and healthy. The example of RHG showed that health education and family planning programs can significantly decrease the number of unwanted pregnancies in a population in a settlement to below the national average, which is valuable to many women who either don’t want or can’t support more children (4).
  • Just one can make a difference. The example set by RHG, in addition to the example set by Dr. Hawa Abdi, show that even one person or group can make a difference in the lives of thousands. It takes someone to recognize a need that isn’t being met in a community and to decide to do what they can to fix that situation.

These themes provide the basis for some policy priorities and actions that should be considered when addressing the issue of women’s education in refugee settlements. The first is that more international attention be brought to the benefits of education in refugee situations, and the challenges of making that education a reality. 40% of the world’s refugees are school aged (5), which means there is a very large number of children in the world at risk for not having their basic right of education fulfilled.

Next, education needs to remain a priority. All the above benefits show that neglecting education could have very serious deleterious effects on a community and the futures of refugee children. The UNHCR already funds many schools that support thousands of children and runs teacher training programs, and should by all means continue to do so.  The Nepalese schools in the third post of this blog (6) serve as an excellent model of schools that aren’t run on much money but have been shown to be very effective at involving the community and facilitating academic success, so the UNHCR should continue working to develop and support effective and efficient programs like these.

Health education should be included in curriculums, and classes for older women health education and family planning should be offered wherever possible in order to help keep women safe and healthy.

The UNHCR should also do whatever possible to facilitate work done by legitimate independent groups, like RHG or Dr. Hawa Abdi, who are able to do so much in their communities and change the lives of thousands.

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

2)   http://adc.bmj.com/content/87/5/366.full

3)   http://womensrefugeecommission.org/images/stories/Jordan_youth_FINAL_01_2010.pdf

4)   http://www3.interscience.wiley.com/cgi-bin/fulltext/122373785/PDFSTART

5)   http://www.refugeelawproject.org/working_papers/RLP.WP09.pdf

6)   http://www.unhcr.org/3b8a1b484.pdf

Developing Innovative, Computer-Based Sexual Health Education Program

March 3rd, 2011

TO: Bill & Melinda Gates Foundation

RE: Letter of Inquiry for Innovative Sexual Education Programs for Children and Adolescents

To Whom It May Concern:

Worldwide, there are over 1 billion people between the ages of 10-19.  These individuals, classified as “adolescents” by the United Nations Population Fund, constitute over one-fifth of the world’s population.   If we extend this range to include all those under the age of 25, we include over half of all people alive today.  By numbers alone, young people are astoundingly important to the economic stability, population health, and security of all nations. Further, this developmental period represents a critical period in which to intervene to promote the public’s health.  Scholars consider adolescence a time of both heightened vulnerability to initiating risk behaviors and a crucial time to establish healthy behaviors.  Adolescent girls and young women an especially important because of their relatively lower status and increased vulnerability to a number of health problems across the life course.  Focusing on ensuring good health and promoting health-enhancing behaviors in young people, especially females, should therefore be a top priority for global health leaders today.

Of particular importance to today’s adolescents is sexual and reproductive health.  There are 33 million people living with HIV/AIDS worldwide, the vast majority of whom live in developing countries.  Adolescents constitute the fastest growing group of new infections worldwide.  Sexually Transmitted Infections (STIs) comprise a leading cause of morbidity in women (often second only to domestic violence), and are the primary killer of 200,000 women annually.  An additional 87,000 deaths during pregnancy and childbirth are due to complications of STIs, and 237,000 women die each year of cervical cancer, a highly treatable illness if caught early, and preventable via vaccination of women not yet sexually active.

Worldwide, millions of young women are sexually active. In developing countries, anywhere from 20 to 70% of teen girls aged 15-19 report in surveys having already initiated sex.  In many countries, up to one-third of sexually active adolescent girls report having two or more sexual partners in the past year, an indicator.  More than 14 million adolescent girls give birth each year.  Over 6 million of these pregnancies are unintended, indicating improved access to and understanding of contraception.  Given that most young women will become sexually active during adolescence, and millions will experience an unwanted pregnancy and/or contract HIV or another STI, the public’s health depends on providing comprehensive, effective sexual and reproductive education to these youth.

Yet, it is clear that governments, civil society, and the private sector alike have failed to meet this basic human right.  Nationally representative Demographic and Health Surveys across the globe underscore this failure.  These data show, for example, that in 24 of 30 countries with adequate data, 30 to over 50% of young women do not know that a healthy looking person can carry HIV.  This is true even in some high-HIV-prevalence countries, such as Kenya, Ethiopia, Mozambique, and Nigeria.   Knowledge of modern contraceptive methods is no more encouraging.  As many as one third of teenage girls report they do not know of any modern contraceptive methods.  While more report knowledge of condoms, this appears to be only a general awareness of condoms: most countries show a stunning gap between the proportion of girls who have heard of condoms and the proportion that know where to obtain one.  Clearly, current programs are falling short.  New efforts are needed to ensure that young women receive the knowledge they need to protect themselves from STIs, HIV, unintended pregnancies, and cervical cancers, and to ensure they can develop positive, healthy, and satisfying sexual relationships.

Most current efforts to provide comprehensive sexual and reproductive health information to adolescent girls suffer from important limitations.  School-based education fails to reach the huge numbers of youth who drop out of school or whose attendance is only sporadic.  This is particularly true for girls, who are much less likely to complete primary or secondary school than their male peers.  Teachers frequently lack training and resources to successfully implement sexual education.  Mass-media campaigns are often unidirectional in their communications – youth may not have the opportunity to ask questions or seek clarification.  Mass-media messages are also limited to topics and curricula considered socially acceptable, which is particularly problematic in the case of sexual health education for adolescents, an extremely taboo topic across the globe.  Also, the very poor and those living in rural areas may lack access to many forms of media because of their poverty, remoteness, or high rates of illiteracy.  Internet-based education faces similar limitations.  Some of these challenges are being met with SMS-based hotlines; however, these programs can offer only very brief communication (i.e. messages soften limited to 140 characters) and are considered one-time services to answer specific questions rather than provide comprehensive education.

Because of the importance of educating young women, particularly those living in developing countries, combined with the clear gaps in current programs, I seek funding for an initiative to develop a comprehensive, interactive, computer-based sexual and reproductive health curricula, based on the HIV/AIDS curriculum used by the internationally renowned organization, TeachAIDS.  TeachAIDS is a 20-25 minute, interactive computer application that teaches adolescents key aspects of HIV/AIDS prevention using proven pedagogical and communication theories and culturally appropriate euphemisms, metaphors, and explanations.  The application was originally developed for use in India as a tool to provide effective heath education on socially taboo topics and has since been adapted for use in countries across the globe.  A large, randomized-controlled trial of the application in India demonstrated its efficacy.  Students who received the computer-based instruction showed significantly greater knowledge of HIV/AIDS as well as positive changes in attitudes compared to students who did not receive the intervention.  These differences were still significant at one-month follow-up.  Importantly, while males performed significantly better on a pretest of their HIV/AIDS knowledge, no gender differences were present following the program, indicating the tool’s powerful ability to close the gender achievement gap.

TeachAIDS shows us that it is indeed possible to educate youth on socially taboo topics with a very brief intervention.  Given the program’s success, I argue for funding to expand this program to cover comprehensive sexual health information.  TeachAIDS was developed using rigorous, research-based iterations to ensure its cultural appropriateness and effectiveness.  This process is resource-intense; funding is therefore needed to develop and test new modules addressing other topics in sexual health.  Based on national recommendations, these topics should include human development (reproductive anatomy and physiology, reproduction, puberty, and sexual orientation and identity), relationships (including with friends, love and dating, and relationship abuse and domestic violence), personal skills (including learning decision making, assertiveness training, and increasing skills in negotiation), sexual behavior (including masturbation, abstinence, and sex response), and sexual health (including contraception, STIs, HIV, and reproductive health).  Material should culturally appropriate and inclusive, and tailored to specific age and education-levels.  Ideally, modules would be created for young children as well as adolescents.  Because so many adolescents begin sexual activity at such young ages, it is important that education reaches them before they establish patterns of risky behavior.

Developing and testing each module will be time and resource intensive.  However, the return-on-investment will likely be unparalleled.  Thus far, little seems to be slowing the HIV/AIDS pandemic, which has ravaged the globe for over 25 years.  Maternal mortality rates have remained high over the past few decades, despite increases in infant and child mortality.  STIs, unwanted pregnancies, and unsafe abortions continue to affect millions of women worldwide.  Providing adolescents, particularly adolescent girls, with access to sexual and reproductive knowledge empowers them to protect themselves, perhaps finally reversing the gloomy trends in sexual and reproductive health worldwide.  Further, such efforts are likely to improve the overall health of girls, thereby conferring extensive positive externalities by keeping girls in school longer, delaying childbearing, increasing child spacing, lower overall fertility, and providing economic opportunities otherwise unavailable due to childbearing or illness.

The health of young people worldwide, as well as our global security and stability, depends on new efforts in sexual education, and I hope you will consider exploring this exciting opportunity to address this need.

Sincerely,

Anna Grummon, Stanford University

References

Agha, S (2003). The impact of a mass media campaign on personal risk perception, perceived self-efficacy and other behavioral predictors.  AIDS Care, 15(6): 749-762.

AVERT.org (2011).  “Sex Education that Works.”  Retrieved from www.avert.org/sex-education.htm.

Bertrand et al. (2006). Systematic review of the effectiveness of mass communication programs to change HIV/AIDS related behaviors in developing countries.  Health Educ Res, 21(4): 567-597.

Dixon-Mueller, R. (2009). Starting young: Sexual initiation and HIV prevention in early adolescence. AIDS and Behavior, 13(1):100-109.

Ferguson, J (2010).  Evidence based approaches to sexuality education for adolescents: Training course in sexual and reproductive health research. World Health Organization: Geneva.

Guttmacher Institute (2010). Facts on the Sexual and Reproductive Health Of Adolescent Women in the Developing World – Brief.

International Center for Research on Women (2001). The critical role of youth in global development.  ICRW Issue Brief, December, 2001.

Murray, AF (2008).  From Outrage to Courage.  Monroe, Maine: Common Courage Press.  See especially pp. 44-46; 65-79; and 103-109.

SEICUS (2004). Guidelines for Comprehensive Sexuality Information: Kindergarten through 12th Grade.  3rd Ed.  New York: SEICUS.

Singh, Bankole and Woog (2005). Evaluating the need for sex education in developing countries: sexual behavior, knowledge of preventing sexually transmitted infections/HIV, and unplanned pregnancy. Sex Education 5(4), 307-331

Socar, P and Nass, C. (2010).  Teaching Taboo Topics Through Technology.  Handbook of Research on Digital Media and Advertising: User Generated Content Consumption.  Eastin, MS, Daugther, T, and Burns, NM (Eds).  IGI Global.

Takura & Zaidi 2010.  Addressing critical gaps in achieving universal access to sexual and reproductive health (SRH): The case for improving adolescent SRH, preventing unsafe abortion, and enhancing linkages between SRH and HIV interventions.  International Journal of Gynecology and Obstetrics, 110, p. S3-S6

Takura & Zaidi 2010.  Addressing critical gaps in achieving universal access to sexual and reproductive health (SRH): The case for improving adolescent SRH, preventing unsafe abortion, and enhancing linkages between SRH and HIV interventions.  International Journal of Gynecology and Obstetrics, 110, p. S3-S6

Taylor, S.E. (2006). Health Psychology. 6th Ed. New York: McGraw-Hill.

UNAIDS (2011).  Report on the Global AIDS Pandemic: 2010.  Accessed 1 March 2011 from http://www.unaids.org/globalreport/

United Nations Educational, Scientific, and Cultural Organization (2007). Asia Regional Training Workshop For UNESCO Staff On Regional And Country-Level Resource Mobilization For HIV And AIDS. Bangkok, Thailand.

United Nations Population Fund (2004a). State of the World Population 2004.  New York: UNFPA, 2004.

United Nations Population Fund (2004b). Adolescent realities in a changing world. New York: UNFPA, 2004.

United Nations Population Fund (UNFPA), State of World Population 2003—Making 1 Billion Count: Investing In Adolescents’ Health And Rights, New York: UNFPA, 2003.

From Academia to Public Policy: Bringing 'Bodily Integrity' into the Picture

March 3rd, 2011

Date: March 3, 2011

To: Equality NOW

From: Cordelia Sendax, B.S., Science, Technology and Society ‘13, Stanford University

Dear Equality NOW,

I am a sophomore at Stanford University who has spent the past three months studying global women’s health and researching cultural practices that specifically violate a woman’s right to bodily integrity. I have focused my research on sex tourism, forced-feeding, nutritional taboos and the practice of wife inheritance.  I have found that there is a vast disparity between the rhetoric employed in academic circles to discuss the inherent humanitarian wrongs of these practices and the rhetoric employed by NGOs and independent organizations focusing on ending abuse against women.  I strongly believe that bringing the rhetoric of ‘bodily integrity’ into the arena of women’s rights advocacy and framing this violation in the context of cultural practices will have vast implications for reducing and eventually, abolishing abuse against women across the world.

I am writing to Equality NOW, as I have researched your many success stories and believe strongly in the work you are doing to stop rape, domestic violence, trafficking of women, female genital mutilation and to promote equal access for women to economic and political opportunity.  Most importantly, I am choosing to share with your organization in particular my concerns with the current lack of emphasis on the right to ‘bodily integrity,’ for I see your organization as a leader in the gender equality movement with great influence over other independent organizations working on similar efforts.

Background:

The right to ‘bodily integrity’ is the right to the ownership of one’s own body and ability to determine what happens to it, how it happens, and why it happens (1.)  While the term ‘bodily integrity’ often creeps up in discussions of bioethics and policy debates in the U.S. and in Europe, the term is rarely used in non-scholarly discourse to characterize the types of abuses the majority of women are experiencing daily in developing countries, such as Kenya, Ethiopia, Cambodia and Mauritania.  Yet, there is not a more vivid and compelling term to aptly and saliently articulate the humanitarian wrongs women experience daily in developing countries than violations of ‘bodily integrity.’

The 13-year-old Cambodian girl who sleeps with over fifteen men a day, develops HIV and drops out of school, all because she has no other options than for her body to take on the responsibility of providing for herself and her family (2.)  The 9-year-old Mauritanian girl who is forced-feed a diet of over 16,000 calories to prepare her for child-marriage, putting her at risk for heart disease and death (3.)  The pregnant Ethiopian girl, iron deficient and stunted due to traditional nutritional taboos that restrict her from receiving the necessary nutrition to avoid maternal mortality (4.)  And finally, the Eastern Kenyan widow whom social custom obligates to marry and continually sleep with a male relative of her deceased husband who will eventually infest her with HIV/AIDS (5.)

These four girls, while victims to a variety of cultural practices, ranging from the modern practice of sex tourism, an offshoot of the tourism industry, to the historic practice of force-feeding that dates back to pre-colonial nomadic times, are all tied together by their lose of their ownership over their own body through involvement in these cultural practices.

Cultural practices (such as, sex tourism, forced-feeding, nutritional taboos and wife inheritance) that violate a woman’s right to ‘bodily integrity’ share these commonalities:

1. All of these cultural practices possess the intrinsic quality of female submission and realization of male fantasy.  Through these practices, young girls and women are deprived of their command over their own physical existence, which renders them vulnerable and accessible to being molded into the dominant male ideal, whether that is being sexually complacent or morbidly obese.  These practices deprive females the ability to sustain their bodies’ basic needs and to control how they are used and in what activities they engage.  In this way, the ‘body’ becomes a symbol of the female’s self-determination.  Violating her right to ‘bodily integrity’ is tantamount to violating her right to self-determination.  And thus, customs that violate bodily integrity are a primary impediment to females becoming educated community leaders and must be urgently addressed.

2. Cultural practices that violate ‘bodily integrity’ pose significant health risks, such as HIV/AIDS transmission in the case of wife inheritance, heart disease with forced-feeding and anemia with nutritional taboos.  These health risks take center stage over the more fundamental risk to the involved women’s right to bodily integrity, which should be sufficient justification to warrant ending these practices.  Thus, the attention these practices get from governments and NGOs often focus on the second-order offenses, the prominent health risks, in their advocacy efforts.  However, without addressing the first-order offense, the violation of the sanctity of a woman’s right to bodily integrity, cultural practices such as wife inheritance that are on the decline will only reemerge in the form of similar practices, such as sex tourism, that are adaptations to the current social, cultural and economic circumstances of the present time.

3. Cultural practices that violate ‘bodily integrity’ reflect a lack of accessible resources on health and sexual education, specifically, information on the human body, its nutritional needs, its physical limitations and the sole claim of individual to her own body.  Most victims of these cultural practices are completely unaware of both the health risks of the practices and that what happens to their bodies is their own decision, not that of their community leaders, fathers, future husbands, nor their culture to decide.

Recommendations:

1. Equality NOW should develop an umbrella advocacy program that ties together cultural practices indigent to different areas under the common mission to stop violations of ‘bodily integrity.’  Equality NOW has made tremendous strides with its programs that focus on eradicating FGM.  Equality NOW should use this program as model off which to base its development of this umbrella program.  However, this program would not focus on ending a specific instance of female abuse, but a specific nature of female abuse.  By raising funds and gaining public support for a program founded solely on the need to protect a woman’s right to bodily integrity, Equality NOW will lead the initiative in drawing ‘bodily integrity’ into the common rhetoric of social activism.

2. Equality NOW should focus on additional education efforts by enacting complementary educational programs to its well-established campaigns, such as its campaign against sex trafficking.  These complementary programs should include two components: a focus on providing public information to governments and policy-makers on how the specific instances of human rights violations threaten a woman’s ownership over her body and a focus on creating educational programs within developing countries that provide public access to sexual and general health education in regions where these cultural practices are most prevalent.

Conclusion:

If Equality NOW makes a commitment to developing these two initiatives, I strongly believe that Equality NOW will catalyze the movement of the emphasis on ‘bodily integrity’ from the academic arena into the public and social sectors.   If the umbrella program gains public prominence and manages to grasp the attention of national governments, this program could compel policy-makers and governments to centralize the rhetoric of ‘bodily integrity’ in legislation.  Furthermore, the complementary educational programs could have a huge impact on helping women in these developing countries realize their right to ownership over their own bodies, which might compel women to act out against these practices and become part of the solution themselves.   Additionally, these educational programs will provide policy-makers, activists and general interested parties with a rhetorical framework that has potential to effectively transform concept into action at the intersection of health and women’s rights.

Sources:

1. http://whr1998.tripod.com/documents/icclbodily.html

2. Jeffrey, L. A. 2002. Sex and Borders: Gender, National Identity, and Prostitution Policy in Thailand. UBC Press, Vancouver, Canada.

3. Haworth, Abigail. “Forced to Be Fat.” Marie Claire. 2010. http://www.marieclaire.com/world-reports/news/international/forcefeeding-in-mauritania.

4. C.E. Onuorah. “Food Taboos and Their Nutritional Implications on Developing Nations like Nigeria a Review.” Nutrition and Food Science. 2003.

5. http://www.kenya-information-guide.com/luo-tribe.html