News Review – 20 October 2017

by admin · Published October 20, 2017 · Updated January 9, 2018

Worlds apart: Reproductive health and rights in an age of inequality

The comprehensive UNFPA State of World Population 2017 report has detailed information about how gender inequality, and specifically denial of reproductive rights, “threatens social stability” and “development”.

UNFPA’s executive director Natalia Kanem summed it up this way: “Inequality today is not only about the haves and have nots … (it) is increasingly about the cans and cannots… Poor women who lack the means to make their own decisions about family size or who are in poor health because of inadequate reproductive health care dominate the ranks of the cannots”

Another article noted, “Last year, the McKinsey Global Institute calculated that achieving the economic potential of women will require up to $2tn in incremental annual spending on essential services in 2025. But the economic gains could be six to eight times the outlay. McKinsey said $12tn could be added to the global economy by 2025 if women had equal opportunities in the labour markets… Achieving this will require universal access to family planning, increasing school attendance, ending female genital mutilation and child marriage, and providing decent childcare, said Kanem. The UNFPA estimates that limited access to family planning translates into 89m unintended pregnancies and 48m abortions in poorer countries each year, which can limit women’s future ambitions.” Kanem also called for “moral leadership” in the family planning sector.

This week’s news review is structured around five of the report’s “ten actions for a more equal world.”

Meet all commitments and obligations to human rights agreed in international treaties and conventions

Madagascar’s Senate is set to debate legislation that would modernize a family planning law that dates back to 1920 and prohibits the promotion of contraception. South Sudan ratified the Maputo Protocol, which guarantees comprehensive rights to women, though it did so with some reservations about clauses relating to abortion, polygamy, and contraception. Legislators from the Pan African Parliament urged all Maputo signatories comply and harmonize their abortion laws, to “safeguard reproductive health rights of women by permitting abortion in cases of sexual assault or where pregnancy poses a risk to the physical or mental health of a woman.” The same PAP congress saw South Africa commit to strengthen its safe and legal abortion implementation.

As Hilary Clinton famously emphasized, “Women’s rights are human rights,” so perhaps more women in leadership in global health will help. UN Women highlighted on International Day for the Eradication of Poverty how improving women’s rights and opportunities can lead to an end of poverty for all. Engender Health released its annual impact report, “The Power of She”, highlighting prevention of 1.4 million unsafe abortions, 38,174 fistula surgeries, SRHR training for more than 38-thousand individuals and increased modern contraception use (60% increase in Tanzania over the past decade). Though women’s rights remain “in crisis”, look out for “Wonder Girls” – girls leading local activism around the world, 90 of whom were featured in a new book. WHO updated its tool to monitor rights-based contraception programs.

Another basic right is the right not to be harassed, which received significant coverage with the #MeToo hashtag prompting women all over the world to share stories and demand an end to sexual predation. The movement “challenges [the] taboo against admitting sexual abuse in Africa,” with a call from Phumzile Mlambo-Ngcuka, UN Under-Secretary-General and Executive Director of UN Women to bring “an end to the cruel privilege of impunity.” Can the moment turn into a movement? Some suggestions: bystander accountability, name and shame, stronger institutional polices, third-party reporting and outside investigation, include harassment in health and safety reviews, and, counter-intuitively, reward managers for increases in complaints – it shows trust in the system. A Harvard University report, The Talk: How Adults Can Promote Young People’s Healthy Relationships and Prevent Misogyny and Sexual Harassment, outlines six tips for parents for engaging in meaningful, constructive conversations.

Philanthropy Women examined the major non-profits fighting sexual assault, and their funders.

The World Economic Forum’s global gender gap index captures differences between men and women in accessing resources and opportunities, and “of the 142 countries the index covered in 2016, 68 had larger gender gaps than the previous year. Inequalities in access to sexual and reproductive health and rights undeniably contribute to these gaps.”

A week-long equality showcase in Rwanda was widely reported and well-attended.

Involvement in world bodies often encourages adherence to minimum standards. The Trump administration pulled out of UNESCO, “the agency that protects LGBT rights, education for girls, and world cultural sites,” which last week sponsored the International Day for the Eradication of Poverty.

Media outreach can be used to keep governments and institutions on board with family planning commitments. The stakes are high in abortion policy coverage, making it “hard to get right”. Pathfinder is spreading the word about reducing maternal mortality in northern Nigeria. Johns Hopkins Center for Communication Programs showcases examples of health communication in Uganda. Egypt, which wants to tackle overpopulation with a “two-child plan”, wonders if the power of cinema can help. In Liberia, one result of the Ebola outbreak was a radical increase in health reporting, so that now journalists are “forcing change”.

One proponent writing in The Conversation warns, though, that attitudes need to change about women who have had more than one abortion and remain stigmatized.

Tear down barriers that prevent young women from accessing sexual and reproductive health information and services

Malawi university students are demanding quality reproductive health services, as Senegalese youth “tackle sex taboos in a bid to boost contraceptive use.” Following rising cases of unplanned pregnancies among teenage girls, the Nigerian Urban Reproductive Health Initiative (NURHI) called for the inclusion of sexuality education in school curricula to help curb it. While some in Kenya are calling for “engaging youth in this healthy conversation,” others, at a Catholic school, were “alarmed” and accused Marie Stopes International of “administering birth control to secondary school students in Kitui without their parents’ consent.” The Ugandan Ministry of Health declined to endorse proposals to tackle teen pregnancy rates, with distribution of contraceptives to 15-year-olds branded an ‘erosion of morals’.

There’s a nice story about New York City kids “teaching the sex ed they never had.”

African First Ladies reaffirmed their commitment to work towards “securing, realization and extension of women’s rights as enshrined in the African policies through the State of the African Woman Campaign project.”

Reports of softening on restrictions come from Ireland and Northern Ireland, Samoa and Timor-Leste.

Of course, many barriers remain. A few examples this week: In Botswana, where the abortion rate is “way above the WHO guideline of 12%”, young women are turning to ulcer medication for abortions. In El Salvador, the abortion ban “has women fearful of miscarriage.” Polish women are winning some struggles but their rights are “still under threat.”

An editorial in The Lancet speaks of Decisions only she should make: “The health community can co-create sustained momentum to support each girl today to fulfil her full potential in life, free from objectification and fear. But only if we change the narrative to allow dreams of a future that are uniquely hers to decide.”

Contrary to that notion, the US government is attempting to prevent an undocumented teen from having an abortion, a case which is bouncing its way through the judicial system.

The “Unprecedented attack” on contraception access and abortion rights, “Tom Price’s Revenge”, continues, even opining that NAFTA led to increased abortion; and the analyses continue to show that restricted contraception access will lead to “Trump’s Abortion Surge.”

Other activity in the US: The Wisconsin legislature is considering a ban on state university professors or students from learning about or participating in abortion care, a move that will “destroy the OB-Gyn program.”

The fight continues. Current Planned Parenthood head Cecile Richards says she is seeing a progressive resurgence, though “It feels like we are back in the 1850s instead of 2017. The thought that the president of the United States and all of the people that he’s put in office, and the folks in Congress, are trying to take away birth control benefits for people is absolutely crazy.” Former PP president Faye Wattleton keeps fighting as the organization hits 101 years old, “I guess I’m not surprised, because I know that the opponents of this progression, and those who want to roll back the clock for women, are not willing to give up, because they believe themselves to be divinely anointed to do so. They believe that their values should be imposed through government on every woman.” (Locally in Michigan, PP had a record turnout for its Day of Action at the state capitol.) OB-Gyn’s including North Carolina OB-Gyn (and current president of the American College of Obstetrics and Gybecology) Haywood Brown, and Colorado’s Harvey Cohen, who practiced for 50 years, testify on the terrifying past and the current need for contraception access.

Reach the poorest women with essential, life-saving antenatal and maternal health care

Low use of family planning is one of the main factors in Kenya’s poor health indicators. UNFPA looks at Increasing Access to Sexual and Reproductive Health and Rights for Young Persons with Disabilities in East and Southern Africa. The Levels and Trends in Child Mortality 2017, released by the Inter-agency Group for Child Mortality Estimation (IGME) – comprised of the UN Children’s Fund (UNICEF), the World Health Organization (WHO), the World Bank and the Population Division in the UN Department for Economic and Social Affairs has grim data: “Despite the drop in under-five mortality rate, 7,000 newborns die every day.”

ODI has a useful briefing paper on “10 things to know about ‘leave no one behind’”, including overlapping inequalities amplifying the lack of opportunity.

Another technological innovation to give healthcare to deprived areas: a University of Michigan pediatrician is using tech to expand genetic counseling to Ethiopia, Ghana, using a software application he developed in conjunction with Ethiopian computer engineering students.

High-volume delivery comes through in an astonishing look at maternity care at one of the world’s busiest maternity wards in Manila.

Meet all unmet need for family planning, prioritizing women in the poorest 40 per cent of households

Some good news as USAID Launches $181 Million in Activities to Help Prevent Maternal and Child Deaths, yet at the same time the US is planning to drastically cut family planning aid around the world, including millions of dollars for Madagascar, where Marie Stopes International says “hundreds of thousands of women in this country of 25 million people will lose access to contraception… It will be a disaster.”

Kenya’s “Condom Queen” can be found in Nairobi’s slums most weekends, handing out male and female condoms and educating women on sexual health and their rights. Research in Kenya published in the journal Contraception found that “Two-thirds of postpartum women with a need for FP used effective contraception at 9-months postpartum, and use was associated with discussing FP during post-natal care,” leading to the conclusion that “integrating FP counseling in ante-natal and post-natal care could be an effective strategy to increase effective contraception use.” One way to get more condom use? Sell “custom-fit” condoms, which come in 60 sizes, in combinations of 10 lengths and nine circumferences.

Another study looking at women in Kenya, Rwanda, Tanzania and Uganda, in Reproductive Health, “shows that contraceptive use increased among young East African women, yet, unmet need remains high. As youth populations continue to grow, governments must develop more targeted strategies for expanding access to reproductive health services for young women. Engaging the private sector and task-shifting to lower-level providers offer promising approaches.”

Work towards measuring all dimensions of inequality and how they influence each other, and strengthen links between data and public policy

The Global Women’s Leadership Initiative and the Wilson Center launched a “groundbreaking index of women’s leadership”, which explores “ data through three pillars – pathways, positions and power – to understand the correlations between different variables, decisions and policies and how those decisions ultimately affect how much power women hold in public office.”

H3C updated its SBCC packages, including Family Planning and Reproductive Empowerment.

The Global State of Evidence on Interventions to Prevent Child Marriage was released by the Population Council.

As always, Guttmacher provides excellent information, this week on Abortion Is a Common Experience for U.S. Women, Despite Dramatic Declines in Rates, Overall Contraceptive Use in the United States Remained Steady from 2008 to 2014 and Contraceptive method use in the United States: Trends and characteristics between 2008, 2012 and 2014. UNFPA has guidance on assessing adolescent and youth-friendly health care delivery in the East and Southern Africa Region. WHO sets Programme reporting standards for sexual, reproductive, maternal, newborn, child and adolescent health.

The Thomson Reuters Foundation reported on indices which inform that Cairo is the “most dangerous megacity for women” (London is best), Kinshasa is the worst city for “get-ahead women”, and “teen pregnancy, backstreet abortions make Lima [the] worst megacity for women’s health.”

The One campaign research shows that 130 million girls worldwide fail to attend school every day of the year, and shames the ten worst countries for girls to get an education, nine of which are in sub-Saharan Africa. The National Institute for Reproductive Health ranked “The best and worst cities for reproductive care in the US” – top marks for Los Angeles, New York and San Francisco; avoid Jacksonville – and the Human Rights Campaign’s Municipal Equality Index (MEI), “a nationwide review of LGBT inclusivity in law, policy and services in more than 500 cities and towns across America has its own rankings. First the good news: A record 68 cities earned perfect scores for advancing LGBT-friendly policies and practices… On the other side of the spectrum, 11 cities scored zero points.”

Complete News Review References:

General/Global

Decisions only she should make, The Lancet, 21 Oct 2017

A Groundbreaking Index of Women’s Leadership GWLI/Wilson Center, 20 Oct 2017

#MeToo challenges taboo against admitting sexual abuse in Africa, Thomson Reuters Foundation, 20 Oct 2017

Good Men Should Not be Quiet Spectators: Is Shared Outcry Bringing an End to the Cruel Privilege of Impunity?, AllAfrica.com, 20 Oct 2017

7,000 newborns die every day, despite steady decrease in under-5 mortality, new report says. Every Woman Every Child, 20 Oct 2017

From #MeToo to Now What? 7 Actions That Could Actually Help Stop Sexual Harassment, Fortune, 20 Oct 2017

The NYC Teens Teaching the Sex Ed They Never Had, Broadly, 20 Oct 2017

Africa First Ladies commit to advocate for women’s sexual reproductive health rights, IPPF/IPPFAR, 20 Oct 2017

GMB report: Attitudes to abortion in Ireland are ‘softening’, Irish News, 20 Oct 2017

Court Puts A Hold On Order That Approved Undocumented Teen’s Abortion, NPR, 19 Oct 2017