Showing posts from category gender.
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Maternal Health Challenges in Kenya: What New Research Evidence Shows
›“Although there have been improvements in the recent past, the status of maternal health care has not met the required international standards,” said Professor at the University of Nairobi Geoffrey Mumia Osaaji during a live video-conference from Nairobi on July 12.
As part of the 2011 Maternal Health Dialogue Series the Woodrow Wilson Center’s Global Health Initiative is partnering with the African Population and Health Research Center to convene a series of technical meetings on improving maternal health in Kenya. The 20 Kenyan experts attending the workshop in Nairobi also shared their strategies and action points with a live audience in Washington, DC during a video conference discussion. [Video Below]
Osaaji was joined by panelists Lawrence Ikamari, director of Population Studies and Research Institute (PSRI), and Catherine Kyobutungi, director of Health Systems and Challenges at the African Population and Research Center to discuss new maternal health research in Kenya. Panelists also shared recommendations for moving the maternal health agenda forward that came out of discussions during the two-day, in-country workshop with Kenyan policymakers, community health workers, program managers, media, and donors. Following the panelists’ presentations, Dr. Nahed Mattta, senior maternal and newborn health advisor at U.S. Agency for International Development (USAID) and John Townsend, vice-president of reproductive health program for Population Council provided reflecting remarks from the Woodrow Wilson Center during the live webcast.
Maternal Health Challenges in Rural Kenya
“Maternal mortality in rural Kenya is still very high,” said Ikamari. “Rural women in Kenya need to have increased access to maternal health services.” Ikamari discussed a number of factors that contribute to high rates of maternal mortality in rural Kenya, including lack of access to quality care and skilled birth attendants, the high burden of HIV/AIDS, and an unmet need for family planning.
Though nearly 90 percent of women in rural Kenya seek antenatal care, according to the UNFPA, many wait until the second or third trimester, limiting the benefits. Additionally, a majority of women in rural Kenya give birth outside of health facilities, oftentimes without the care of a skilled birth attendant, said Ikamari. In a recent survey, many rural women indicated that transportation to often distant health facilities prevented them from seeking adequate maternal health care, he added.
Additionally, “the burden of HIV is really felt in rural Kenya,” said Ikamari. Survey results show that HIV/AIDS prevalence is about seven percent in rural Kenya and because the majority of the Kenyan population lives in rural areas, this adds yet another layer of complications.
“Family planning saves lives,” said Ikamari, stressing the importance of contraception on maternal health outcomes. Only 35 to 40 percent of currently married Kenyan women use family planning, according to the last demographic and health surveys, and unmet need remains particularly high in rural areas. Promoting institutional delivery systems, improving antenatal and postnatal care, and finding other ways to increase access to family planning can help to improve maternal health outcomes and reduce preventable deaths in rural Kenya, concluded Ikamari.
Comparison of Urban and Rural Areas
“The interventions to address maternal health are well known: family planning, increased access to safe abortion services, skilled health workers, health facilities that are accessible, as well as referral systems that work,” said Kyobutungi. “Yet urban averages [of maternal mortality] are becoming either close or worse than rural averages.”
“As much as we appreciate the rural-urban divide that exists for most health indicators, the urban-urban divide (the fact that there are huge intra-urban differences) needs attention”
“Teenage pregnancy is a failure of family planning,” said Kyobutungi. Studies indicate that there are three times more teenagers that are pregnant among the urban poor, compared to the urban rich.
As in rural Kenya, access to quality health facilities and care is also limited in cities. “Health facilities are few and far between and the referral systems are weak,” said Kyobutungi, and “when you remove Nairobi from the numerator, the number of skilled physicians per population is in the decimals.”
Moving forward, there is a need to promote effective integration and improvement of health worker training and monitoring but also development of performance-based incentives to ensure successful programs are properly funded. “It’s not all gloom and doom in urban areas,” concluded Kyobutungi.
Innovative Ideas for Better Results
“By year 2025 there will be 25 percent more people [in Kenya],” said Townsend. “What that means is, when we are planning…we have to think about the scale of solutions that we are proposing in 2025 and 2050.” Therefore, it is essential to acquire new models of data and evidence to better predict future population growth and maternal needs, he suggested.
In addition to expanding services to meet the needs of a growing population, the panelists in Washington emphasized the need to support integration at all levels. Trends are moving in the right direction: Within the Obama administration’s Global Health Initiative, “there is a strong push and recommendation for integration among the health sectors,” said Matta.
But integration is not a magic bullet to improve maternal health, warned the panelists. “Integration is a terrific issue, but when the health sectors are weak, putting more burden on a local community health worker does not usually make sense; we have to think about smart integration,” said Townsend.
Focusing on Kenya’s health sector from all aspects, both at the private and public level, and improving family planning, institutional delivery care, as well as antennal care will help Kenya overcome its maternal health barriers. Additionally, thinking of ways to utilize new models of data and integrating the various sectors will yield substantial benefits, concluded Matta and Townsend.
Following the technical meeting, a public dialogue was held on July 13 in Nairobi to share the recommendations and knowledge gaps identified with members of Kenya’s Parliament, including Hon. Sofia Abdi, parliamentary health committee member; Hon. Ekwee Ethuro, chair of the parliamentary network for population and development; and Hon. Jackson Kiptanui. They joined a group of more than 50 maternal health experts, program managers, members of the media, and donors – such as the UK Department for International Development (DFID) – to identify real solutions and action points for improving maternal health in Kenya.
The formal report from the in-country technical meeting will be available in the near future.
See also the Maternal Health Task Force’s coverage of the event, here and here.
Sources: Kenya National Bureau of Statistics, UNFPA.
Photo Credit: Jonathan Odhong, African Population and Health Research Center. -
Emily Puckart, MHTF Blog
Maternal Health in Kenya From a Human Rights Perspective
›The original version of this article, by Emily Puckart, appeared on the Maternal Health Task Force blog. This is the second post about MHTF and the Woodrow Wilson Center’s trip to Nairobi, Kenya to host a cross-Atlantic web-cast meeting on “Maternal Health Challenges in Kenya: What New Research Shows.” The first is available here along with video of the conference.
“Do you want to be a pregnant woman or a prisoner in Kenya?” asked Dr. Margret Meme, one of speakers in Nairobi at the recent policy dialogue “Maternal Health Challenges in Kenya: What New Research Shows.” She explained that the last prisoner killed in Kenya through capital punishment was over 20 years ago, yet pregnant women continue to die of treatable causes not just in Kenya, but globally.
As Dr. Meme addressed maternal health through the lens of a human rights perspective she highlighted a number of recommendations in order to more adequately address maternal health challenges in Kenya. She was concerned that pregnancy was treated more like a medical disease with purely medical solutions. Dr. Meme urged maternal health advocates to also focus on the cultural, social, gender, and economic factors that influence maternal health and asked that these factors be addressed along with medical solutions in order to truly address maternal health challenges.
Naturally, addressing maternal health challenges can come with a monetary price. However, instead of viewing that cost as a cost that must come after more immediate government priorities such as infrastructure and defense, Dr. Meme argued that cost should be borne as the government would bear any other cost for public goods. As pregnancy builds a nation, Dr. Meme argued that maternal health is a public good, in the same vein as defense. Therefore maternal health should have a budget allocation that is just as important as the budget line for defense.
Of course, pushing for more public funding of maternal health can lead to other complications. If advocates successfully encourage politicians to increase funding for maternal health programs, the work of maternal health advocates cannot simply end there. Advocates should hold governments accountable; not just in putting aside funding for maternal health, but also for actually making sure that the money reaches the intended beneficiaries. Therefore budget accountability tracking mechanisms should go hand and hand with pushing for increased public funding to maternal health programs.
Finally, Dr. Meme addressed the need for men to be more involved in maternal health. As she clearly stated; the role of men in maternal health shouldn’t stop at conception. Men focused programs which clarify reproductive and sexual health rights, as well as educate men on issues of maternal mortality and morbidity should encourage men to respect the rights of women to space their pregnancies and deliver their babies safely.
Emily Puckart is a senior program assistant for the Maternal Health Task Force (MHTF).
Photo Credit: Jonathan Odhong, African Population and Health Research Center. -
Farahnaz Zahidi Moazzam on the Population Reference Bureau’s “Women’s Edition” Trip to Ethiopia
›The original version of this article, by Farahnaz Zahidi Moazzam, appeared on the Population Reference Bureau’s Behind the Numbers blog.My name is Farahnaz Zahidi Moazzam, and I’m a freelance journalist, writer, and editor from Pakistan. My passion is writing about human rights with a special focus on gender issues and reproductive health. Blogging is a personal joy to me, as I put my heart into my writing and blogging allows for a more personalized style. Digital journalism is a sign of evolution – one I happily accept. My pet peeve is marginalization on any grounds. I am a mother of a teenage daughter and live in Karachi.
As part of the Population Reference Bureau’s (PRB) group of journalists in Women’s Edition 2010-2012, I recently had the chance to travel to Ethiopia on a visit that was unforgettable. The visit inspired a series of seven brief travel-blogs, based on my seven days there. Women’s Edition is a wonderful opportunity to connect with other like-minded female journalists from developing countries around the world, and learn solutions to the problems from this interaction. The program has reaffirmed my belief that our commonalities are more than the differences.
Read Farahnaz Zahidi Moazzam’s posts from her trip to Ethiopia on her blog, Impassioned Ramblings, and view photos from the trip on PRB’s Facebook page.
Photo Credit: PRB. -
Robert Jenkins, OpenDemocracy.net
Women, Food Security, and Peacebuilding: From Gender Essentialism To Market Fundamentalism
›July 5, 2011 // By Wilson Center StaffThat women’s engagement in resolving and recovering from conflict is crucial to sustainable peace has been an article of faith, and an element of international law, since the UN Security Council passed Resolution 1325 in 2000. It took a decade of missed opportunities, however, for the UN to develop a systematic action plan for redeeming the promise of 1325. The September 2010 Report of the Secretary-General on women’s participation in peacebuilding contains a concrete set of commitments for UN actors working in post-conflict settings.
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Watch ‘Dialogue’ TV on the Future of Women and the Arab Spring
›This week on Dialogue, host John Milewski discusses the role that women played in the Arab Spring and how these roles might evolve in the coming months and years with the enormous political changes sweeping the region. He is joined by Moushira Khattab, Lilia Labidi, and Haleh Esfandiari. [Video Below]
Moushira Khattab is a human rights activist who formerly served as Minister of Family and Population for Egypt. She also served as Assistant Minister of Foreign Affairs, Vice Chair of the UN Committee on the Rights of the Child, and was Egypt’s ambassador to South Africa during the Mandela era. Lilia Labidi is an anthropologist and professor at the University of Tunis who currently serves as Minister of Women’s Affairs in the Republic of Tunisia. Previously she was a visiting professor at the American University in Cairo and a fellow at the Wilson Center. Haleh Esfandiari is author of the book, My Prison My Home: One Women’s Story of Captivity in Iran. Haleh serves as the director of the Wilson Center’s Middle East Program.
Dialogue is an award-winning co-production of the Woodrow Wilson International Center for Scholars and MHz Networks that explores the world of ideas through conversations with renowned public figures, scholars, journalists, and authors. The show is also available throughout the United States on MHz Networks, via broadcast and cable affiliates, as well as via DirecTV and WorldTV (G19) satellite.
Find out where to watch Dialogue where you live via MHz Networks. You can send questions or comments on the program to dialogue@wilsoncenter.org. -
Women in Agriculture: Closing the Gender Gap for Development and World Hunger
›June 22, 2011 // By Kellie FurrProviding women with equal access to productive resources and opportunities may be the key to bolstering the struggling global agricultural sector and feeding communities living in extreme hunger, according to the UN Food and Agriculture Organization’s (FAO) latest State of Food and Agriculture report, which this year is sub-titled, “Women in Agriculture: Closing the Gender Gap for Development.”
“Women are farmers, workers, and entrepreneurs, but almost everywhere they face more severe constraints than men in accessing productive resources, markets, and services,” write the authors. “This ‘gender gap’ hinders their productivity and reduces their contributions to the agriculture sector and to the achievement of broader economic and social development goals.”
Barriers to Productivity
Globally, women comprise 43 percent of the agricultural labor force, ranging from 20 percent in Latin America to 50 percent in southeastern and eastern Asia and sub-Saharan Africa, according to the report. But despite their significant global presence, female farmers face gender-specific constraints that hinder access to productive resources, financial support, information, and services required to be viable and competitive. “The yield gap between men and women averages around 20 to 30 percent, and most research finds that the gap is due to differences in resource use,” write the authors.
Generally, women are more likely than men to hold lower-wage, part-time, or seasonal positions and tend to get paid less even when they are more qualified. Furthermore, domestic and occupational lines are blurred for women, who are often not compensated for work that is closely related to domestic food preparation. Most significantly for agricultural productivity, women across the developing world often lack access to quality land, sometimes being barred from land ownership. This ban precludes female farmers from exercising managerial discretion over farming activities, such as entering contract farming agreements. Women also generally own less livestock and contract for less labor – two crucial assets for marketable agricultural production in many developing countries. Moreover, because of insufficient land and resources, women farmers are also more vulnerable to climate shocks.
Resource barriers for female farmers extend to education, finance, and technology as well. The authors observe that “female household heads in rural areas are disadvantaged with respect to human capital accumulation in most developing countries, regardless of region or level of economic development,” which represents a historical bias against females in education. Despite notable success observed in finance projects involving female farmers, gender bias exists in the financial system, which prevents women from bearing initial financial risk in order to increase long-term productivity gains. Sources of gender bias in the financial sector include legal barriers, cultural norms, lack of collateral, and institutional discrimination by public and private lenders. Due to the aforementioned lack of credit, labor, and education, women farmers are deficient in all aspects of technology, such as the acquisition of new equipment, information about new seed varietals and animal breeds, pest control measures, and management techniques.
Global Implications
Closing the gender gap could have profound implications for easing world hunger. According to the FAO, approximately 925 million people are currently undernourished, most of whom live in developing countries. If women were given all the inputs and support as men, agricultural output could increase by 2.5 to 4 percent in developing countries, potentially reducing the world’s hungry by 100 to 150 million people. “This report clearly confirms that the Millennium Development Goals on gender equality (MDG 3) and poverty and food security (MDG 1) are mutually reinforcing,” FAO Director-General Jacques Diouf argues in his introductory remarks.
Increasing the economic viability of women farmers may also translate into better infant and child health indicators – when women control additional income, they tend to allocate more of their earnings toward the health and well-being of their children. Closing the agricultural gap is “a proven strategy for enhancing the food security, nutrition, education, and health of children,” Diouf asserted. “Better fed, healthier children learn better and become more productive citizens. The benefits would span generations and pay large dividends in the future.”
Finally, the FAO notes that in addition to reducing child mortality rates, increasing female education and economic prosperity helps lower fertility rates, which over time increases human capital and can help drive a demographic transition towards lower dependency rates and higher per capita growth.
Closing the Gender Gap
“The conclusions are clear,” write the authors:1) Gender equality is good for agriculture, food security, and society; and
Though they note that “no simple ‘blueprint’ exists for achieving gender equality in agriculture,” the authors do recommend some basic principles to the development community, including working towards eliminating discrimination against women under the law, strengthening rural institutions and making them gender-aware, freeing women for more rewarding and productive activities, building the human capital of women and girls, bundling interventions, improving the collection and analysis of sex-disaggregated data, and making gender-aware agricultural policy decisions.
2) Governments, civil society, the private sector and individuals, working together, can support gender equality in agriculture and rural areas
Recognizing that “women will be a pivotal force behind achieving a food secure world,” the U.S. Agency for International Development (USAID) has actually launched initiatives aimed directly at closing the gender gap. The Feed the Future initiative, announced last spring, includes a heavy focus on gender equity and integration with small-scale farming initiatives. For example, the Office of Women in Development is supporting a three-year project in Liberia, “Integrated Agriculture for Women’s Empowerment,” that aims to train and support 1,500 small farmers in Lofa county, two-thirds of whom are women. And in Rwanda, USAID helped the Ministry of Agriculture and Animal Resources – headed by Dr. Agnes Kalibata – develop a national investment plan, which has been successful in bringing in donor support.
However, the FAO report does not offer specific feedback on programs like Feed the Future, which is arguably a crucial component of a truly comprehensive assessment on the current state of agriculture. Though they write that the State of Food Agriculture series is intended to simply be “science-based assessments of important issues,” the infancy of these food security efforts and the immediacy of the problems examined (see recent food price instability) creates an excellent opportunity for critical input. “Women in Agriculture” offers perhaps the most comprehensive report on the gender gap and development to date, but more specific critiques on the current efforts of USAID and others might make more of an impact in a field where the issues at play have been fairly clearly enumerated many times before.
Sources: Food and Agriculture Organization, The Hunger Project, International Fund for Agricultural Development, Population Action International, USAID.
Photo Credit: Adapted from “Ngurumo Village-Ntakira (Kenya),” courtesy of flickr user CGIAR Climate. -
The Future of Women in the MENA Region: A Tunisian and Egyptian Perspective
›Lilia Labidi, minister of women’s affairs for the Republic of Tunisia and former Wilson Center fellow, joined Moushira Khattab, former minister of family and population for Egypt, on June 2 at the Wilson Center to discuss the role and expectations of women in the Egyptian and Tunisian revolutions, as well as issues to consider as these two countries move forward. Haleh Esfandiari, director of the Middle East Program at the Wilson Center, moderated the event.
Labidi focused on the participation of women in the protests in Tunisia and their aftermath. She emphasized that these developments give hope, as they attest to the mixed nature of the demonstrations in which women were not sidelined but marched amongst men. (Editor’s note: The gender balance of the protests was a feature demographer Richard Cincotta also observed in his post about Tunisia’s age structure.) She pointed to the way that Tunisian women have entered the public space and played vital roles in spreading images and information about the protests around the world. Labidi said that although the future of women in Tunisia remains uncertain, it is unlikely that they will cease to be active and retreat to the private sphere. She commented on the new parity resolution calling for an equal number of male and female candidates for each party in Tunisia’s July elections and the opportunities afforded by an increase in political pluralism and media outlets.
Labidi also elaborated on her efforts as Tunisia’s minister of women’s affairs, discussing the ministry’s results and future goals. She stressed the importance of aiding women living in poverty, changing the cultural role of women, and boosting confidence in the government’s ability to address women’s needs. In particular, Labidi spoke of the work to expand the ministry’s regional offices to become more accessible to rural and non-elite sectors of Tunisian society. She hoped that recent events will encourage recognition of women as regional political actors and that the United States will expand intellectual and political ties with Tunisia.
Khattab pointed out the numerous similarities between the role of women in Tunisia and in Egypt, saying that women’s participation in public demonstrations and disseminating information to the media “has set the stage for a paradigm shift in the rights of citizens.” She noted that there are many advances yet to be made for women, youth, and other groups but that the protests have begun a change towards “a democratic, rights-based Egypt.”
Although she sees women’s involvement as a part of continuing progress in women’s rights, Khattab made note of the various obstacles to freedom that women in Egypt still face. She expressed concern that the politics of revenge against the previous regime might sideline women in politics, who already have less representation in the government than they did under Mubarak and have been excluded from the committee drawing up a new Egyptian constitution. She noted the need to change social perceptions that “women already enjoy all their rights.” She also discussed how the new media freedom gives fundamentalist groups a platform to propagate narrow interpretations of faith that call for the repeal of some of the existing women’s rights laws. She posed the question of what interpretations of the faith would allow for a greater harmonization with domestic laws based on the ideals of human rights.
Laura Rostad is an intern with the Middle East Program at the Woodrow Wilson Center.
Photo Credit: David Hawxhurst/Wilson Center. -
Yemen Beyond the Headlines: Women’s Health and Well-Being, Foundations of a Fragile State
›Part one of the “Yemen Beyond the Headlines: Population, Health, Natural Resources, and Institutions” event, held at the Wilson Center on May 18.
“Ultimately, whether Yemen is able to achieve its goals for social and economic development, will to a large extent depend on its future population growth and size,” said Gary Cook, senior health advisor at the U.S. Agency for International Development, in his opening address on Yemen’s population and development challenges at the Woodrow Wilson Center. [Video Below]
Cook was joined on the opening panel of the all-day conference, “Yemen Behind the Headlines: Population, Health, Natural Resources, and Institutions,” by Dalia Al-Eryani, former project officer for Pathfinder International’s Safe Age of Marriage Project, and T.S. Sunil, professor of sociology at the University of Texas San Antonio, to discuss issues related to population, reproductive health, and child marriage. Drawing speakers and participants form the Middle East, Europe, and the United States, the conference was part of the Wilson Center’s HELPS Project, a multi-year effort to deepen understanding of links among health, environment, livelihoods, population and security.
Yemen’s Population and Development Challenges
Since 1950, the population of Yemen has increased from 4.3 million to 24 million, with an annual population growth rate above three percent, Cook said. High fertility drives Yemen’s rapid population growth, with an average total fertility rate (TFR) of 5.5 births per woman. Rates are even higher in rural areas and among women with limited or no education, he said.
Future population growth will have tremendous impacts on the country’s economy, education, health, and natural resources, said Cook, and “there is a very large gap between the high fertility assumption and the low fertility assumption.”
An additional 1.5 million new people will be added to the labor force and 29 percent less income per person will drop by 29 percent by 2035 if current fertility rates persist, said Cook. Though Yemen has a national population policy that outlines TFR targets of 3.3 in 2025 and 2.1 by 2035, the latest UN Population Division projections suggest these expectations are optimistic. Education and health demands and expenditures will increase greatly, while per capita arable land and water will decrease, exacerbating ongoing land and water scarcity in Yemen.
“We do not have enough local and external resources to address the needs of a rapidly expanding population,” said Cook. “Helping couples who want to limit and space their births will also help the nation,” he added.
Law, Culture, and Child Marriage
“Enforced by law and culture alike,” early marriage in Yemen is common, said Al-Eryani, with over 50 percent of Yemeni women married before they are 17 years old, and 14 percent before they turn 14. Opponents of child marriage argue that children are neither emotionally nor physically ready for marriage and that the practice increases health risks and lowers educational opportunities for girls.
Currently, Yemen has no minimum age for marriage law, and recent attempts to pass such a law have failed, said Al-Eryani. “The practice never really has been questioned.”
“There is a belief that child marriage is a good thing – both for the girl and for the family,” she said. Early marriages are a way to build family honor and tribal ties, and many poor families see opportunity for financial gain in the form of a dowry. “These families see no socially acceptable alternatives for the girl…and all of this is supported by the belief that Islam condones child marriage,” she said.
Through awareness sessions, health fairs, and school plays, the community-based Safe Age of Marriage Project has helped to change social norms around child marriage in two districts in Yemen.
After participating in the program, community members were significantly more likely to believe that delaying marriage gives girls more educational opportunities, empowers them to make decisions, and promotes healthy pregnancy and children, Al-Eryani said. Child marriage was banned in one of the communities, and the marriages of 53 girls and 26 boys were canceled as the result of the project. In the future, she hopes involving more religious and local leaders could further increase the program’s impact.
Youth and “The Reproductive Health Transition”
“When we talk about fertility transition, we only talk about the number of children born,” said Sunil. “A reproductive health transition takes into account not just total fertility rate, but a number of different dimensions.”
Women should have the freedom to decide if, when, and how often to reproduce, said Sunil, through access to safe, effective, affordable, and acceptable family planning methods. They also should have access to quality maternal health care throughout pregnancy and birth, he said.
“It’s a popular belief that Islamic societies with poor and limited resources are not compatible with a reproductive health transition,” said Sunil. “But the onset of a reproductive health transition is underway in Yemen.”
While the transition in Yemen is progressing more slowly than in other countries in the region, many positive trends can be seen among the country’s youth, said Sunil. Trends indicate a drop in fertility rates, especially among younger women; marriage of girls under 15 years old has declined; and contraceptive use among young women age 15 to 24 has increased significantly.
Government and international donor agencies “must capture the growing momentum among the younger cohort” and meet demands for better education, postponement of marriage, and healthcare services, said Sunil. Continued focus on adolescent reproductive health will be the key to achieving the reproductive health transition, he concluded. “From an economic and human perspective, the growing young population in Yemen is potentially a tremendous asset.”
See parts two and three of “Yemen Beyond the Headlines: Population, Health, Natural Resources, and Institutions” for more from this Wilson Center event.
Sources: Population Reference Bureau, UNICEF, U.S. Agency for International Development.
Image Credit: “Young girl with her mom – Sanaa,” courtesy of flickr user fveronsei1.
