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Delivering Solutions to Improve Maternal Health and Increase Access to Family Planning (Policy Brief)
›The Wilson Center Policy Briefs are a series of short analyses of critical global issues facing the next administration that will run until inauguration day.
According to the World Health Organization (WHO), approximately 800 women die daily from preventable causes related to pregnancy and childbirth. Almost all of these deaths occur in developing countries, with higher rates for women living in rural areas and among poorer communities.
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Should Maternal Health Goals Be Combined With WASH?
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Does access to quality water and sanitation have an effect on maternal health outcomes? That was a surprising topic of discussion on day one of the second-ever Global Maternal Health Conference hosted this week in Arusha, Tanzania.
Surprising because, to be honest, I did not think there would be strong disagreements over the relationship between water and sanitation (WASH) and maternal health. In my work with the Comparative Urban Studies Project, the two seem to be clearly linked.
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Three Critical Maternal Health Medicines That Could Save Women’s Lives
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“We know maternal health medicines are safe, we know they’re effective, we know they’re essential to keeping women healthy throughout pregnancy and childbirth,” said Kristy Kade at the Wilson Center on October 23. But lack of supply, poor quality, and misuse means they do not always help the women who need them. [Video Below]
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Programmatic and Policy Recommendations for Addressing Obstetric Fistula and Uterine Prolapse
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Obstetric fistula is “not just a medical issue, but a human issue,” said Dr. Luc de Bernis, senior maternal health advisor at UNFPA, during a September 27 panel discussion at the Wilson Center. Obstetric fistula, a hole in the birth canal that can develop between the vagina and the bladder and/or rectum during prolonged labor without proper medical intervention, is preventable and treatable but continues to affect more than two million women worldwide, mostly in developing countries where women lack access to cesarean services. Women stricken with it face severe pain and suffering, social stigmatization, and usually give birth to a stillborn child.
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Kate Gilles and Marissa Pine Yeakey, Behind the Numbers
World Contraception Day
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The original version of this article, by Kate Gilles and Marissa Pine Yeakey, appeared on the Population Reference Bureau’s Behind the Numbers blog.
World Contraception Day “centers around a vision for a world where every pregnancy is wanted,” with a goal of enabling “young people to make informed choices on their sexual and reproductive health.”
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The Challenges and Benefits of Addressing Young Adolescent Reproductive Health
›There are 1.2 billion adolescents (ages 10 to 19) in the world today, accounting for 17 percent of the global population. They are the largest youth cohort in history, and 90 percent live in the developing world. Within that broad age group, very young adolescents (ages 10 to 14) often fall through the cracks of international development work, especially when it comes to health, and reproductive health in particular.
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Taking On Domestic Violence in Post-Conflict Liberia
›Liberia is a case study in post-conflict violence against women, said panelists at the Wilson Center on July 24. “Confined merely to performing household chores and childrearing duties, from early childhood, women and girls have been socialized into subservience and powerlessness and acceptance of domestic abuse as a norm,” Annette Kiawu, deputy minister for research and technical services at the Liberian Ministry of Gender and Development, told the audience. [Video Below]
Kiawu was joined by Pamela Shifman of the Novo Foundation and Esther Karnley and Elisabeth Roesch of the International Rescue Committee (IRC). They discussed the prevalence of domestic violence in Liberia after the 14-year civil war, which ended in 2003.
Violence Stemming from Changing Norms
Kiawu pointed to women’s changing roles in Liberia as a source of household tension. She noted that women are increasingly “demanding a greater role in household decision making,” which some men see as “encroachment on their sphere of influence.”
“According to the LDHS [Liberia Demographic and Health Survey], the persistence of domestic violence is directly linked to the increased status of women on the one hand and men’s [perception] of loss of power and authority on the other,” she said. Some men’s urge to assert dominance is exacerbated by higher levels of alcohol abuse and a tendency towards violence learned during the civil war.
There has been legislation against gender-based violence – including the Rape Amendment Act, also known as the “revised rape law,” the Revised Gender-Based Violence Action Plan, and the African Union Protocol – as well as action plans and community-based groups meant to decrease the rate of domestic violence, like the Gender-Based Violence Network, an initiative designed to increase community ownership of domestic violence issues and improve response at the grassroots level. But despite these advances, Kiawu stressed that there still is a long way to go, saying that increased funding and coordination between domestic and international agencies and the Liberian government is necessary to have a real impact on the lives of the “countless women” whose lives are threatened by domestic violence.
Making Reality Match Rhetoric
Pamela Shifman agreed that domestic violence prevention programs need more funding. “So often in conflict-affected settings we hear that we need to address other issues first…that domestic violence is a back-burner issue,” she said. Domestic violence is often perceived to be “not that serious” when compared to other issues in conflict-prone and post-conflict countries.
But Shifman argued that divorcing domestic violence from other types of violence is problematic. “Violence in the home normalizes violence in the street, normalizes violence in the community, and normalizes violence by the state,” she said.
NoVo is one of the few private organizations which prioritizes domestic violence and gender equity, Shifman said, but she asserted that all humanitarian organizations should devote time and money to these issues, saying that “if we ignore domestic violence, all of the other investments we make to improve the quality of life for communities will suffer.”
Empowering women can have significant results for the whole community. Shifman remarked that “investing in women is smart economics,” citing studies which suggest directing funds towards women “pays off at huge levels” for women’s families and communities. But when women experience violence, “their potential is thwarted,” she said. “They suffer, their families suffer, their community suffers, the entire nation suffers.”
Programs targeting domestic violence need greater awareness, more long-term commitment, and more funding, she said. “We don’t expect that violence is going to end overnight – no deep-seated social problem will be solved that quickly,” she said. “In order to make a dent in improving the lives of girls and women and ending violence against girls and women, we need more direct funding” from private and public sources.
“To put it bluntly, I think the reality needs to match the rhetoric,” Shifman concluded.
Perspectives from the Field: Social Isolation
Esther Karnley described the results of interviews conducted with Liberian women, both survivors of domestic violence and fellow community members. She found that a key reason women stay in abusive relationships is financial dependence. “Most of them said, ‘it’s because we depend on the men for everything… we don’t have any money, we are not empowered financially, we depend on the men for everything. Because of that, we remain in that relationship and we get killed.’”
She added that social isolation means that many women lack the resources to leave a relationship. “We are isolated socially, we don’t have access to services, we are all by ourselves,” they told her. Without support from friends, relatives, or organizations, it can be difficult to find the means to relocate.
Part of the problem in Liberia is the prevalence of informal education, especially Sande bush schools – schools run by a traditional women’s society designed to prepare girls for marriage, teaching them traditional housekeeping methods and culminating in female circumcision. Girls leave home to attend these traditional schools for several months, which severely curtails their access to formal education. Kiawu reported that “over 60 percent of girls attending Sande school drop out of regular school.” This means that “successive generations of young children, especially young girls, are expected to forgo formal education in favor of attending the Sande school.”
In addition to formal education, Karnley said financial empowerment and legislation holding perpetrators of domestic violence accountable for their actions would enable more women to leave abusive relationships.
Reaching Both Women and Men
Each of the panelists recognized that working against domestic violence requires comprehensive societal reforms. Karnley stressed that the impetus to begin working with men came from Liberian women. “Initially when we started working on GBV issues, we talked to women, and then the women came and said, ‘OK, you talk to us every day, and when we go home, we go and meet fire. Can you also talk to our men?’” In response, the IRC developed a 16-week program designed to change men’s behavior and views about violence and relationships. Karnley also mentioned a desire to reach out to the religious community to change the constant focus on the man as the head of a relationship to one based on love.
The Liberian government is also working with churches and mosques to change norms that encourage the subjugation of women, including work with a network of religious leaders known as Christian/Muslim United against SGBV (sexual and gender based violence). Kiawu said this organization emphasizes partnership within a marriage and teaching equality to children in the home. The panelists also mentioned additional efforts to increase the responsiveness and sensitivity of the police and judicial system to domestic violence issues, as well as the need for resources like safe houses to provide relief to survivors.
“The family, far from being off limits, has to be a priority for us in the humanitarian community as we help to rebuild nations where peace not only exists between nations, and among nations, and among communities, but among families,” Shifman contended. Kiawu agreed, adding that without interventions, violence and isolation prevent women “from taking advantage of opportunities that peace presents.”
Event Resources: Photo Credit: A woman prays during a Sunday morning service in Monrovia, courtesy of Bruce Strong/Newhouse School. -
‘Motherland Afghanistan’ Shows Maternal Mortality Not Just A Health Issue
›Afghanistan has one of the highest rates of maternal mortality in the world: 327 out of every 100,000 women who give birth die during childbirth. Despite some recent improvements, political, social, cultural, and economic factors present enormous challenges. Last month, the Center for Population and Development Activities hosted an online viewing and dialogue discussion of the PBS Independent Lens film Motherland Afghanistan, which follows Afghan-American filmmaker Sedika Mojadidi and her father, Dr. Qudrat Mojadid, as they return to their home country and visit the Laura Bush Maternity Ward in Kabul. The conditions they find are devastating and underscore not only the need for greater commitment to reproductive health services, but also the advancement of women’s and girl’s access to education, security, and political participation.
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