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.
]]>What we saw in the media was the fight at the podium with people who had one motive only; to disrupt the tribunal. Their aim was to divert the attention from the discussion that was taking place and direct it to drama. The media played into the game and that's what got most airplay and space in our papers.
It is a fact that the law in Kenya is restrictive as far as abortion is concerned but in the same breath is skewed towards the rich. A rich woman can have access to termination of pregnancy under the law, but a poor woman can't.
This is simply because in a country where the doctor patient ratio is 1:10,000, poor women can't access health care let alone reproductive health care. The law requires two doctors to certify that your life would be in danger if you carried the pregnancy to term; unfortunately the law is oblivious of the fact that many people can't get access to even one doctor.
In an attempt to have a sober discussion with all stake holders including the pro-choice and anti-choice groups, the Alliance and KHRC brought a "taboo" subject to the fore. The programme stated that we would listen to the women's testimonies then people would be welcome to give their comments and finally have "judgement" on the human rights violation, medical and social economic issues raised by the testifiers
There was an interlude of drama when some men decided they didn't like the way the programme was set and chose to jump onto the podium to voice the same. Before I turn this article into a dramatic narrative, let me proceed to say that it's about time we stopped casting the stone at the woman and looked at what drives women to insert needles, pens, bicycle spokes and coat hangers in their uteruses to try and terminate a pregnancy. It's about time we asked "where are the men in all these situations?"
While this article is not about a debate of whether or not to legalise abortion in Kenya, it's my prayer that hypocrisy will not rule the day and cloud this issue that is taking away Kenyan women's lives.
A woman who chooses to terminate a pregnancy -- for whatever reason -- should be heard before judgement is passed upon her. It's been a long journey to where we are now, with laws allowing men to walk free while the woman carries the burden of proof of sex -- pregnancy.
I have had the opportunity of listening to women who have undergone unsafe abortions speak and it has left a harrowing impression in my mind. I was once of the school of thought that someone should never get pregnant in the first place! But that is when my ignorance led me to believe that all women have access to contraceptives; when I thought that a woman's body belonged to her to do as she pleases with it; when I wondered how a man could actually rape his child; when the society embraced children born out of wedlock and when men took responsibility for their actions; a world where the poor and rich were on the equal footing.
Sadly, growing up has made me look at life's harsh realities. That the man who makes you pregnant will not always be there. In fact, sometimes the love dies as soon as he realizes you are pregnant. For those who stay around, child support is hardly there and the law doesn't make them pay. Society, on the other hand, looks down upon the woman and the church does not embrace a single woman with a child out of wedlock the same way it does if the woman walked down the isle first and then got pregnant.
For the poor woman it's even worse. Poverty alone inhibits one to negotiate for sex or even use protection. Coming from a background of vulnerability leaves the woman in a precarious position from the time she is born to the time she dies because of an unsafe abortion.
In a world where respect for women is almost nonexistent, it's not strange to hear stories of incest, rape and abandonment on the rise. With these a woman is still stigmatized and it's always a woman's fault. The society refuses to take responsibility for its action and put mechanisms in place to deal with the issue of unintended pregnancies; instead it looks for a scapegoat and in this case it's the woman.
If you ask me, put contraceptive measures in place, ensure that men are responsible for the children they sire and an adoption mechanism would be a good place to start. Next, increase incidents for abortion where rape and incest occur, then start fighting over who is right or wrong.
And as young women meet to discuss violence, HIV/AIDS and their reproductive health rights, I hope that one of these fine days we will put our emotions away and listen to each other on this issue of abortion. Or maybe we should ask ourselves why a woman's uterus should be governed.
So as men fight over the uterus they should look at themselves and society and start taking responsibility because as long as you continue pointing fingers, women will still injure themselves and die. I wish we could have more tribunals on abortion, if nothing else to just highlight the hypocrisy and selectiveness society puts on a woman's uterus.
]]>Lucy is one of the women around the world who is attending the first women-only HIV/AIDS conference that has been organised by the Young Women Christian Association in Nairobi, Kenya. For the first time, women are talking amongst themselves to deal with the pandemic and find out women-friendly strategies that work for them.
Most women in Africa get to know their HIV status when they go for antenatal care, and most countries know the HIV prevalence rates of their nations through routine tests done on pregnant women. Of all people worldwide living with HIV, only 1 in 10 has been tested for the virus and most likely this person is female.
Once women learn of their status, they then inform their husband, some of whom abandon them or, worse still, beat them up for "bringing" the disease home. Others are chased away from their matrimonial home and their property taken after their husbands die of the disease.
"The stigma around the disease affects women most, yet they are the most vulnerable given the patriarchy that exists in the African society," says Jane Koyoo of the Widows and Orphans support network in Kenya.
According to the 2004 UNAIDS report Women and HIV/AIDS: Confronting the Crisis, for every 10 African men infected with HIV, there are 13 African women. In sub-Saharan Africa, 13.1 million women are infected.
This in itself is a clear indicator of how badly hit women are in Africa. Lucy is the president of the Women United Against AIDS (WUUAG) based in Accra, Ghana—a group that brings out women and helps them build their self esteem and income generating programmes to feed their children.
Through the African Women Development Fund (AWDF), the group which used to meet under a tree has acquired a shelter where they care for the most vulnerable members and nurse them back to strength before teaching them the life skills to continue living positively.
The figures above and stories of women like Jane and Lucy have compelled the AWDF to create a program the specifically looks at funding groups that would otherwise not get funding from the "usual suspect" donors. Speaking at the Conference, the Fund's executive director said that the initiative is "something that supports African women to take control of their own destiny."
AWDF launched the 13 Campaign based on the 2004 UNAIDS report stating that 13.1 million women were infected. The campaign is meant to raise resources to the Fund's HIV/AIDS arm, which are then injected into grassroots organisations in Africa dealing with specific needs of women.
AWDF, an Africa-wide fundraising and grant-making initiative, aims to support the work of Africa women's organisations; the HIV/AIDS fund aims to deal specifically with work around the pandemic.
Statistics show that in Zambia and Kenya, married women are up to 65 percent more likely to be HIV-positive than unmarried sexually active women. At least 50 percent of Senegalese women living with HIV/AIDS have only one risk factor—living in a monogamous union.
As much as the HIV/AIDS has taken on a feminine face, UNAIDS estimates that women participated in the development of fewer than 10 percent of National AIDS Plans.
The 13 Campaign looks at contribution from individuals within and outside of Africa to donate any figure related to number 13 starting from $13—or in the case of Kenya even Ksh 13 (19 cent of the dollar). So far the fund has collected over $200,000 since the launch of the campaign in July last year. The fund will provide grants to women's organisations/projects working on: protecting women's rights to own and inherit property and land; programs to combat harmful traditional practices, including wife inheritance; harmonization of national laws and constitutions in line with regional and international commitment.
It will focus on local, national or regional African women's organisations, from any part of Africa and priority will be given to those organisations already working in the specified areas and to communities of women living with HIV/AIDS.
]]>I am deeply saddened by what happened, and as a frequent flyer on the route from between West Africa and Kenya, I am glad to be alive and my sympathies go to the families of all the 114 people who lost their lives including the crew. We are told all on board died and there are no hopes of getting anyone alive, especially because it took so long to even locate the wreckage of the plane. Two days to be specific.
This article is not in any attempt trying to piece together why the plane went down; I leave that to the experts. While everybody is trying to understand what went wrong and the newspapers awash with all possible angles to the story, my prayer is that the same attention could be accorded to the number of women who die needlessly because of pregnancy related issues that could easily be prevented.
It is said the chances of you dying in a plane crash are 1 in 400,000 to 1 in 10,000,000. In sub-Saharan Africa chances of dying out of pregnancy are 1 in 17, while in high-income countries the chances are 1 in 4,000. If this does not warrant a year of mourning, I don't know what does.
I know for a fact that some of the issues that women die from are mostly preventable, and this day and age women should not be injured because of childbirth. The little I have read of the mechanism of aircrafts, it is said that they are kept at the highest optimal safety and frequently checked and that's why air travel is relatively safe.
Because aircrafts cannot stop for roadside repairs, aircraft maintenance is kept to the highest standards. Prior to every flight, the maintenance personnel conduct a thorough visual inspection of the aircraft, checking for dents, damage or cracks on the body and any oil or fuel leaks. In addition, ever three to five days the plane's surface controls are checked. This includes the landing gears, breaks, various fluid levels as well as the oxygen system. Every eight months, the internal control system, all the emergency equipment and the hydraulic systems are checked. This requires a lot of technical expertise. Now before I bore you, I would like to see similar checks and balances around maternal mortality and morbidity to ensure that pregnancy and subsequent delivery is safe.
In Africa, "simple" issues like access to a qualified attendant while giving birth, transport to the health care facility, plus decision-making power are all a big deal. Still, some of these issues do not require technical expertise to solve. They only require government commitment. It's interesting to note what the Minister for Planning, Mr Henry Obwocha highlighted on the increase of registered health care workers, while releasing Kenya's 2006 economy survey. He stated as part of the 6.1 percent economic growth for Kenya, we had an increase in registered medical personnel by 1.8 percent. This is definitely a drop in the ocean, as skilled health care providers are needed to reduce maternal mortality.
In the next survey, I would like to hear more of how the lives of women lost has slowed the economy (if they would remember to include these statistics). But that's a topic for another day. Women do not die because we can't save them, but simply because we lack the will to see that their lives are worth saving.
Having said this, it was only in 2005 that maternal mortality became an agenda item during the annual World Health Assembly, a body that brings together health ministers from all over the world under the umbrella of the World Health Organisation.
At least they didn't enter the 21st century not acknowledging that maternal health should be and is a priority issue. Reduction of maternal mortality by 2015 should be one Millennium Development Goals that is achievable. It doesn't require engineers, just political will. If it's not achieved, it will simply mean that we don't think women's lives are important enough to be saved. Come 2015 I want to believe that once we have recognised our failures, we will probably declare a day of mourning for all the women we lose every year due to preventable causes.
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