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The blog of the Wilson Center's Environmental Change and Security Program
Showing posts from category gender.
  • DRC’s Conflict Minerals: Can U.S. Law Impact the Violence?

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    July 13, 2010  //  By Schuyler Null
    Apple CEO Steve Jobs, in a personal email posted by Wired, recently tried to explain to a concerned iPhone customer the complexity of ensuring Apple’s devices do not use conflict minerals like those helping to fund the civil war in the Democratic Republic of Congo. However much one might be tempted to pile on Apple at the moment, Mr. Jobs is on to something with regard to the conflict minerals trade – expressing outrage and raising awareness of the problem is one thing but actually implementing an effective solution is quite another.

    As finely articulated in a number of recent articles about conflict minerals in the DRC (see the New York Times, Guardian, and Foreign Policy for example), the Congo is, and has been for some time, a failed state.

    Although a ceasefire was signed in 2003, fighting has continued in the far east of the country around North and South Kivu provinces, home to heavy deposits of tin, gold, coltan, and other minerals. The remote area is very diverse ethnically and has seen clashing between government troops and various militias from the Congo itself as well as encroachments by its neighbors Rwanda, Uganda, and Burundi. Referred to as “the Third World War” by many, there are by some accounts 23 different armed groups involved in the fighting, and accusations of massacres, rampant human rights abuses, extortion, and pillaging are common. According to the UN Special Representative on Sexual Violence in Conflict, “there is almost total impunity for rape in the Congo,” and a survey by the International Rescue Committee puts the estimated dead from preventable diseases, malnutrition, and conflict in the area at over five million over the past decade (or 45,000 deaths a month).

    At a recent event in Washington, DC on this terrible conflict (see Natural Security for an excellent summary), DRC Ambassador Faida Mitifu expressed her hope to the audience and panel (including U.S. Under Secretary of State Robert Hormats) that they would not limit themselves to “just talking.” Hosts John Pendergast and Andrew Sullivan of the NGO Enough Project hope to address the demand side of Congo’s mineral trade by pushing Congress to pass the Conflict Minerals Trade Act, which would require U.S. companies to face independent audits to certify their products are conflict mineral-free.

    But Laura Seay, of Texas in Africa and the Christian Science Monitor, is dubious of this proposal, pointing out that:
    Without the basic tools of public order in place and functioning as instruments of the public good in the DRC, the provisions of this bill are likely to work about as well as the Kimberley Process Certification Scheme does in weak states that lack functioning governmental institutions – which is to say, not at all.
    The Kimberely Process (KP) is a certification scheme that is supposed to stem the flow of “blood diamonds” that support corrupt regimes and fuel human rights abuses. But the KP’s governing body has recently reached a crisis of action over whether or not to punish Zimbabwe for alleged abuses, with one diamond magnate even claiming, according to IRIN, that “corrupt governments have turned the KP on its head – instead of eliminating human rights violations, the KP is legitimizing them.”

    The problem with international transparency schemes like the Kimberely Process, the proposed Conflict Minerals Act, or even EITI, is that at the very least, a functioning government – if not a beneficent one – is needed to enforce regulations at the source. In the DRC’s case, not only does the government have little to no authority over the affected areas, but the mining militias are smuggling their loot, on foot in some cases, directly into neighboring countries anyway. By the time they reach U.S. companies (if ever – Americans are not the only consumers in the world), conflict minerals have passed hands so many times that proving their provenance is next to impossible.

    Then there is the question of whether or not cutting off the militias, rogue military officials, and government forces from conflict mineral monies would even end violence in the region in the first place. Certainly many armed groups gain a great deal from their illegal mining activities (as do some locals), but is it the root cause of their discontent? In the best case scenario where mining revenues are actually decreased, would that really convince the remnants of the Hutu Interahamwe, fleeing retribution from the now majority-Tutsi Rwandan government, to suddenly put down their weapons? How about the Mai Mai, who are fighting the Hutu incursion into their homeland?

    I for one find that hard to believe. Stopping the conflict mineral trade from afar is very difficult, if not impossible, and even if we could end the trade, it would not necessarily stop the suffering. Illegal mining does play a large part in supporting rebel groups, but to address the human security problems that have so horrified the world, international attention ought to first be turned toward improving governance mechanisms in the Congo and rethinking the troubled UN peacekeeping mission (how about more involvement out of U.S. AFRICOM too?). The failure of the current UN mission is well documented, but withdrawing the largest peacekeeping force in the world in the face of continued violence, including the recent death of Congo’s most famous human rights activist under suspicious circumstances, seems more likely to cause harm than good.

    Would passing the Conflict Minerals Act make Apple consumers feel better? Perhaps. But that’s not the point. Environmental security measures that prevent the DRC’s tremendous mineral wealth from being used to fund conflict can only make an impact if the government has some measure of accountable control over the area. To make a real difference in east Congo, human security must first be addressed directly and forcefully.

    Sources: BBC, Christian Science Monitor, Daily Beast, Human Rights Watch, IPS News, IRIN News, International Rescue Committee, Enough Project, Foreign Policy, GlobalSecurity.org, Globe and Mail, New York Times, Share the World’s Resources, Southern Times, Times Online, UN, Wired.

    Image Credit: “Minerals and Forests of the DRC” from ECSP Report 12, courtesy of Philippe Rekacewicz, Le Monde diplomatique, Paris, and Environment and Security Institute, The Hague, January 2003.
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  • An “Aye” for an “Aye”: Everyone Has a Right to Be Counted

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    July 12, 2010  //  By Kayly Ober
    Around the world, countries from Afghanistan to Papua New Guinea to the United States are taking part in their decadal census, leading the UN Population Fund (UNFPA) to select the theme “Everyone Counts” for World Population Day 2010, which was celebrated on July 11.

    Everyone has the right to be counted, because “censuses and population data play a critical role in development and humanitarian response and recovery,” said UNFPA Executive Director Thoraya Ahmed Obaid in her World Population Day message. Obaid added that “with quality data we can better track and make greater progress to achieve the Millennium Development Goals, and promote and protect the dignity and human rights of all people,” especially among vulnerable populations like women, girls, the poor, and the marginalized.

    USAID similarly supports quality data collection, which it says plays a critical role in advancing voluntary family planning in the developing world. For the last 25 years, USAID has funded the Demographic and Health Surveys (DHS) program, which collaborates with national health ministries to collect data on family planning, child and maternal health, disease prevalence, and other health indicators.

    This invaluable data is made freely available for public use, which can foster new research in the field and stimulate innovative approaches to addressing public health issues. Praising the DHS program, Gapminder Foundation Director Hans Rosling told a Wilson Center audience last year that “statistics should be the intellectual sidewalks of a society, and people should be able to build businesses and operate on the side of them.”

    Accurate census counts are also important elements of “good governance, transparency and accountability,” said UN Secretary-General Ban Ki Moon in his World Population Day message. “Population data helps leaders and policy-makers to make informed decisions about policies and programmes to reduce poverty and hunger, and advance education, health and gender equality,” he said.

    But no one is suggesting that coming up with reliable population data is an easy task. As Sean Peoples and Elizabeth Leahy point out in the May/June 2009 issue of World Watch magazine, issuing population projections can be a risky business:
    In the 2008 Revision of World Population Prospects, the UN Population Division projects that our planet will grow to 9.15 billion people by 2050. Yet this medium-variant projection is just one of several possible scenarios released in this latest round of number crunching. The low- and high-variant projections—7.96 billion and 10.5 billion, respectively—could instead become reality, given uncertainties in the developing world due to factors such as inconsistent data collection, weak health system infrastructure, and low government capacity.
    The goal, then, is to make sure everyone counts.
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  • New Film Looks at Sub-Saharan Africa’s Unmet Need for Family Planning

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    Eye On  //  July 9, 2010  //  By Russell Sticklor
    A new documentary film released recently by Population Action International brings attention to the plight of women across sub-Saharan Africa who lack access to basic reproductive health supplies, such as condoms and contraceptives. Funded with the support of the Reproductive Health Supplies Coalition, “Empty Handed” documents the unmet need for family planning services in the region, which has some of the world’s highest fertility rates.

    PAI filmmaker Nathan Golon shot the film in Uganda earlier this year. The film’s focus on Ugandan women’s struggles in particular is with good reason, as the country has a well-documented history of providing insufficient family planning services. According to the CIA’s World Factbook, Uganda has the world’s second highest total fertility rate at 6.73 children per woman.

    “Empty Handed” examines how a lack of family planning tools and services can lead to a slippery slope of unintended consequences, from unplanned pregnancies to the rampant spread of sexually transmitted diseases. The film revolves around interviews conducted with women who share common hardships as they try to access family planning from under-resourced local healthcare clinics, often traveling long distances only to find upon arrival that no contraceptives or condoms are available.

    In addition to identifying past and current issues with reproductive healthcare access in sub-Saharan Africa, “Empty Handed” also puts forward some ideas for better meeting family planning needs of the more than 200 million women throughout the world without access to even basic contraception.

    To watch the full film online, visit the “Empty Handed” website.

    Sources: C.I.A., FHI, Population Action International, Reproductive Health Supplies Coalition
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  • ‘Interview:’ Educate Girls, Boys, To Meet the Population Challenge, Say Pakistan’s Leading Demographers

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    June 25, 2010  //  By Russell Sticklor
    Pakistan is at a major demographic crossroads. With a youth-heavy population of some 180 million and an annual population growth rate around 2 percent, the country’s population is projected to swell to roughly 335 million by mid-century. Such explosive growth raises major questions about Pakistan’s future, from looming food and water scarcity, to yawning inequalities in the nation’s educational and economic systems. Some warn that these problems threaten to drive a new generation of disaffected Pakistani youth toward political and religious radicalization.

    Recently, I asked a number of leading Pakistani demographers visiting the Wilson Center how their country could best achieve more sustainable population growth rates and effectively harness the economic potential of Pakistani youth.

    Educate Girls

    Zeba Sathar, Pakistan country director for the Population Council in Islamabad, told me empowering girls through education represents one of the most important means of reducing the total fertility rate, which currently stands at four. “When children are educated—particularly when girls are educated—they take care of their fertility and their family size themselves,” Sathar said.

    Yet securing educational opportunity for Pakistani girls has often been an uphill battle, largely due to entrenched social norms. Yasmeen Sabeeh Qazi, Karachi-based senior country adviser for the David and Lucile Packard Foundation’s Population Program in Pakistan, pointed out that a traditional preference for male children in Pakistani society has meant girls do not often receive the same level of family resources as males. This phenomenon has historically fed gender inequality, she said.

    “Since boys are preferred, girls are not given the same kind of attention and nutrition, especially in the poorer and less-educated families,” Qazi told me. “But as the education level goes up, you see that this divide starts narrowing.” For Qazi, one of the keys to heightening educational access for girls is to increase both the quantity and quality of schools in rural districts, where two-thirds of Pakistanis live.

    Decentralize Family Planning Services

    Others I spoke with emphasized improving access to reproductive health and family planning services in rural and urban areas. The federal government’s relatively recent move to delegate operational authority for family planning services to the provincial or district level has encouraged many, such as Dr. Tufail Muhammad with the Pakistan Pediatric Association’s Child Rights & Abuse Committee in Peshawar.

    Muhammad said the ongoing decentralization—which he described as “a major paradigm shift”—is meant to increase ownership of population planning policies at the local level, and therefore lead to more effective implementation because “the responsibility will be directly with the provincial government.” Once capacity is established at the local level to design and implement those policies, Muhammad added, “supervisors, administrators, and policymakers will be very close to [family planning] services.”

    Manage the “Youth Bulge”

    Yet despite the fact that both the public and private sectors are taking steps to address Pakistan’s growth issues, the population crunch will intensify before it potentially eases. Even assuming that greater educational opportunity for girls and increased local control over family planning services help drop Pakistan’s total fertility rate, the sheer size of the current youth bulge—two-thirds of the country’s population is under age 30—means population issues will inform every aspect of Pakistani society for decades to come.

    In discussing the current state of Pakistan’s education system, some speakers also asserted that the influence of madrassas, or religious schools, over the student-aged population has often been overstated. Shahid Javed Burki, Pakistan’s former finance member and recent senior scholar at the Wilson Center, said during the panel discussion that inaccurate enrollment estimates created “the impression that the system is now dominated” by those institutions. He noted that more recent figures place madrassa enrollment at just five percent of the total student population.

    With a majority of Pakistani students enrolled in regular public schools, he insisted that “public policy in Pakistan has to focus on public education” in order to prevent those students from slipping through the cracks. The problem, he added, was that “the education that they are receiving is pretty bad. It really does not prepare them to be active participants in the workforce and contribute to the economic development of the country.”

    Still, most of the experts sounded optimistic about Pakistan’s potential to mitigate some of the adverse effects associated with the near-doubling of the country’s population during the next 40 years. By starting to more openly address an issue that the government and the powerful Pakistani media have long preferred to ignore, they seemed to agree the country is taking a big step in dealing head-on with its looming demographic challenges.

    “I don’t look at the Pakistani population as a burden, but rather as an asset,” remarked Burki. “But it has to be managed.”

    Photo Credit: “School Girls Talk in Islamabad,” courtesy of flickr user Documentally.
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  • Brookings’ “Taking Stock of the Youth Challenge in the Middle East”

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    Eye On  //  June 22, 2010  //  By Schuyler Null
    Samantha Constant and Mary Kraetsch of the Brookings Institution have created a handy visual aid to understanding the Middle East’s demographics. The interactive flash graphic shows select economic and demographic information as you scroll over each country, including GDP per capita, youth percentage of the population, secondary school enrollment rate, and unemployment figures. Clicking on each country brings up a more detailed fact sheet that breaks down economic, education, and demographic statistics.

    The companion write-up to the map stresses the importance of these figures to youth-inclusive development. Citing the 2009 UN Arab Human Development Report, the authors point out that the region will need to create about 51 million jobs by 2020 to account for youth entering the work force and already high unemployment rates.

    The report does however shy away from some of the Middle East’s most difficult demographic challenges. Iraq and the West Bank are mentioned as areas that will continue to have large youth bulges, but Yemen, which has far and away the most troubling demographics in the region, is not mentioned at all. Adding “total fertility rate” as a statistic, which shows the average number of children born to an average woman over her lifetime, might illustrate these trouble areas more clearly. As illustrated by data from the Population Reference Bureau, Yemen (5.5), the Palestinian Territory (4.6), and Iraq (4.4) all have noticeably higher total fertility rates than other countries in the region, which helps explain why their demographic problems will continue.

    The inclusion of total fertility rates would also help make a stronger argument for closer attention to be paid to women’s rights issues, as generally better women’s rights translates to lower total fertility rates, which help draw down youth bulges over time. The report only briefly mentions that more research is needed to create better paths for young women to become productive members of society with “greater career opportunities beyond traditional roles.”

    The map does mention that information will be updated on a regular basis so it is worth checking back to see what it added to this useful primer.

    Sources: The Brookings Institution, Population Reference Bureau.

    Interactive Map: “Understanding the Generation in Waiting” courtesy of The Brookings Institution.
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  • Women Deliver in the Climate Change Debate

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    Dot-Mom  //  June 21, 2010  //  By Russell Sticklor
    One of the hottest topics at the “Women Deliver” conference earlier this month—where panels ran the gamut from HIV prevention and family planning to gender-based violence and maternal health—was the intersection of women’s reproductive health, global population growth, and climate change.

    As panelists at three of the conference’s climate-focused events noted, women in poor, rural areas are especially vulnerable to the impacts of climate change. In many developing countries across Africa, Asia, and Latin America, women take on much of the burden of farming, gathering fuel, and supplying fresh water for their communities. As a result, they bear the brunt of hardships when climate change alters seasonal precipitation patterns, or increases scarcity of key natural resources.

    In addition, “the more assets, the less vulnerable one person is,” said Lorena Aguilar of the International Union for Conservation of Nature. “Worldwide, compared to men, women tend to have more limited access to resources that would enhance their capacity to adapt to climate change—including land, credit, agricultural inputs, decision-making bodies, technology, and training services.”

    Women’s hardship in the face of climate change can also have a negative effect on reproductive health. Aguilar remarked that during the dry season in parts of rural India and Africa, 30 percent or more of women’s daily caloric intake is spent on fetching water alone. The enormous physical strain placed on women’s bodies because of those tasks has resulted in higher miscarriage rates among those populations, she noted.

    Educating Girls to Protect the Environment


    Organizations like the United Nations and the Global Gender and Climate Alliance have been working in recent years to bridge the gap between women’s rights and climate change, and reframe climate change in terms of human development. But to date, women’s struggles with climate change have not translated into meaningful economic, educational, or healthcare support at the local government level, with women’s welfare “at the very bottom of the priority list” for most developing countries, according to Nickie Imanguli with Advocates for Youth.

    The unmet need for family planning tools and services is perhaps the movement’s principal challenge going forward. With an estimated 200 million women having an unmet need for family planning, unintended pregnancies could be exacerbating environmental problems such as depletion of forests, water, and other finite resources. But most panelists expressed optimism that the growing recognition of a connection between climate change and women’s reproductive health might lead to a boost in funding for family planning initiatives in underserved areas of the world.

    Speakers at Women Deliver emphasized that reproductive health can be bolstered by improving educational opportunities for girls in poor rural areas. Joy Nayiga with Uganda’s Ministry of Finance Planning Economic Development noted that “girls are more likely than boys to drop out of school to help their mothers gather fuel, wood, and water.” This trend, she said, robs females of an opportunity for educational advancement, and heightens the likelihood they will end up starting families of their own while very young.

    Nayiga and other panelists asserted that empowering females through education leads them to take greater control over their own sexual health, making it easier for them to start their families later in life, or perhaps have a smaller number of children.

    Encouraging women to take a more active role in family planning in this regard serves as “a win-win situation for women, their communities, and the nations of the world,” by “bending down the overall trajectory of population growth,” asserted the Worldwatch Institute’s Robert Engelman.

    Some speakers also argued that enabling women to delay motherhood if they want could yield direct environmental benefits for nations of the Global South that are struggling to adapt to climate change. Since women are often responsible for overseeing agriculture and forest resource management practices in their communities, they help create localized carbon sinks across the developing world.

    “Women pull carbon out of the atmosphere and bury it, in farm soils, in trees that they grow,” noted the Worldwatch Institute’s Engelman, who even suggested women’s aggregate impact removing carbon could be more effective than cap-and-trade plans.

    Moving Slowly From Talk to Action

    Given both their vulnerability to the effects of climate change—and their potential to help offset those same impacts—“women are critical stakeholders in climate change moving forward,” said Population Action International’s Kathleen Mogelgaard. So far, however, while there may be growing discussion about giving women a more prominent seat at the table when developing climate change adaptation and mitigation plans, that has not yet happened.

    “We’re not seeing big government investment in empowering women on the issue of climate change,” remarked Leo Bryant, with Marie Stopes International, a U.K.-based NGO specializing in sexual and reproductive health. Instead, Bryant said, it has been NGOs that have been doing much of the heavy lifting of bringing women into the conversation.

    But many panelists felt that, in time, governments will recognize it is in their enlightened self-interest to link issues of gender rights and climate change. “By upholding women’s rights,” concluded the IUCN’s Lorena Aguilar, “we are in fact making one of the most crucial preparations associated to climate change that any society can make.”

    Click here for additional New Security Beat coverage of reproductive health talks at the Women Deliver conference, or here for more coverage of the interplay between traditional gender roles and family planning.

    Sources: International Institute for Sustainable Development, International Union for the Conservation of Nature, Marie Stopes International, Population Action International, Population Reference Bureau, The Times (U.K.), United Nations Development Programme, Women Deliver, Worldwatch Institute.

    Photo Credit:
    “Climate Change Canvas” courtesy of Amnesty International.
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  • Sustainable Development

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    Reading Radar  //  June 17, 2010  //  By Tara Innes
    Are Women the Key to Sustainable Development?, by Candice Stevens and appearing in Boston University’s Sustainable Development Insights series, asks whether gender-conscious development strategies are the missing link in the three pillars–social, economic, and environmental–of sustainable development. She points out that “An increasing number of studies indicate that gender inequalities are extracting high economic costs and leading to social inequities and environmental degradation around the world.” In the policy world gender-conscious initiatives are often more effective as well. “United Nations and World Bank studies show that focusing on women in development assistance and poverty reduction strategies leads to faster economic growth than ‘gender neutral’ approaches.” Stevens finds that achieving greater gender parity may be the key to better governance, increased growth, and a safer environment.

    The Role of Cities in Sustainable Development, by David Satherwaite and also appearing in Boston University’s Sustainable Development Insights series, argues that traditional depictions of cities as dirty and unsustainable are inaccurate. Instead, “…with the right innovation and incentives in place, cities can allow high living standards to be combined with resource consumption that is much lower than the norm in most cities today,” he finds. Satherwaite contends that high-density living arrangements can reduce per capita energy consumption, transportation emissions, and costs of public service provisions like hospitals and schools. However, he warns that none of these potential advantages are guaranteed, and city planners must utilize effective local governance in order to make cities safe, clean, and sustainable.
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  • Women Deliver: Real Solutions for Reproductive Health and Maternal Mortality

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    Dot-Mom  //  June 16, 2010  //  By Calyn Ostrowski
    The landmark Women Deliver conference, which concluded last week, reinvigorated the global health community’s commitment to improve reproductive health at both the grassroots and global levels. Providing a major boost was the Gates Foundation’s announcement that it will commit an additional $1.5 billion over the next five years to support maternal and child health, family planning, and nutrition programs in developing countries.

    “We haven’t tried hard enough,” said Gates Foundation co-founder Melinda Gates. “Most maternal and newborn deaths can be prevented with existing, low-cost solutions.” Examples of these efficient and effective solutions were presented at the three-day conference’s dozens of panels on a wide range of issues, including climate change, contraceptive commodities, fistula, gender inequities, adolescent family planning, communications and technology, and much more.

    Empowering Young Girls to Access Family Planning

    “When we speak about adolescents we typically think of prevention. However, we must also think about providing access to safe abortions and supporting young women who want to be mothers and empower young women to make choices,” said Katie Chau, a consultant at International Planned Parenthood Federation.

    In Nigeria, “there is not much attention on adolescent sexual and reproductive health, even though a majority of rapes occur before the age of 13, and the rate of teenage pregnancy and abortions is high,” said Bene Madunagu, chair of the Girls’ Power Initiative (GPI) in Nigeria. GPI teaches girls about their rights to make decisions, including those regarding sex and reproductive health, as well as improving their critical thinking skills, self-esteem, and body image. “Girls develop critical consciousness and question discriminatory practices, while also learning about the legal instruments to take up their concerns,” he said.

    Sadaf Nasim of Rahnuma Family Planning said child marriages are common in his country, Pakistan. “Marriage is an easy solution for poor families. Once a girl is married she is no longer the responsibility of the family,” he explained.

    While laws in Pakistan and other parts of the developing world condemn child marriage, the prevalence of child marriage remains high: 49 percent of girls are married by age 18 in South Asia, and 44 percent in West and Central Africa. Nasim said birth registration at the local and national levels should be improved to prevent parents from manipulating their daughter’s age.

    In Kyrgyzstan, “community-based efforts worked to galvanize media attention and disseminate information to demonstrate the need for improved adolescent family planning,” said Tatiana Popovitskaya, a project coordinator with Reproductive Health Alliance of Kyrgyzstan. Such community-based approaches use grassroots education to mobilize community leaders, which is a critical step in overcoming child marriage and other harmful traditions.

    Cell Phones and Maternal Health

    “There is a lot of information being collected, but it is not necessarily going where it needs to because of fragmentation,” said Alison Bloch, program director at mHealth Alliance. In developing countries, the people most in need are often the most isolated, but mobile technology is emerging as a way to bridge the gaps.

    According to a recent report by mHealth Alliance, 64 percent of mobile phone users live in developing countries and more than half of people living in remote areas will have mobile phones by 2012. The potential for improving global health with cell phones and PDAs is significant, and can address a wide range of health issues, such as human resource shortages and information sharing problems between clinics and hospitals.

    “Mobile technology provides benefits to individuals, institutions, caregivers, and the community. It reduces travel time and costs for the individual, improves efficiency of health service delivery, and streamlines information to health workers to reduce maternal mortality,” said Elaine Weidman, vice president of sustainability and corporate responsibility at Ericsson.

    “Mobile technology is the most rapidly adopted technology in history and represents an existing opportunity to reach the un-reached,” said Fabiano Teixeira da Cruz, a program manager for the Inter-American Development Bank, speaking of the benefits of using mobile technology to train field-based healthcare workers in Latin America.

    While mobile phones are indeed reaching parts of the world not currently equipped with quality healthcare, the lack of systematic coordination and infrastructure at the district and regional levels must also be addressed, as highlighted during a recent Wilson Center event, Improving Transportation and Referral for Maternal Health.

    Read about our first impressions of Women Deliver 2010 here.

    Calyn Ostrowski is program associate with the Wilson Center’s Global Health Initiative

    Photo credit: Woman and child in South African AIDS clinic, courtesy Flickr user tcd123usa.
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