By Kamayani Bali-Mahabal, Women Feature Service ( WFS)
The year 2015 has been set as the deadline for countries around the world to attain the ambitious Millennium Development Goals (MDGs). Of the eight goals, the only three that won’t be achieved are related to the well-being of women and children – promoting gender equality and empowerment of women (MDG Three), reducing child mortality (MDG Four) and improving maternal health (MDG Five).
Keeping in mind this need of the hour, at the recent Annual Global Health Conference, ‘Universities 2.0: Advancing the Global Health Agenda in the Post-MDG Era’, organised by the Consortium of Universities for Global Health (CUGH) at Washington, D.C., United States, women academics, activists and researchers from countries of the Global South brainstormed on ways to boost reproductive health care. ‘Women’s Voices and Solutions from the Global South’ was the only all-women panel at the conference, facilitated by The Network: Towards Unity For Health (The Network: TUFH) that comprises individuals, institutions and organisations committed to the cause of bettering social and health indicators. With a longstanding history of over 30 years, the Belgium-based network has played an important role in fostering community-oriented innovations, leading to curriculum reforms in education institutions around the world. Its Women’s Health Task Force (WHTF) has been specifically working to uplift the status of women, support the next generation of female health providers and increase awareness of gender inequity.
Apart from looking at reproductive health from within the rights framework, the panel shared some valuable observations and insights on key culturally-appropriate interventions and advocacy initiatives that have worked effectively in their countries. Prof. Judy Lewis, Professor Emeritus, Departments of Community Medicine and Pediatrics, University of Connecticut School of Medicine in the US, who moderated the discussion, addressed women’s health from a social justice perspective, emphasising that women are important not just as mothers but in all phases of life.
“This year the WHTF will publish the Third edition of the Women’s Health Learning Package (WHLP), modules on nine global women’s health topics, with country overviews and cases from the Global South,” she informed. The topics included are Gender and Health, Violence against Women, Adolescent Health, Safe Motherhood, Mental Health, Contraception, Unwanted Pregnancy and Unsafe Abortion, Nutrition and Cervical Cancer. “While these modules have been developed for health professionals, previous editions have demonstrated their usefulness in adaptation for community use,” she added.
Providing an overview of the status of reproductive rights in Mexico, Deyanira González de León Aguirre, Professor – Metropolitan Autonomous University, Department of Health Care, Mexico City, talked about abortion. Incidentally, in Mexico, a woman can go in for an abortion only if her life is in danger or in cases of rape or incest. Those who perform or undergo illegal abortions are subject to imprisonment of anywhere between six months and five years. Stated González de León, a pro-choice voice, “The legal context of abortion in Mexico has become extremely complex in the recent years. An aggressive conservative campaign to prevent states from legalising abortion has been in place since 2008. Of a total of 31 states in the country, 16 have passed constitutional reforms that grant embryos the right to life. Today, an unknown number of women are in jail and in most cases health professionals have played a central role in putting them there.”
Given that an estimated 500,000 women per year have illegal abortions in Mexico, and that unsafe abortions remain a serious cause of maternal mortality nationwide – as well as the fact that poor women are disproportionately burdened with the consequences of lack of access to safe, legal abortions – the struggle for the decriminalisation of abortion is central in the broader movement for women’s rights nationally.
Julie Hester, Senior Lecturer, School of Nursing at the University of Western Cape (UWC) Bellville, South Africa, while giving a historical overview, said that the UWC has “a proud history of creative struggle against apartheid, oppression and discrimination. It has been at the forefront of South Africa’s historic change, playing a distinctive academic role in helping to build an equitable and democratic society”. Since 2006, the School of Nursing has been the largest stakeholder in the Faculty of Community and Health Sciences at the university and has done some pivotal work on the subject of Gender Based Violence (GBV). In fact, its GBV curriculum was linked to the government’s Community Higher Education Service Partnership (CHESP) project from 2002 to 2005. During this phase, the school had become the regional leader in development of GBV modules in the nursing curriculum at both the undergraduate and postgraduate levels.
In the context of gender violence, Hester spoke about the vulnerabilities faced by nurses in South Africa, “They are experiencing physical threats, verbal abuse and psychological violence on a regular basis. But these women professionals tend to ‘normalise’ abusive patient behaviour simply because there is the perception that workplace abuse comes with the territory. This attitude has resulted in the under-reporting of such incidents. However, it is also a reality that the perpetrators receive compromised care as they are either avoided or ignored or given only minimal nursing care.” She underlined the fact that tolerance of non-physical violence and the absence of policies to deal with such violence contribute to under-reporting.
Dr Hiba Salih, a physician from North Sudan, who has worked for three years in post-conflict sites in South Sudan to improve maternal and child health, shared findings from a unique project that has transformed women’s lives. A bloody civil war that raged for 50 years, with the more developed north of the country pitted against the south, affected eight million people with an estimated two million killed and about four million displaced. Said Dr Salih, “In 2010, a group of motivated postgraduate students from the Reproductive and Child Health Research Unit (RCRU) at the University of Medical Sciences and Technologies (UMST) in Khartoum, Sudan, embarked upon a project in South Sudan, which has the highest rate of maternal mortality in the world – 2054 deaths per 100,000 live births. While in the past, health interventions had a top to bottom approach they inverted the pyramid and adopted a bottom-up strategy. The idea was to take local traditions and use them in untraditional ways in the advocacy for health.”
Today, women in South Sudan, who are the sole bread-earners for nearly 70 per cent of the households in the country, are more likely to die of complications during pregnancy or childbirth than to finish primary school. Added to this dismal reality is the fact that 62 per cent of the population is illiterate. So this dedicated team had to devise ways to really connect with the community in order to empower them. “To make this happen, 15 illiterate women from 15 different villages in the Upper Nile state were trained to identify the most important maternal health issues before the community and were taught how to create messages to address these problems using methods relevant to their cultures and daily lives. Through songs and pictures these women learnt to reach out to their people. By the end of the project, those 15 ended up teaching what they had learnt to more than 55 men and women from all over Upper Nile state,” elaborated Dr Salih.
The engaging discussion at the conference clearly flagged the fact that participatory research as well as the use of local communication tools in interventions related to maternal and child health can truly make a huge impact if the world has to save its mothers and in the process fulfil its MDG commitments.