Beth Fredrick's blog

Giving Girls a Choice and a Chance

2009-05-20T08:00:00-04:00

Here in the United States, we have the privilege of talking with young people about the changes their bodies experience during puberty, and their choices about when is the right time to have sex, marry and have children. For many girls throughout the world, there is no conversation. For many girls, the "right" time to have sex is when their parents marry them off to a much older man.

A bold move by Representative McCollum and Senators Durbin and Snowe provides the opportunity to change this reality. Legislation to prevent child marria ge around the globe was just introduced in both the U.S. House of Representatives (H.R. 2103) and U.S. Senate (S. 987) that will give parents another choice, and ultimately give the girls who are married too young a choice and a chance.

"It is deeply troubling that girls, little girls only nine or ten years old, are being given as child brides to men sometimes decades older, putting these girls at greater risk of contracting HIV, dying in childbirth, delivering under-weight babies or living in extreme poverty," said US Representative Betty McCollum (MN-4), in a media statement issued by more than 20 organizations in support of the legislation. "The U.S. invests billions of dollars to improve the lives of people in the poorest countries. Child marriage is a horrific human rights violation that undermines that investment."

The bills authorize U.S. foreign assistance funding over five years to prevent child marriage and provide educational and economic opportunities to girls in the developing world. The policy would help ensure that the fundamental human rights of girls are protected by:

Promoting community understanding of the practice's harmful impact;
Requiring the State Department to report on this harmful practice in its annual Human Rights Report; and
Scaling up community-based efforts to offer viable alternatives to early marriage.

Child marriage is common in many parts of the world, and if current patterns continue, during the next 10 years more than 100 million girls will marry without any say in the matter. Beyond being a fundamental human rights violation, early and forced marriage increases girls' vulnerability to serious health risks (such as HIV), social isolation and poverty.

It takes strong women and strong men to stand up for young girls. Congress now has the power to change the lives of millions of girls, to help parents see a different reality for their daughters, and to give these very young women back their future.

2008 Top Ten Wins for Women's Health

2008-12-24T08:00:00-05:00

1) New U.S. Administration Offers Hope for Women and Girls

The election of Barack Obama as the 44th President of the United States provides an opportunity to uphold human rights, promote health for all, and change the future of millions. Women's health and rights advocates in every corner of the world expressed excitement and hopefulness.

What's next: For many, the most urgent issues facing the United States are the financial crisis and the wars in Iraq and Afghanistan, but achieving global peace requires securing every woman's right to a just and healthy life. The International Women's Health Coalition (IWHC) was among the first to outline an agenda for women's rights and health for the new Administration and is working with the transition team and other advocates to promote priorities for women and girls. ?

2) A New "Mexico City Policy" Leads the Way on Comprehensive Sexuality Education

Prior to the XVII International AIDS Conference in Mexico City in August, health and education ministers from throughout Latin America and the Caribbean pledged to invest in comprehensive sexuality education and increase access to health services to strengthen the region's HIV/AIDS response. The resulting Mexico City Declaration on Sex Education in Latin America and the Caribbean was unanimously endorsed.?

What's next: Advocates, including IWHC, are working with the Pan American Health Organization to assist countries in fulfilling their commitments, including dramatically increasing the number of schools that provide comprehensive sexuality education by 2015.

3) U.S. Citizens Turn Back Attempts to Restrict Abortion Access

In November, U.S. voters overwhelmingly rejected ballot measures to restrict access to safe abortion in South Dakota, Colorado, and California. In April, the Council of Europe called for all 47 member countries to make abortion safe and legal.

What's next: In South Dakota, abortion opponents insist that they will try to pass an abortion ban in 2010, and a new organization has formed to push measures in 17 other states similar to the measure to provide rights to a fertilized egg defeated in Colorado. These campaigns are costly and out of touch with a wider global trend of liberalizing abortion laws, according to a recent study by researchers at Harvard School of Public Health and the Center for Reproductive Rights. ?

4) Indian Government Puts the Power of Prevention in Women's Hands

This year, India's National AIDS Control Organization (NACO) will provide sex workers in four states with about 1.5 million female condoms, which is the only woman-initiated HIV prevention technology currently available.

What's next: Female condoms are available in 116 countries, and public-sector programs are underway in over 90 countries. In Cameroun, IWHC partner The Society for Women and AIDS in Africa - Cameroun Chapter is advocating for a national strategic plan to ensure that women, including those living in rural areas, have continued access to female condoms.

5) Clinton Global Initiative Prioritizes Adolescent Girls

At the Clinton Global Initiative (CGI) annual meeting in September, longtime IWHC partner Bene Madunagu, head of the Girl's Power Initiative (GPI) in Nigeria, spoke to the need for comprehensive sexuality education programs for the 1.5 billion people in the world today between the ages of 10 and 25.

What's next: Over the next two years, IWHC will invest nearly $1 million in 19 organizations in Nigeria, Cameroun, Pakistan, Brazil, Peru, and Mexico to ensure that education and health services for young people integrate human rights, gender equality, health, and sexuality. GPI will continue to collaborate with education officials in four Nigerian states to reach nearly one million young people with information and education about their health and rights.

6) Women's Advocates Secure Advances in Ecuadorian Constitution

After a year of negotiations, Ecuador's Constitution now says that young people must receive sexuality education and that the State has an obligation to provide sexual and reproductive health services to its people.

What's next: Ecuador's President, Rafael Correa, is opposed to legalization of abortion and same sex marriage. CEPAM-Quito and other advocates were unable to prevent some harmful language, including prohibition of marriage and adoption by same-sex couples, but are working to protect the advances and prevent further challenges.?

7) Colombia's High Court Rules on the Side of Science — and Women's Rights

In June, the highest administrative court in Colombia ruled that the sexual and reproductive health services provider Profamilia can continue to import and distribute emergency contraception (EC)-in accordance with women's right to access a full range of safe and effective contraceptive methods.

What's next: Since 2000, Profamilia has provided EC to Colombian citizens through its network of clinics. Yet emergency contraception in Colombia still requires a prescription-an important barrier to access, considering that EC must be taken within 72 hours of unprotected sex. Profamilia has worked to overcome this barrier by offering EC to women without an appointment. ?

8) Connecticut, Colombia and Others Stand Strong for Sexual Rights

This year, Connecticut joined Massachusetts in legally recognizing same-sex marriages. Internationally, a Colombian court extended pension benefits to same-sex partners, acknowledging that to exclude them would violate the principles of non-discrimination and human dignity.

What's next: In November, California voters approved Proposition 8 by a slim margin, overturning an earlier state Supreme Court decision allowing same-sex marriage. The decision has sparked peaceful protests and candlelight vigils throughout the state, and three lawsuits have been filed to overturn Proposition 8. Globally, IWHC's partners continue to promote sexual rights in the face of conservative opposition. For example, the International Centre for Reproductive Health and Sexual Rights in Nigeria is currently working with other African feminists to combat unbalanced attacks by some media groups on lesbian, gay, bisexual, transgender, queer, questioning and intersex community groups there. ?

9) U.S. States Prioritize Youth Health Over Ideology

In 2008, the number of U.S. states refusing to participate in the federal government's abstinence-only-until marriage education program (Title V) reached 25, as state governments recognize what research and evaluations have repeatedly shown: abstinence-only programs are ineffective.

What's next: Despite pushback from the states, Congress may vote to extend Title V for another year or longer. President-elect Obama has repeatedly called for "age-appropriate" and "science-based" sex education in schools. The U.S. federal government and the states now have a new opportunity to work together to develop state and federal programs that support the comprehensive sexuality education young people need to make informed choices about their bodies and their health.

10) Muslim Women in the United Kingdom Granted Equal Rights in Marriage

Muslim leaders in the United Kingdom succeeded in creating a new marriage contract under Sharia'h law that gives husbands and wives equal rights, after four years of negotiations. The new contract no longer permits men to practice polygamy and grants women the right to initiate divorce.

What's next: This change represents a powerful example for Muslim leaders and communities throughout the world. In Northern Nigeria, Islamic Sharia'h law was introduced at the state level in 2000. Based in the state of Kano, IWHC partner Action Health Information Projects (AHIP) has built relationships with over 1,000 religious leaders throughout northern Nigeria to encourage their support for women's reproductive health through their sermons and influence in the community. Each of these leaders reaches an average of 5,000 people every week through Friday congregational prayers and sermons.

For the complete report, visit IWHC.

A Misguided Prescription for Women and Girls

2008-02-08T08:43:24-05:00

A group of people held a press conference today on Capitol Hill to explain why they couldn't possibly support a U.S. Global HIV/AIDS strategy (PEPFAR) unless the bill reauthorizing funding for the strategy requires that at least 33% of prevention funds go to support abstinence-until-marriage programs.

The trouble with their position is that this earmark for abstinence-only prevention programs puts more lives at risk...so how can we, who are committed to confronting the epidemic, not fix this misguided law?

Protestors stand behind Pastor Rick Warren, one of the speakers at today's press conference.

The group at the press conference today - which included Reps. Chris Smith (R-NJ) and Steve Chabot (R-OH), Pastor Rick Warren of Saddleback Church, and Chuck Colson, Founder of Prison Fellowship - were so focused on ensuring a dedicated amount remain in the re-authorization bill to abstinence-only-until-marriage programs, they failed to see the whole picture:

The number of new HIV infections continues to grow around the world, especially among women and girls, precisely because we haven't invested in prevention resources that address their real-life circumstances.

The fixation on abstinence-only-until-marriage programs is out of step with the crushing weight of the evidence.

It's not just a bunch of uppity women wanting this abstinence-only earmark gone. An Institute of Medicine report calls for removing the earmark, as does the Government Accountability Office.

As the Elizabeth Glaser Pediatric AIDS Foundation's President, Pamela Barnes, said today,

"Proposals to maintain partisan, ideologically-driven mandates that constrain countries' abilities to respond to their own epidemics threaten the continued success of the President's Emergency Plan for AIDS Relief (PEPFAR)."

Furthermore, the 33% of funds set aside is a completely arbitrary number. It could have easily been 99% if Congress would have gone along with it in 2003.

At the time, when amendment author Rep. Joe Pitts (R-PA) called for the earmark, he couldn't really explain why it should be 33% - just that it should be there. My guess is that he thought it was one part of the A-B-C prevention message, and since it's one letter of the first three in the alphabet, it should get one third of the funds. But, really, who knows?

None of these reports - or the bill that Congress will soon take up - call for ending work that encourages abstinence and delaying sexual debut. The new legislation simply allows for the U.S. staff in-country to look at what is specifically needed there to prevent and reduce HIV transmission and decide what prevention efforts should be undertaken.

The bottom line is that not providing people with what they need to protect themselves is a sin. The abstinence earmark skews the programs and gives short shrift to all the other prevention efforts that need to be undertaken as well.

Next week, the House Committee on Foreign Affairs will mark up the U.S. Global HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008.

Among the improvements to the existing law are increased flexibility for developing country programs, and for addressing the vulnerability of specific populations, including women, youth, and men who have sex with men. The bill also provides increased technical and financial support to countries that would support the training of health workers and fund scientific research for new vaccines and prevention technologies.

Simply put, there is another way forward.

Two Steps Forward, Three Steps Back

2007-10-30T08:17:40-04:00

Taking a page from the Clinton Global Initiative, the recent Women Deliver Conference in London was full of commitments. The U.K. government announced a $200 million grant to the United Nations Population Fund for contraceptive commodities, and the Japanese government vowed to make global health a priority at the Group of Eight Summit meeting next year in Japan. The John D. and Catherine T. Mac Arthur Foundation placed an extremely large bet--$11 million--on a four-part intervention strategy to dramatically reduce maternal mortality. First implemented in Nigeria and India (where 30% of all maternal deaths occur), the strategy is significant in that it specifically trusts and empowers women, families and communities to take action when a woman's health and life are in danger during childbirth. Following on the heels of Women Deliver, the Global Safe Abortion Conference may not have played host to the grand gestures made at Women Deliver, but private and public donor agencies, with the notable absence of the U.S. government, were there in force.

The take-home message was clear: At least a few thousand people from among the world's 6.6 billion are ready to shake up priorities for women's health and end the unnecessary suffering that in much of the world endures. Both conferences attracted policymakers who actually hold much of the power over that progress. But it was the final policymaker in the final plenary who brought home just how much of an uphill climb we still have to ensure a woman's health and dignity during pregnancy.

In addressing the Global Safe Abortion Conference, Lord David Steel--architect of the 1967 law legalizing abortion in England--underscored his preference for contraception over abortion. His remarks reinforced quotes in that day's Guardian, where he lamented that the law had led to far too many abortions: "If things go wrong you can get an abortion, and it is irresponsible, really...people should be a bit more responsible in their activities, and in particular in the use of contraception." Ann Furedi, Chief Executive of the British Pregnancy Advisory Services, responded that, "Abortion is not in itself the problem. The problem is the unwanted pregnancy and abortion can be the solution to that for many women. There's no right or wrong number; we need as many abortions as are necessary to solve the problem pregnancies that women face." It is unfortunate that Lord Steel's remarks come at a time when the U.K Parliament reviews its abortion law. Though the British public is firmly prochoice, 1 in 10 say that a woman does not have the right to decide to have an abortion.

The debate underscores just how important these two conferences were. Nothing is ever assured when it comes to women's rights and health, and we gain strength from one another. There is no hiding from the fact that achieving Millennium Development Goal number five, to improve maternal health, will require drastic course correction.

Though the conferences were two significant steps forward, we were put at least three steps back by Lord Steel's remarks, the absence of many policymakers at the Global Safe Abortion Conference (especially those who support reproductive rights) and the great distance we have to bridge between maternal health and gender equality and equity.

We need to acknowledge that until women gain equal status, health systems improve and laws change, many women will have a baby or an abortion on their own or with unskilled help. We will have to be vigilantly on the lookout for policymakers who forget or ignore that women have the right and the sense to make their own decisions when it comes to pregnancy and deserve every support that communities and societies can provide.

Does the Breeze Kill HIV?

2006-10-23T09:01:00-04:00

Beth Fredrick is Executive Vice President of the International Women's Health Coalition.

The session starts simply: eight young men stand at the front of a room in Minna, Nigeria. Each young man holds up a large piece of paper with a word written on it, each word a type of sexual activity.

From there it becomes more complicated.

First, the youngest boys are asked to leave. This is not a lesson on birds and bees and community leaders, though supportive, need to be reassured that this workshop is only for those who are mature enough. The 50 or more young men, ranging in age from 16 to 19, are learning how to stay safe from HIV. That will require frank conversation about what will put them at risk and what they can do to protect themselves and their sexual partners. In other words, this is a life-saving conversation.

Three professionals in the room stand back and observe as each card is raised. Idris, Rose, and Helena are there from the International Centre for Reproductive Health and Sexual Rights (INCRESE), a six-year-old Nigerian organization that works to protect and promote sexual and reproductive health and rights. They want the questions and concerns of the young men themselves to drive the conversation.

In Hausa, the common language of this village in a largely Muslim State in Nigeria, the young men discuss what they learned about preventing HIV transmission in previous lessons and whether the activity on the card places them at any health risk, including HIV infection.

Their misconceptions are understandable. At first, the young men define oral sex as a conversation between a boyfriend and girlfriend. But it soon becomes clear that some of the young men are well aware of what oral sex really is. What they don't know - and I hadn't fully appreciated - is that lack of oral hygiene in much of the developing world means bleeding gums and persistent sores. Both can facilitate transmission of HIV/AIDS, if one or both people are infected.

For over two hours, the young men Beth Fredrick with classdiscuss a range of similar issues and Idris, Rose and Helena field a battery of questions:

"When blood leaves a person's body, does the breeze kill HIV?"

"I cut myself when I shave; am I at risk of getting HIV?

"Is masturbation dangerous?"

"If I want to be intimate with a girl, what will keep us from becoming infected?"

When Idris, Rose and Helena were teenagers, Nigeria was only beginning to awake to the realities of HIV and AIDS. Nigerian leaders increasingly face challenges in tracking and preventing new HIV infections and ensuring care and treatment. Nigeria ranks second only to South Africa in the number of people living with HIV among countries in Africa.

The need for programs such as the one that INCRESE has pioneered is acute. According to UNAIDS, one in five Nigerian young women (aged 15 to 19) had her first sexual experience before age 15. Though young men begin later, 8% of them will have had sex before they turn 15. Schools are one avenue for learning about HIV/AIDS and prevention, yet only one in five primary or secondary schools have teachers who have been trained in life skills-based HIV education and who taught it within the last year.

Last month, the World Bank released its World Development Report. Rightly, it focuses on young people and the challenges they face in reaching their full potential to spur healthy development - for themselves and their communities. The Bank goes far in prescribing some fundamentals to protect and empower young people. Implementing prescriptions like these - and bolder - will require coordinated action at all levels, from governments to parents and families, including young people themselves.

First, we must invest in programs like INCRESE, which educate and empower boys and young men to understand their sexual responsibility, listen to their partners, and use condoms. Change requires more men like Idris and the young men in the INCRESE program.

Second, we must empower young women to share equally in the knowledge and agency needed to determine when, where, and under what circumstances to have sex. The healthiest exchanges will be open exchanges, with input from both partners.

Finally, we must provide all young people with information and services. In too many places, marriage is a prerequisite for health services or knowledge. Community leaders need to embrace and encourage any means of starting a dialogue with youth about gender equality, life skills and sexuality.

When you look into the eyes of a young person, for a moment, you see the future - theirs and ours. Working with them, we can make that future healthier and happier. We have an obligation to them from which the world can no longer shrink away.