Investing in women: a human rights approach

At Women Deliver, a message is extolled throughout the dozens of sessions, plenaries, panels and press conferences: “Invest in women and girls, it pays.” This simple message, however, has several layers of subtext. Many of the conference’s attendees are emphasizing the broader concepts that underpin it – one of the great takeaways of this conference, at least in my mind, is that it will take more than an additional $12 billion to ensure that women and girls around the world are able to fully realize their rights. Among these concepts, is the notion that women’s s rights are, first and foremost, human rights.

I listened to Mary Robinson, the former President of Ireland, former United Nations High Commissioner for Human Rights and current president of Realizing Rights: The Ethical Globalization Initiative,  speak about the importance of framing maternal health with a human rights approach. She eloquently articulated the need for a holistic human rights approach towards the issues affecting girls and women. Robinson noted that so much of what we talk about when we talk about improving maternal health and reproductive rights is related to broader, human rights issues: access to health care and family planning, nutrition, religious and cultural dimensions, discrimination, domestic violence, early childhood marriages, to name a few.

And indeed, there is a very strong case to be made for envisaging maternal health as a broader human rights issue. Ever since the 1994 United Nations International Conference on Population and Development in Cairo and the 1995 Fourth World Conference on Women in Beijing, women’s rights are being increasingly framed as human rights. This is critical because it can help circumvent the barrage of opposition typically put up by conservative groups. Religious leaders, right-leaning or traditional family-oriented groups have all at some point or another been antagonistic to the notion of women having control of their bodies and fertility.

I attended two panels today where this point was driven home very vividly. First, was the panel entitled “Delivering Solutions at the Margin: Reaching the Hard to Reach”. The conversation, which was moderated by Mary Robinson, featured several activists and advocates for women’s rights in vulnerable environments. One speaker, Martha Sanchez, who works for organizations advocating the rights of indigenous women in Central America and Mexico, spoke powerfully on this issue. She explained that issues related to indigenous women’s rights and maternal health were often circumscribed by structural discrimination and stigma. Dealing with this marginalization requires a holistic approach: you cannot look at maternal health in a silo: it belongs to a much broader picture of persistent inequity and unequal access.

In the same vein, Malika Saada Saar, president of the Rebecca Project for Human Rights,  spoke of the oft-forgotten American women who are not able to avail themselves of their rights. Specifically, Saar discussed the case of pregnant women in U.S. prisons who are shackled when they begin labor, and until after they deliver their baby. Often, these new mothers have to breastfeed their newborns while still shackled, and then have to deal with the trauma of having their children taken away from them and put into foster care. She spoke movingly about how this “drachonian practice” is, in effect, depriving women of their rights and is tantamount to “cruel and unusual punishment”, thus establishing the link between women’s rights, human rights and legal protection.

Fulfilling Millennium Development Goal 5 (reducing maternal mortality by three quarters and ensuring universal access to reproductive health) is not just an issue of financing programs that build clinics, train health workers, and provide services. It is an issue of fair, transparent, equal and indiscriminate access. Maternal health and reproductive rights are also fundamentally part of a broader narrative of respecting and promoting human rights. There are several international legal instruments which should, in theory, guarantee women’s rights.

The Convention on the Elimination of Discrimination Against Women (CEDAW) is one of those treaties which, in theory, were it fully enforced, would ensure (among other things) that women would have safe and equal access to health care. Regarding maternal health specifically, Article 12 of CEDAW states that”States Parties shall ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation.”

“Human rights are women’s rights and women’s rights are human rights” is the rallying call for those who advocate for a comprehensive approach that tackles the complex, multi-dimensional issue of maternal health and reproductive rights. In her concluding remarks at this afternoon’s panel, Mary Robinson spoke of the need to be proactive in dealing with the barriers that “dehumanize us.” She urged attendees to “go beyond the statistics”, to really look at whether people at the margins are being reached and their needs, addressed.

Poverty, inequality and discrimination are among some of the structural barriers that need to be done away with in order for not just MDG5 to be achieved, but also the full spectrum of women’s rights to be realized.

One in eight

From the NYT Lens blog, “Showcase: from birth, death“:

Standing in the only operating room in the only medical hospital in all of Guinea-Bissau, Marco Vernaschi watched a nurse take an unsterile needle out of her pocket and, without anesthetic, suture a woman’s vagina after a difficult childbirth. The woman screamed. Mr. Vernaschi took a photograph. Moments later, she was required to walk out of the filthy room and go home.

The slideshow is not recommended for the faint hearted.

Amnesty International released a report today, calling the alarming rates of maternal and child mortality in Sierra Leone a “human rights emergency”, as one in eight women risk dying during pregnancy or childbirth.

According to USAID:

“Both maternal and child mortality rates in West Africa are among the highest in the world where outdated clinical, social, and cultural norms create obstacles to quality maternity services. It is estimated that for every woman who dies as a result of childbirth, at least thirty others are severely incapacitated from fistulae, chronic pelvic pain, and infertility. Poor sanitation and nutrition, along with inefficient health service management, put young children at risk of easily preventable illnesses.”

Gordon Brown is slated to announce millions of dollars of new funding to provide “free healthcare for millions more women and children in the developing world.” I wonder if this promise will go to rest in the great graveyard of broken promises. “Throwing money (with many strings attached) at the problem” has been the rich country M.O., requiring governments – like Sierra Leone’s – to spend inordinate amounts of time and resources proving to donors they can manage aid transparently. It takes months, years, for countries to turn around their public sectors and make their public health delivery systems functional.

Meanwhile, one in eight women in Sierra Leone faces the risk of death for becoming a mother – so how do we solve the “emergency” part of this equation?

One possibility could be training midwives and other pregnancy and child birth attendants in areas where access to clinics and health centers is limited. Many NGOs and agencies have the capacity to deploy such programs in a matter of weeks — pending funding. Africare was implemeting such a program last year in Liberia. I am cautiously hopeful that a renewed commitment to solve issues affecting women will create the political space necessary for emergency interventions to complement longer-term, more systemic efforts at improving the state of maternal and child health in West Africa.

Donor fatigue for soap making

The Niapele Project‘s country director in Liberia, Megan Sullivan, often sends hilarious  email updates about her adventures navigating the intricacies of Liberian bureaucracy. With her permission, I’m posting the email she sent today about a meeting at the Ministry of Gender and Development (slightly edited, for privacy and clarity).

“So, yesterday afternoon was my second try at carrying [NDLR: carrying = Liberian way of saying “bringing someone”] Finda to the monthly women’s empowerment meeting at the Gender Ministry.  If you recall, we went last Wednesday of last month but it had secretly been converted to a memorial service for a deceased Min employee.

So it’s not setup at all like a dialogue of women NGO leaders as I had been explicitly told.  Instead, it was like a lecture where about 50 women gather to voice concerns and then receive a lecture on a topic of interest.

When the minutes from the late June meeting were passed around the tone of every meeting immediately became clear.

For example, under AOB [Any Other Business]:

  • Korpu from War Widows with One Leg Vocational School stated that the Ministry of Gender should empower the women of Liberia by giving them support.  But the GoL [Government of Liberia] is not supporting (ie funding) the women’s groups like they promised.
  • Annie from Good Lord Jesus Praise His Name Help Us and Save Us Tie and Dye expressed concern that the GoL is not supporting and empowering the women of Liberia and her organization needs supplies and the staff has not been paid.
  • Hawa from Bless Jesus who Died for Our Sins Hair Plaiting Academy mentioned – as she has mentioned at every monthly meeting since 2006 –  that she would like for the Ministry of Gender to please give her funding.
  • The women present decided to form their own committee to investigate how exactly they can better convey to the Ministry that they need some support.  Findings will be reported at the next meeting.

Ok, so I was a little loose in my interpretations but that’s TOTALLY the gist.  This next one, my fave, is a verbatim quote though:

“Rita Harper of the Women’s Empowerment for the Upliftment of Females in Liberia through Microloan said that she was promised rain boots by the Her Honorable Minister at this meeting and where are they?”
🙂

Approx 3:15 of the 1:00 (scheduled to begin) meeting we move past the prayer, greeting and reading of minutes and the surprisingly contentious voting on the acceptance of said minutes, and onto the main presentation of this month’s meeting.

Reproductive Rights.

Which is good and relevant but it doesn’t really help these women improve their businesses and you will see why the info was not incredibly helpful.

The guest speaker seemed like a bright, friendly successful Liberian woman in her late 50s (I would guess?) She has been at the Ministry of Health in the Division of Family Health for 30 years and recently became a consultant (or something) with the UNFPA for women’s health in Liberia.

Seems great to promote the importance of family planning within this demographic.  She starts off with some stats (no visible notes with her)

  • 983 Liberian women die during childbirth every SECOND (the crowd gasps)
  • 983 Liberian women out of every 1,312 die during child birth
  • you need to switch the type of birth control you use every 2 years or it will make you sterile
  • a woman loses half of all her ovaries by the time she is 18, so she should finish school right away so that she can start having babies by 19
  • The egg waits in the fallopian tube for the sperm to come and fertilize it (maybe thats correct, but it didnt sound it).

The women had a MILLION questions that were the equivalent of 7th grade sex ed in the US – which I guess is not totally shocking, but wow.  One man there said that he had done his own research at a hospital in Lofa County and 70% of the children in the hospital had HIV.  So he had the idea of asking the 70 % if they had been circumcised in the bush and then if they had used a clean blade.  Which led to huge discussion on FGM etc.

And back to birth control — is it true that if you have sex standing up you can’t get pregnant?  etc etc. One woman asked if there were different sizes of condoms, the guest expert said no, only one size.  The questioner said “but my friend has a man that it can’t fit”  Expert “he’s not trying hard enough.”

(I took detailed notes cause it was pretty amusing).

At the end Finda was like “So when do I talk about the work that Malaya does?” [NDLR: Malaya is the agricultural co-op The Niapele Project is sourcing food supplies from for our school nutrition program]

The words “business strategy” “planning” and others like that were never mentioned.

In other non useless details — the Director of Women’s Empowerment mentioned that women’s empowerment programs that make soap and tie dye need to move in a different direction so that women can build real skills.  (The Nike/Clinton Foundation has multimillion dollar project on vocational training like mechanics and engineering and nursing and stuff for women in LIB).  She said “there are no more grants for tie and dye.  The international community has donor fatigue for soap making.”  🙂

Maternal Health in Liberia (or lack thereof)

An alarming report from IRIN brushes a broad picture of the state of maternal health and child mortality in Liberia – reading reports such as these strengthens my belief that Liberian refugees in Buduburam might be better off not repatriating quite so quickly… Excerpt:

“New statistics showing an increase in maternal mortality since the end of Liberia’s civil war in 2003 have created alarm among health workers who say the country’s almost non-existent healthcare system is to blame […]The new results, which come from the Liberia Demographic and Health Survey (LDHS) for the years 2006 to 2007, show that deaths among infants and children under five years old have gone down since the last survey was conducted in 1999 to 2000. However maternal mortality has gone up by about 71 percent with 994 women dying for every 100,000 who give birth, compared to 580 out of every 100,000 women in the previous survey. Doctors say the most common cause of death is vaginal hemorrhaging following childbirth.”

The average maternal mortality rate for Sub-Saharan Africa is 900 deaths for 100,000 births, and the global rate reaches a staggering 400 deaths/100,000 births (in comparison, developed countries have a rate of 9 deaths/100,000 births). Liberia has a truly dismal rate – and what’s particularly shocking from this report is that it’s actually worse than it was during the war… (UNFPA Maternal Mortality Statistics)

Of course, maternal mortality figures are not the ultimate measurement of a country’s post-conflict reconstruction progress, but it is very indicative of the slow pace of change that Liberia is experiencing. Reading the most recent progress report of the UN Secretary-General on the UN Mission in Liberia (UNMIL), it’s very clear that the situation in Liberia is far from ideal.

“Liberia has become a generally stable country in a volatile sub-region. However, the prevailing peace is very fragile, and Liberia is still susceptible to lawlessness. The most immediate threats to sustained peace and stability in Liberia at this stage include increasing violent criminal activities, especially armed robbery and rape; the limited capacity of the security sector to curb violent crime; the weak justice system; the limited capacity of key national institutions to deliver on the promised peace dividend; the proliferation of disaffected groups such as unemployed ex-combatants, deactivated soldiers and police personnel, and elements from the dismantled irregular militias; economic insecurity, in particular youth unemployment; resurfacing ethnic and social cleavages; and the perception by some that the Government is not genuinely pursuing national reconciliation”

Thinking back to the women’s protest in Buduburam, this comforts me in the idea that local integration efforts for Liberian refugees in Ghana need to be further developed – it seems so obvious that Liberia does not have the capacity to absorb tens of thousands of returnees (even if they each have $1,000 in cash – which they won’t.) In fact, the Government of Liberia should communicate this to the refugee population, whether in Ghana or elsewhere. Life as a refugee is certainly difficult, but life in Liberia will probably be even harder – particularly for those who have been gone for a very long time, and who need to rebuild their entire livelihoods from the ground up.