Even as President Obama entered his new position of power, he was quick to remind the American people, as well as the rest of world, that we were going to face challenges. I agree with him that we are facing challenges, but I believe that we will overcome them if we work together. Acknowledging we still face problems resonated well with my country Kenya and also with African women at large.
The last many years of Bush's rule saw a decline in contraceptive security in countries like mine. But it also brought a new way of thinking. Why can't our own governments commit to protecting their own mothers, wives and daughters from unwanted pregnancies and unnecessary abortions?
2015, the target date by which the global community intends to reach the Millennium Development Goals, is not far away and maternal mortality poses a greater danger to this resilient continent than ever before. I believe Obama has demonstrated his appreciation for where he comes from by the stroke of his pen. Mothers in this part of the world would say "We are glad that you have returned us to the days when we can access family planning services irrespective of how rich or poor we are." Having healthy women will make a whole lot of difference: when we are healthy we will continue tilling the land and feeding our nations. When we are healthy we will continue taking care of children whose fathers left them. When we are healthy we will actualize what Ted Turner said: "I think we men have messed up the world and should just move over and allow the women to do it."
After peace was restored in Kenya following months of political unrest, women candidates won elections by a landslide majority and continued to even in subsequent elections. What that means is that the Kenyan voter has realized that it's about time he or she give a woman the chance to represent the country's citizens in elected office. I feel like we have voted twice. First we have increased the number of women in Parliament but secondly we have been given an opportunity to protect ourselves from unintended pregnancies.
Even though the US elections are big news in this part of the world, I cannot resist warning African governments and especially mine: Don't wait for Obama to do what you were supposed to do from the beginning, and provide contraceptive security to your women. I am happy that funding for UNFPA will be restored and more women will be reached but I don't want our governments to sit on their laurels.
African governments should now follow Obama's example and put a pen to paper saying that a budget line for contraceptives is mandatory, and that mechanisms must be put in place to ensure that every woman on the continent have access to the family planning method she wants when she needs it. The recession does not reduce the importance of the budget line at all!
In Kenya the budget line for education does not fluctuate based on the country's financial footing. The same should apply to family planning.
On behalf of the women and girls of Africa, I say thank you once again for making it so that a woman will be able to get the contraceptive she needs when she needs it. Contraceptive access will reduce the chances of women dying. While African governments are still behaving as if our mother's lives are not worth saving, it's imperative that you Americans help African women by cracking the whip on corrupt African governments. It's this corruption that takes away money which could otherwise go to organizations dealing with the reproductive health and rights of women.
By reducing the number of women who die or are injured, we can increase the number of women who make it to decision-making positions.
Obama has given African women something to help them make the right choices, but our governments also need to take responsibility. By his signature many women are going to be saved but...our governments owe it to us to do more than expect handouts where women's lives are concerned.
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"Before I could sit up,"
says Miryam, a 54-year-old widow, "About ten men stormed in and started
ransacking the house. They ordered me not to make any noise.One of them,
who was carrying a blunt object, hit me on the right leg."
One man grabbed Miryam by
the neck, pushed her hard on the floor and raped her.
"I could not imagine that at my age somebody could do that to me.
Up to three men raped me that morning," she sighs with resignation.
She went to a nearby dispensary to have her swollen leg treated but never mentioned the sexual assault. Neither did she report to the police as she did not deem it necessary. The thought of reliving her trauma, as well as the stigma that would follow were sufficient to buy her silence.
This is an excerpt from the book "In the Shadow of Death...My Trauma, My Experience," documenting the voices of Kenyan women discussing the post-election violence that took place last year. At around this time President Kibaki and Prime Minister Raila, the two principals, signed the peace accord that led to the formation of the grand coalition.
After the peace accord, a commissioned
inquiry into the post-election violence collected evidence
and issued a report to the government. One entire chapter of this
report was dedicated to sexual violence. One year later, politicians are still arguing over whether to form local tribunal to
try the perpetrators of violence or to go to the Hague. As this goes
on, many women are yet to get the justice that they deserve.
Women came up to testify at the commission to make sure that the issue of sexual violence does not occur again or, at very least, laws are put in place to make sure that perpetrators are brought to justice.
In the middle of the crisis, a group of 40 civil society organizations came together and formed the Interagency Gender-Based Violence sub-cluster, co-chaired by the UNFPA and the National Commission on Gender and Development. This group informed the commission and offered counseling services to the women who were ready to testify. Most of them are featured in this book. Most importantly, they are not just the horror stories but a look into the social justice system of this country, where sexual violence was used to pit one group against the other and the government didn't do much in response.
Millicent Obaso of Care International, who worked with several women who testified at the commission, told of terrible tales of women being raped in front of their spouses and children and also discussed the fact that those women were often turned away at police stations. Some were asked to report only one of the offenses against them. A woman whose house was burned down and who was also raped was reported as saying:
They asked me to decide which case I wanted to report...whether it was the rape or the arson..they even advised me that the arson was better because I would get compensation and the rape which was by a police officer was not going anywhere.
These are some of the situations that women found themselves in what the report says clearly were as a result of the inequalities in Kenya. The lack of security at the time of the violence meant that many women could not access medical help and others, like Miryam, saw no reason to report crimes against them because "perpetrators would not be brought to book."
A total of 31 women testified at the commission in various parts of the country. In its report, the commission notes that the culture of impunity allowed violence, including sexual violence, to reign in the country, with perpetrators being both state agents and gangs of young men knowing that they would get away with murder or violence.
Legal issues arising from these
violations present a very gloomy picture at the status of women in Kenya.
Kenya has ratified a number of international legal instruments yet it
has not incorporated them into its local statues because of lack of
political will at the government and parliament level.
As Kenyan women count a year since all this happened, we have yet to see what is going to be done to give them justice. Parliament has already had a debate on whether to form a local tribunal thrown out and the government is weighing its options on whether to go to the Hague for the perpetrators.
Since the violence came about because of political reasons, the two principals have already agreed on power sharing but the political class has yet to agree on what would be the best way to make sure that the perpetrators are brought to justice and women can at least have some closure.
As International Women's Day approaches, it is prudent to go back and see what hope there is for
these women and the status of women in general in Kenya and in Africa
as a whole. Sierra Leone, Rwanda, Liberia and the Democratic Republic
of Congo have had their share of sexual violence being used as a weapon
of war and Kenya is now facing the dilemma of what to do with the perpetrators.
The activist and woman in me will say castrate them, while the Christian in me would say forgive them. On second thought, the Christian in me would still insist that people need to take responsibility for their actions otherwise the world will remain the same. Yet another side of me says that we need to find justice for these women by domesticating the international instruments so that the silence stops -- not just for them but for any woman who will have the unfortunate incident of being sexually violated.
As per the report, a lot of the sexual violations indicated clearly where women are placed in the society and Kenya's justice system as a whole. It would be nice to wipe the slate clean, but if we forget to punish these perpetrators we might as well forget about the women as a whole. We refuse to forget because as the theme of this year's women's day says, "Women and men together in the fight against sexual violence," and that's the only way we can fight.
Maybe it's a good thing that
the commissioners were all men -- because they were able to give
recommendations that hopefully will last. They had to sit and listen
to all the horrific stories that women know so well by virtue of listening
to their friends, relatives or by going through it themselves.
Let there be no stone left unturned in bringing justice through parliament, police, political class and also the society at large...that's the only way the silence will stop.
]]>That may sound absurd coming from someone who lives in a country, Kenya, whose prevalence rate has risen by 3%. But I have my reasons for supporting Porritt's point of view.
Porritt, the founder-director of Forum for the Future, told a science festival recently that failure to prioritize family planning programs will have a more damaging impact than HIV and AIDS.
In the controversial presentation, Porritt compared current levels of international aid available for family planning and for addressing HIV and AIDS. Funding for family planning has significantly reduced over the years, Mr Porritt said, while funding for HIV and AIDS has grown from USD 300,000 in 1996 to USD 8.3 billion in 2005.
The United Nations is now calling for funding to be increased to around USD 22 billion per annum. While acknowledging the crucial importance of continuing to address a disease which kills around three million people a year, Porritt argued that the world "would simply not be able to sustain a population of nine billion by 2050'' and family planning could be a solution.
A combination of accelerating climate change, severe water shortages, increased hunger and collapsing eco-systems, all worsened by high levels of average fertility in some of the worst-affected countries, represents more of a threat than HIV and AIDS on the world's population, he argued.
At the Town Hall in Cheltenham, his home town, Porritt said, "It's not that funding for HIV/Aids programmes should be reduced - though many are now approaching the effectiveness of that level of spending, particularly through US-funded programs."
On July 10 and 11, several media outlets reported on World Population Day and its focus on gender equality and family planning. UNFPA, the United Nations Population Fund, predicted that without proper family planning programs, world population will double to 12 billion by 2050. Family planning could also save the lives of a third of the 536,000 women who die every year from pregnancy-related complications, 99 percent of them in developing countries.
A country like Niger has a
total fertility rate of 7.5, according to the last DHS report of 2005
if the trend continues, and with the current population of 14 million, the
country will hit the 82 million mark in 2050 but if fertility is reduced to
3.5 the population will be at be 50 million that year.
While this is happening the world is yet to pay serious attention to family planning. Apart from rooting for someone who supports international family planning to win the US presidential elections, on behalf of my African sisters, I pray that family planning gets as much as funding as HIV/AIDS or more. I don't want to forget the role that traditional and religious have to play in helping the population understand the importance of using contraceptives.
In a message observing World Population Day, Thoraya Ahmed Obaid, Executive Director of UNFPA, the United Nations Population Fund, said that family planning "is essential to women's empowerment and gender equality. When a woman can plan her family, she can plan the rest of her life."
]]>I have highlighted on RH Reality Check before how Kenyan women bore the brunt of the violence -- but now I know that it was a window into the status of women's rights in Kenya and the gaps in responding to sexual and gender based violence in this country and indeed in most African countries.
A recent report released by UNIFEM, UNFPA and CCF indicates that the internally displaced people still face sexual exploitation within the camps as they wait to be repatriated.
Both women and humanitarian actors across multiple sites reported cases in which women and girls are coerced into exchanging sex for basic resources, such as food, sanitary supplies, transport, etc. Perpetrators were identified as men from the encamped population, the community and, in some cases, security personnel. Some reports suggest that sexual exploitation "rings" are being organized by profiteering men from the camps and/or host communities.
These risks to women and girls are compounded by a general failure to promote inclusion of women in camp decision-making and coordination processes. Equal participation of women as compared to men in internally displaced persons (IDP) camp management committees was not evident in any of the sites visited. Similarly, camp-based services -- such as reproductive health services -- designed to meet the specific needs of women and girls, including access to antiretroviral drug therapy (ATRs) were almost non-existent the majority of camps. In addition to the lack of health services, women are in need of basic necessities such as underwear, sanitary napkins and contraception.
According to a UNFPA report titled "We want Birth Control Now!" and highlighting the issues of IDPs in Northern Uganda, the reproductive health needs of refugees are usually not considered a priority; yet when disaster occurs, a proportion of women are going to be pregnant while others are in need of maternity services without which they are at risk of dying in child birth.
Dr. Primo Madras, the National RH Emergency Officer, says gender based violence increases in the context of humanitarian crises and there is need for prevention and response: "Access to RH services including STI treatment and contraceptives is poor as a result of disrupted health systems."
The conflict in northern Uganda had lasted for more than 20 years. Almost 2 million people were forced into displacement camps that were characterized by overcrowding and unsanitary conditions and over 30,000 children abducted by the LRA.
While all these look unpleasant, I just want to reflect on lessons learned that if dealt with, we could probably make meaningful headway into sexual and gender based violence.
Lesson 1: While there are laws that punish perpatrators of violence, the justice system is not supported with meaningful and modern ways of gathering evidence thus most cases will end up being dismissed for lack of evidence.
Lesson 2: It is important the every woman or child who is violated gets proper medical attention and follow-up psychosocial support and therefore medical systems need to be strengthened from the rural to urban areas.
Lesson 3: The government needs not only to promote human rights but be at the forefront so that the whole society is enlightened enough to respect women and children.
While the above are not the only lessons to be learned from this crisis, I want to believe that the crisis merely highlighted the gaps within our medical, legal and rights systems and that we need to fill them so that women live in a safe environment even in time of crisis.
]]>We've always known this, but now a study has now been done to support our intuition. If the findings released late last year at the fifth Africa population conference are anything to go on, you might want to reflect on when you last asked your husband to use a condom.
The study, conducted in the Mbeya region of Tanzania and in Nigeria, highlighted what most women might find to be obvious: that most married men do have extramarital affairs. What makes it scary is that Mbeya is a region that has the highest HIV/AIDs prevalence rate in Tanzania, twice the national average. During this study, 70% of sex workers tested in Mbeya were found positive.
The respondents in the study were asked whether or not they had had sex outside marriage. It was found that men who live in urban areas are likely to be involved in extramarital affairs due to availability of hiding places, said the lead researcher. When I heard this fact I nodded to the fact that there are indeed many hiding places in the urban areas, especially in our towns, as opposed to the rural area where word goes round very fast if one is spotted "walking" with another man's woman. That means that the risk of getting caught in your village is higher than in Nairobi.
Let me also note another interesting fact the study found: a man who has premarital sex is likely to be involved in extramarital affairs after he gets hitched. According to another study done by the Guttmacher Institute and the Africa Population and Health Research Center, half of fifteen- to nineteen-year-olds in Uganda have had sex, even though more than eight out of ten adolescents think that both women and young men should remain virgins until they marry. If less premarital sex means fewer extramarital affairs later on, great. But my thinking is that everyone needs to get information on condom use as early as possible, no matter what their intentions are. That way condoms will be commonly used the same way one takes a pill to prevent pregnancy.
Dr. Oyediran Kola, who carried out the Nigerian study, also had the same results with an indication that there is a correlation between first sexual encounter to extra marital sex.
Their conclusion was that efforts should be directed at empowering married women to negotiate for condom use in marriage. The challenge is now for married women to negotiate for safer sex especially if their husbands are having extramarital affairs. How do you start negotiating for condom use 20 years into a marriage?
The highest number of extramarital affairs, according to both studies, occurs in the 40-49 and the 30-39 age group. Its no wonder that there is a website dedicated to philanderers to help married men and women cope with the pain of being cheated on.
The fact that 62% of Kenyan women are HIV positive tells a lot, especially because the rate of infection is higher in married couples, thanks in part to extramarital affairs.
The studies wanted to find out the linkage between men's behavior especially in sexual relationships to the spread of HIV/AIDS. This would be something probably our ministry of planning through the National Council for Population and Development might want to look at to probably give an insight as to why most married women are living with HIV.
This is a dilemma that every African woman and indeed every woman is faced with as the epidemic continues to hold a female face.
]]>It is at this point that I wear my feminist hat and wear it proudly. Since the crisis in Kenya began, I haven't yet heard of a woman who picked up a machete and killed her neighbor. In fact, most of the stories of hope I am hearing are of women trying to help each other irrespective of where they stand as far as this crisis is concerned.
As in many conflict-ridden places in the world, women stand out as victims as well as the ones in the tribe looking for peaceful means to resolve the situation. Look at the ongoing crisis in Kenya and Chad, who are the victims? Mostly women.
In Chad, for example, as the crisis has continued women have fled to neighboring Cameroon. As we all know pregnancy does not care whether there is conflict or not...when the baby decides to come it doesn't care whether you are a refugee or internally displaced person or not. Concerns are being raised by UNFPA, the United Nations Population Fund, for the health and safety of expectant mothers and their children. Thousands of refugees have streamed across the border between Chad and neighboring Cameroon to seek shelter from the fighting.
In Kenya the situation is no different for the internal displaced persons (IDPs). What amazes me is that the things that women need in crisis are so different from what a man will want. While a man in an IDP camp wants to know how he will get from point A to B a woman worries about access to clean water, obstetric care and how to get food for her children.
I am in an initiative of senior women journalists in Kenya who chose to come together and use their, pen, camera, or microphone as tool of peace and started a campaign to heal the nation. The initiative, supported by several UN bodies and embassies in Kenya, has made us women think of ourselves as the tribe that will save Kenya from its current crisis.
We have chosen to look at ourselves as the tribe called women. We know like ants we work in small ways but are able to make a great difference. It is our responsibility to ensure the special needs of women and girls are fully considered in all humanitarian response.
As women we must indeed all hang together or most assuredly, we shall all hang separately. In the Rwandan genocide, women breastfed children without caring which ethnic community they came from.
Women have been quick to realize that if the crisis continues, the children will continue to suffer and it is better that they unite, while the men haggle over what went wrong. While the women's tribe has been marginalized for so long, they have never taken up arms and fought the tribe called men. They have always resolved to use peaceful but strong means to put their points across. In 1959, when Kenya was still colonized, women said there was not going to be sexual until the political prisoners were released. It worked.
Recently women all over the world joined the "Panties for Peace" campaign to make their point to the Burmese government. So while the men continue to fight we choose to use all means within our disposal to get peace in Kenya and elsewhere on the continent. For those in this tribe: Woman, I urge you to soldier on as we work towards liberating our tribe.
]]>As mediation continues headed by former UN secretary general, Kofi Annan, there is a new crisis coming out as a result of this conflict and that is the increase in the number of HIV infections.
Almost two thirds (63%) of all people living with HIV globally live in sub-Saharan Africa -- an estimated 24.7 million in 2006. Some 2.8 million adults and children became infected with HIV in 2006, more than in all other regions of the world combined. As if the situation is not grave enough, the 2.1 million AIDS-related deaths in sub-Saharan African represent 72% of global AIDS deaths.
Across this region, women bear a disproportionate part of the AIDS burden: not only are they more likely than men to be infected with HIV, but in most countries they are also more likely to be the ones caring for people living with HIV. Provision of antiretroviral therapy has expanded dramatically in sub-Saharan Africa: more than one million people were receiving antiretroviral treatment by June 2006, a tenfold increase since December 2003, this is according to UNAIDS.
Treatment scale-up efforts have been especially strong of late in some countries, including Botswana, Kenya, Malawi, Namibia, Rwanda, South Africa, Uganda and Zambia. However, the sheer scale of need in this region means that a little less than one quarter (23%) of the estimated 4.6 million people in need of antiretroviral therapy in this region are receiving it.
These efforts are about to go to waste especially in Kenya, if the current crisis is not dealt with fast. Already many women in camps and those fleeing violence prone areas have experienced sexual violence with most of them being gang raped. According to Dr. Sam Thenya of the Nairobi Women's Hospital, 187 women and 23 men have been seen at the hospital since the crisis started. "The gains that have been made are going down the drain as rape is used as a tool of intimidation," Dr. Thenya said. "This also means that the spread of HIV is high since most of the people raped don't get to hospital in time for treatment."
The number of displaced people within the country is increasing with current figures reading 300,000. With displacement comes vulnerability, which has made many women susceptible to sexual violation in the camps. By virtue of displacement HIV positive women who have babies have ended up having to breastfeed their children because there is no formula milk or clean water. The other issue is that many women have had to give sex in return for food stuffs at the camps.
So while Kenya is still grappling with sorting out the political impasse, the gains that were made over the years in reversing the effects of HIV/AIDs are going to unravel.
Although anti-retrovirals were available in district hospitals, getting access to these facilities for the displaced is becoming difficult. Those who were getting these drugs had cards that identified them to get the drugs free but some of them having left their homes with nothing else but the clothes on their backs, its difficult to trace them or have them access treatment.
Speaking recently the British Ambassador to Kenya, Mr. Edward Clay stated that security needs to be improved in the camps to protect women and children. With eighty percent of those raped having been gang raped by 2 or 11 people it is difficult to prosecute or trace the culprits. One can only imagine who among these cuprits is HIV positive.
Rape survivors are encouraged to get to health clinics as soon as possible so they can receive post-exposure prophylaxis, or PEP, to prevent possible infection by HIV. According to Florence Gachanja of UNFPA, "Women need to come early for the treatment because after 72 hours the drugs may not be useful anymore. So they need to get to the facilities where these are given, or within the crisis centres within the camps, so that they can get the treatment before 72 hours are over."
In the meantime, the Ministry of Health warns HIV patients against rationing their ARV's, saying that it is better to stop taking drugs altogether than to try stretching out supplies by reducing their daily consumption.
Such behavior allows the virus to build up an immunity against the treatment. People who have already run out of medicine should record the date of their last dose and inform accordingly the next health official they meet.
As protests continue throughout Kenya, all is not lost as different organizations step up to reach the displaced and offer treatement. Doctors with Borders (MSF) has been responding to the additional needs created by the violence of recent weeks. In Nairobi, where MSF has provided HIV/AIDS and tuberculosis (TB) care in the slums for over ten years, medical teams have set up extra clinics and first aid posts in order to assist people wounded during the protests.
However, a considerable number of patients who are on HIV/AIDS and TB treatment with MSF have missed scheduled appointments. Interruptions in treatment can bring long-term consequences in their life-saving treatment.
And the violence and ongoing insecurity has prevented some regular patients from attending MSF's clinics in both Kibera and Mathare. Between December 31 and January 14, for example, 290 patients missed their appointments at MSF's health facilities in Kibera and in Mbagathi hospital.
If HIV/AIDS and TB patients do not regularly take their medicines, their health will deteriorate and there is a risk of resistance developing. If TB patients do not take their medicines there is also an increased risk of infection for those around them.
MSF has set up a free phone hotline for both MSF patients and patients followed in other health structures which are currently closed, so that they can get their treatment. As of January 21, MSF patients throughout Kenya who have not been able to attend their appointments, and may have been displaced by the insecurity, will be able to call for guidance on how to get their medicines and advice on their closest health center.
Let's hope that this issue is soon resolved and we can get back on track.
]]>Never has the American debate over abortion become clearer to us in Africa than during the Bush administration. Towards the end of October Congress made an attempt to hear from us Africans and what we think about the Mexico City policy -- or what we prefer to call here the global gag rule.
Experts from around the world were given an opportunity to address the Foreign Affairs Committee of the Congress. It was believed that such experts will give a true picture of events in their countries to help Congress make a final decision on this controversial policy.
Speaking as an African woman, I was really excited that people working with women were called to speak about this. What didn't make me happy was the fact that someone purporting to be speaking on behalf of African women made a blanket statement about the global gag rule and the fact that America should give us more money to preach abstinence only.
With a maternal mortality in my country high, the World Health Organization has introduced many strategies that could reduce the many deaths. What is often overlooked is the fact that African women are intelligent enough to make their own choices, if those choices are indeed available.
The choices begin from negotiating for sex, using contraceptives and carrying a pregnancy especially where incest and rape are concerned. One of the statements made by Dr. Jean Kaggia, an anti-choice advocate from Kenya, at the Congress was that we needed more money to change behavior. How does one propose that a married woman should change behavior when her husband is the one who makes the decision of whether to go to hospital or not or worse still whether to use a condom or not?
Kenya is a country with 42 tribes, which have varying cultural beliefs -- meaning we can't give a blanket solution to everyone.
I remember during the 2004 elections, many people in my country knew more about the politics of the US than knew what was happening in their own country's economy. I cannot claim to know exactly why Kenyans did not particularly like the reelection of Bush. People like Dr. Joachim Osur and other doctors who deal with family planning issues in Kenya and Africa would have much preferred a Democrat to win the election. For me it meant that we had to suffer another four years of this policy, which, interpreted by the Bush administration, meant a cut in spending on family planning.
Thanks to the global gag rule, many organizations that provided family planning services had to denounce abortion in writing and also not provide post abortion care. Most of them refused for good reason -- but that meant that they lost critical funding for their organizations and the eventual result was a close down of clinics in major districts in the country. This in itself affected many women and of course ended up reducing the gains that had been made over the years in family planning and reduction of unintended pregnancies.
I always say this -- give an African woman or any other woman choices and that will go along way in reducing unsafe abortions that have taken away the lives of many of my sisters, mothers and daughters on the continent.
So, yes -- I am adding my voice to PPFA to tell all Americans to to vote for pro-choice candidates, especially for President.
]]>Unfortunately as the researchers present their facts and figures, it's clear that the fact that PEPFAR funds expect governments to focus solely on abstinence when dealing with youth is having serious implications on Africa's largest population -- which is concentrated in the 15-24 age group.
In 2003, President George W. Bush announced the Emergency Plan for AIDS Relief, a five-year, $15 billion U.S. government initiative that aims to provide treatment to at least two million HIV-infected individuals, prevent seven million new HIV infections, and provide care and support to 10 million people living with and affected by HIV/AIDS, including orphans and vulnerable children.
To help achieve these goals, the U.S. government is rapidly expanding its programs and engaging new partners in 15 focus countries, including Kenya. Under the Emergency Plan, Kenya received nearly $92.5 million in Fiscal Year (FY) 2004, more than $142.9 million in FY 2005, approximately $208.3 million in FY 2006 and are providing $368.1 million in FY 2007 to support comprehensive HIV/AIDS prevention, treatment and care programs.
But according to the Population Action International presentation in Arusha for the conference, a third of these funds are meant for the promotion of abstinence-only. In Uganda the funds have been used to train 46,000 teachers to promote abstinence-only. All adolescents are required to sign virginity pledges and that's all the information they get.
If these funds are meant for prevention, it is clear that prevention is not virginity. One needs to know what to do the first time they have sex -- whether it's the twenty-first year, forty-first year or the one hundredth year.
Rosemary Muganda, the director of the Center for the Study of Adolescents said, "its like walking with into a hospital ward with different patients and using one prescriptions for all of them."
Although this is not an article intended to bash PEPFAR, I think we need to be realistic and deal with the real issues on the ground. The age at first sexual encounter for most Ugandan girls and boys is 12-14 years. If HIV/AIDS is to be prevented, these same adolescents need to have information on how to protect themselves from this and any other disease.
"[PEPFAR] is a good initiative but it may end up reducing the impact on prevention for young people," says Muganda.
PEPFAR funds have supported many African governments, including Kenya, in acquiring anti-retrovirals. At the same time, Africa's population is young and the challenges in reproductive health are high. African governments need to prioritize funding to focus on the need of youth.
But as the debate rages, I am wondering whether allowing adolescents access to condoms is a matter of national security for the US government. New data from Burkina Faso, Ghana, Malawi and Uganda reveal that many adolescents do not use contraceptives, have experienced unwanted sex, have multiple or much older partners and, worse still, lack adequate knowledge about avoiding sexually transmitted infections (STIs) and pregnancy.
The new research findings, jointly conducted by the Guttmacher Institute, APHRC and local research partners, suggest a number of important steps that should be taken to help adolescents avoid unwanted pregnancy, STIs and HIV/AIDS. Encourage the use of modern contraceptive methods and make male condoms widely available.
Its also important that we ensure all adolescents have the specific information and skills they need. Although highly aware of sexual reproductive health issues, adolescents still lack skills needed to protect themselves against HIV, unintended pregnancies and unwanted sex. They must be provided with comprehensive information and skills if they are to delay their sexual debut, resist pressure to engage in unwanted sex and practice safe sex.
Given that among 12-14 year olds, 7-34% have experienced some form of physical activity (kissing, fondling or intercourse) or have a boyfriend or girlfriend, and 11-53% have at least one close friend who has had sex, its imperative that interventions start early.
Its also important to note that all adolescents need access to sexual and reproductive health information and services. However, some groups of adolescents, such as out of school youth and married females, have particular needs or face elevated risks and they require targeted solutions.
According to Dr. Eliya Zulu of the Africa Population and Health Research Center (APHRC), "African governments and people working in programs should stand firm on the knd of funding they get so that they are tailored towards the needs of the African adolescents."
Justin Malawezi, former Malawian vice-president thinks believes strongly that a true sign that the war on HIV/AIDs is being won, is when there will be a decline in new infections. He said that once we understand what drives the epidemic among the youth then we will begin to solve the mystery. He suggests the use of traditional forms of communication and passing of information would be a good starting point.
It was apparent in the discussions after the presentations of the result that most people are still uncomfortable with teaching sex education in schools or to adolescents that they feel are too young to be having sex anyway! One wonders then where will the youth run too?
The US guidance contends that providing adolescents with information about both abstinence and contraception sends a "confusing" and "conflicting message" that "appears to encourage sexually activity" despite clear evidence to the contrary. African governments, on the other hand, are still taking donor funding with conditions that they know very well do not work with their situation and meanwhile the youth are stuck with inadequate information, lack of services, high HIV infections and unwanted pregnancies and nervous parents who have refused to bite the bullet and talk to their children about sex and how to prevent themselves from the consequences of sex.
It definitely beats my logic!
]]>Prior to the elections, we had been told that our vote was important and that it will determine the destiny of our nation. With that in mind we went all out to cast our vote, very assured of the fact that it will definitely reflect what we wanted as a country. When tallying started everybody was excited as it started reflecting what we had in mind. Then the delays started. And everyone wondered except those who were looting the vote on why there were delays.
To make a long story short, the incumbent Mwai Kibaki was declared the winner amidst protests. The journalists were chased out of the room including international electoral observers and leaders, when the results were being announced. Later we were told via the national broadcaster (government owned) that the incumbent was the president and that the opposition leader Raila Odinga had lost the elections.
Immediately after this happened, we were shown the swearing in of Mwai Kibaki, without the presence of the diplomatic corps and the national anthem was not played at the state house (equivalent to the White House in the United States).
Now what followed soon after as if on cue, was violence in the major towns of Kenya and the capital Nairobi. Shops were closed and people stayed indoors as very many Kenyans expressed disappointment at the lack transparency of the process especially the tallying of votes. It did not help matters when the some electoral commission members said that they were not sure of the figures they announced, and the chairman later revealing that he announced the results under duress.
You might be wondering why am making a political statement out of a reproductive health website. Well, as usual with conflict, the people who are mostly affected are women and children. To make matters worse I live near the Nairobi women's hospital which has a gender recovery center that offers free services for women who have experienced violence. As I write this article the hospital has received 29 women and girls who have been raped.
As the political class debate on who won the elections women are being violated and few manage to get to the Nairobi women's hospital and report the cases. Since we are also cut off in terms of communication with a ban on live broadcast information from around the country is not readily available.
My worry is that women will continue to become statistics especially when there is conflict and especially sexual violence. I believe that Kenya will emerge out of this victorious but I also know that women will be the worse off when everybody has been satisfied with the verdict.
As we seek solutions and as people call for peace, I haven't heard yet the first lady say anything around the women who are being violated. The violence must end otherwise I will keep on updating you on statistics...one woman is one too many!
]]>For me what resonated was the fact that girls and women continue to be subjected to unacceptable and appalling levels of discrimination and violence. But the worst violence of all is when a woman who wants to either stop or space childbearing cannot do so because of lack of contraception.
Being at the Africa population conference, I have been confronted by a lot of facts and figures around the contraceptive prevalence rates of the different countries in Africa and I am now more convinced than ever that access to family planning methods is a human right that African women have been denied for so long.
An Ethiopian woman with no education, for example, has 6.1 children on average, but an Ethiopian woman with secondary or higher education has 2.1 children. In developing countries, one in six married women faces an "unmet need" for family planning. I know this is not news but I also know that not much has changed in terms of government or donor commitment to shift this unmet need and reduce the burden of childbearing for the women who want to stop.
Next year leads us to the sixtieth anniversary of the Universal Declaration of Human Rights. Every human being should be able to live and make decisions free of coercion, discrimination and violence. The world has long recognized, for instance, that all couples and individuals have a right to decide whether and when to have children. Yet today an estimated 200 million women worldwide lack access to modern contraception. The world has also long recognized the right to health. Yet today one woman dies every minute during pregnancy and childbirth for lack of maternal health services.
The same predicament confronts young people who face unwanted pregnancies and HIV infection but lack the information and means to protect themselves. According to surveys completed in developing countries in 1999 and 2000, women who said they did not want to become pregnant cited various reasons for not using contraception. They included but are not limited to opposition to family planning, by the family especially husbands; problems with contraceptive methods, including side effects and health concerns; and, to a lesser extent, cost and access. It does not require a genius to note that reducing an unmet need will help reduce unintended pregnancies -- which lead to abortions and unwanted births.
I am happy on one note though: the Ethiopian government is going to focus on providing family planning services to 8.5 million women across the country during the next Ethiopian year. For this purpose, the ministry said it plans to train 600 health professionals, who will then train nurses currently working at health facilities.The ministry is set to revise and distribute family planning guidelines among regional states, partner organizations and educational institutions. In addition, the ministry plans to provide services aimed at preventing mother-to-child HIV transmission at more than 600 health stations and 126 hospitals, he said. The plan seeks to ensure that Ethiopia meets the health-related targets of the Millennium Development Goals.
While this is all good, I am praying that they will also be informing women of the benefits and possible side effects so that they can choose the birth control method most appropriate for them; informing women of their chances of becoming pregnant after using forms of birth control, after abortion or childbirth, during breastfeeding, or when approaching menopause, and counseling them on family planning methods that might be appropriate for them.
As we work towards access to contraceptives let's not forget the men when it comes to family planning. There are many countries where women have to walk long distances to reach a facility that provides family planning and when they get there, the contraceptive method they need is often no longer in stock.
Its funny that politicians are still asking whether we still need family planning. For me access means the degree to which family planning services can be obtained devoid of socio-cultural, geographic, financial and health care system barriers.
The politicians too need to remember that budget lines should be put in place to cater for contraceptives and reduce the donor reliance in support of the same. This is because what is at stake is for every 109 births there is one woman dead. If we only provided family planning we could reduce these deaths by 20-35%, because women and girls have a right to live.
]]>Many women suffer in silence in isolation and silence for a condition that is easy to prevent. Thanks to this training, patients like Julia Karimi can now see a light at the end of tunnel. She and many women in the country can now breath a sigh of relief knowing that they won't be treated as outcasts because their injury can be remedied.
Obstetric fistula is a hole in the birth canal caused by prolonged labor without prompt medical intervention, usually a Caesarean section. The woman is left with chronic incontinence and, in most cases, a stillborn baby.
The smell of leaking urine or feces, or both, is constant and humiliating, often driving loved ones away. Left untreated, fistula can lead to chronic medical problems, including ulcerations, kidney disease, and nerve damage in the legs.
A simple surgery can normally repair the injury, with success rates as high as 90 percent for experienced surgeons. The average cost of fistula treatment and post-operative care is just $300. Sadly, most women with the condition do not have access to skilled personnel.
That is why the training for gynecologists at the largest referral hospital in East Africa is a welcome idea as it open doors to women from the region to access repairs for fistulas.
Obstetric fistula is one of the major complications that result from obstructed labor. When labor is prolonged, before medical attention is can be obtained, several serious complications can occur, says Dr. Solomon Orero, an obstetric gynecologist who works at the referral hospital and refugee camps.
"A woman may die, lose her child or face complications like fistula," he says, adding that this is due to the many delays women have to go through before they reach a health care facility with skilled attendance.
Many women in Africa face a lot of barriers to accessing health care including lack of money, difficulty in reaching a health facility and cultural barriers. Over half of married women ages 15 to 49 on the continent consider money to be a big problem in getting health care. This may reflect not only in poverty but also gender differences in control over household resources.
Geographic access to health care, which involves distance to the health facility and lack of transportation, poses a big problem for women in Sub-Saharan Africa. In Zimbabwe and Namibia, married women cite geographic access more often than other obstacles to accessing health care.
A million women in the world are faced with obstetric fistula, with 50,000 to 100,000 more cases each year, says the UN Population Fund. According to Australian doctors Reginald and Catherine Hamlin, these statistics compelled them to start a fistula hospital in Addis Ababa, Ethiopia.
Fistula patients are often shunned severely due to their odor. At Kenyatta National Hospital ward 42D was put aside for the duration of the fistula patients stay at the medical facility. While it took the Hamlins more than a decade to establish a fistula hospital, I am glad to see that it will be cost effective in this region to train more doctors to perform the necessary surgery to help the victims of fistula.
As the Kenyan doctors wind up the training in Nairobi, one Julia Karimi will be going home today. She came into ward 42D smelling but now she can go home with her self-esteem back.
But treating individual instances of fistula is not an end in itself. More needs to be done to deal with all the factors that contribute to maternal mortality and morbidity as whole. Like all other issues where women are concerned, where there is a will there is always a way.
The persistence of fistula is a signal that health systems are failing to meet the needs of women.
]]>Currently, activists exasperated at the failure of diplomacy to apply pressure on Burma's military regime are resorting to a new means of protest against the regime's recent crackdown: sending female underwear to Burmese embassies.
Embassies in the UK, Thailand, Australia and Singapore have all been targeted by the "Panties for Peace" campaign, co-ordinated by an activist group based in Chiang Mai, Thailand.
The maneuver is a calculated insult to the junta and its leader, General Than Shwe. Superstitious junta members believe that any contact with female undergarments - clean or dirty - will sap them of their power, said Jackie Pollack, a member of the Lanna Action for Burma Committee.
At the moment the issue of "panty power" that is targeted at all Burmese embassies is gaining strength and reminds me of what we in Africa have had to do to bring change. Some things that women have done make me support what is going on around the issue of bringing change in Myanmar.
In Africa, it is believed that if you see your mother naked, you may be cursed. When Kenya was going through a lot of turmoil, many women went on a hunger strike and stayed naked through out for days of the protest in attempt to make the then-government to release political prisoners. This alone in Kenya's case was enough to stop police from arresting the women who stripped naked to force the government to listen. There is a theory that this action is the reason that Kenya went through a stagnated economic growth and donor funding was withdrawn for ten years. So did the stripping work? Well, yes. The incident drew attention to the issue of political prisoners and most of them were released. Kenyans were able to know that the government had a torture chamber built especially for people who opposed the then government.
When Kenyan women were demanding for the enactment of sexual offenses bill and to drum up support for the process, there was talk of resorting to a "no sex" campaign until the bill is enacted. Luckily for the men in Kenya, we didn't have to resort to that.
The strategy worked and that's why when the need arises, as in Burma's case, I support the panty power campaign.
Will the panty power work? I think so. It has generated an interest and focus on what is going on in Burma. Soon, the panties will have an effect. Good luck Burma!
]]>It was a big story in the United States of America when a man was convicted for marrying off a fourteen-year-old girl to her nineteen-year-old cousin. The man is Warren Jeffs (51), the leader of a Mormon sect group. Jeffs could get life in prison after a trial that threw a spotlight on a renegade community along the Arizona-Utah line where as many as 10,000 of his followers practice plural marriage and revere him as a mighty prophet with dominion over their salvation.
I followed this case keenly and am waiting for the verdict to see how seriously this matter will be taken. Why, you ask? Well, in many African communities, it is not strange to see a 14 year old married and with children. My mother was married off at 16. Yet the law regards anyone under 18 as a minor and having sex with her is constituted as rape.
Recently in Kenya there was a story of a man who was demanding bride price before the body of his late 16 year old daughter was laid to rest. The girl had died because of pregnancy related complications. When the media highlighted this story, there was more focus on the issue of bride price and less or none at all on the fact that the girl was actually 16 and married.
The two cases, the one in America and the one in Kenya, tells me that we are keen to make laws but unlike in the States, are not ready to follow through with the promise to protect children and in this case girls.
Jeffs was convicted of being an accomplice to rape. In Kenya, I wonder how many fathers would fill our prisons for being accomplices to a crime if the girls were willing to come and testify. The case in the US indicated that so many girls from this sect refused to come and testify, but it took one girl's courage to find this man guilty. The sad part here in Kenya is that the perpetrators of under age marriage and rape don't see anything wrong with it.
According to UNFPA most countries have 18 as the legal age for marriage, yet statistics show that 100 million girls will be married off in the next decade. In some parts of Ethiopia and West Africa, girls are married off as early as age 7. Because many married adolescents are pulled out of school at an early age, they may be unfamiliar with basic reproductive health issues, including the risk of HIV. Despite the large number of married girls, policies and programs often fail to address their vulnerability to HIV or other reproductive health needs.
Isolation and powerlessness pose additional reproductive health risks: Young wives often have limited autonomy or freedom of movement. They may be unable to obtain health care because of distance, expense or the need for permission from a spouse or in-laws. These barriers can exacerbate the risks of maternal mortality and morbidity for pregnant adolescents.
Married adolescents often face familial and societal expectations to have children as soon as they are married. Even if contraceptive services are available, married adolescent girls may lack the power to use them.
Teenage brides with much older husbands often have limited capacity to negotiate sexual relations, contraception and childbearing, as well as other aspects of domestic life.
While all this issues are facing married children, we have yet to exercise the power of the law that is evident in all the countries in the world and on the continent. To use the laws to safe guard the rights of the child and eventually her reproductive health.
I would like to end with this quote from the now 21-year-old victim of the case quoted above. "This trial has not been about religion or vendetta. It was simply about child abuse and preventing abuse," she said in prepared remarks after the verdict. And I say, this discussion is not about tradition and culture for the sake of it, but it is about preventing child abuse. And in case you didn't know anyone under 18 cannot consent to sex in the eyes of the law.
]]>I won’t get into the discussion of whether women are entitled to affirmative action or not, but I will use the example of Kenya’s female health minister, Charity Ngilu, to illustrate how much we gain when women are in decision-making positions.
This election year more women have presented themselves than ever before to be elected for seats in Parliament. I want to see more women in decision-making positions simply because for once in Kenyan history we have a female health minister and the results in the health care system are evident. I am sure the men preceding her, who were either doctors or professors, made some difference, but not as much as we have seen in the last four years that we’ve had a woman lead the ministry.
The scrapping of maternity fees means that more women will have skilled attendance at birth and maternal mortality rates will decrease. This will move us one step closer to achieving the UN Millennium Development Goals. If there was ever a year that women need to come out in droves to vote for their own, this is it.
It’s largely in Africa that women die due to pregnancy-related diseases, and it’s only in Kenya that we have seen male parliamentarians struggle to outdo each other in ensuring that the representation of women in Parliament decreases, rather than increases. I am still can’t figure out what their fear is. Maternal mortality is still a big issue and contraceptive prevalence is still low. But increasing the number of women who get access to skilled attendance is another way to commit to save their lives.
The Disease Control Priorities Project says that a country’s maternal and infant mortality rates may reveal more about the state of its health system than any other figures. I believe the same rates also reveal the state commitment to gender equity and commitment to women’s health. The health sector alone is unlikely to achieve or sustain maternal health improvements in many countries without commitment to social changes to increase girl’s education, reduce gender biases in employment and pay, and confront imbalances in women’s bargaining power.
I am in America at the moment and the politics of the day have not escaped my ear. It’s clear that America is more liberal than Kenya, but it’s also quite noticeable that many are not as ready to have their first female president come next year’s election. While the Democrats try and seek their candidate, many polls indicate that a female president with the name of Hillary Clinton will polarize American voters. Africa scored first when Liberia elected Ellen Johnson-Sirleaf as President.
Kenyans head to the polls this year and Americans go next year. While I can’t speak for America, I can speak for my home country. I believe that Kenyan voters will make a conscious choice to elect more women to Parliament, not because they are women but because history has proven that women make better choices for both the whole family and the whole country.
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