UN Population Division, Department of Economic and Social Affairs,
with support from the UN Population Fund (UNFPA)
|
| UN Population Division, Department of Economic and Social Affairs, with support from the UN Population Fund (UNFPA) |
|
POPULI -- The UNFPA Magazine
Vol. 23, No. 1 -- March 1996
This is a text-only version of POPULI, a magazine published
quarterly by the United Nations Population Fund (UNFPA).
POPULI
UNFPA
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New York, NY 10017, USA.
Fax: (212) 557-6416
Editor-in-Chief: Stirling Scruggs
Editor: Abid Aslam
Contributing Editors: Alex Marshall, Hugh O'Haire
POPULI is available in print, free of charge, in English, French,
and Spanish. Copies may be obtained from your local UNFPA office or
United Nations Information Centre, or from the address above.
We welcome your views. Please address letters to the editor or e-
mail to <aslam@unfpa.org>.
We also welcome submissions. For our writers' guidelines, address
a letter to the editor or e-mail to <aslam@unfpa.org>.
Articles appearing in POPULI may be freely reproduced so long as
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provided to the editor. If you wish to adapt signed articles to
your needs, please contact us so we can put you in touch with the
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==========
CONTENT -- MARCH 1996
IN BRIEF -- News in brief.
NEWS -- Maternal mortality risks; Politics and female genital
mutilation; Quality of care etiquette; AIDS therapy research;
Female sterilization failures; The European Union and ICPD
implementation; Food and poverty; The Pope and the press.
FEATURES:
REACHING for a healthier future
by Elaine Eliah
Uganda's Sabiny people have made headlines for adhering strictly to
the tradition of genital excision as a rite of passage into
womanhood. Past attempts to enforce compliance with international
health and human rights norms merely provoked cultural indignation
and a resurgence in the practice. Where outsiders have failed, the
community itself is now bringing about change.
Bovine Blessings?
by Joke van Kampen
Uganda's Heifer Project was set up to bring independence and
prosperity to women and their families. A visit to a village brings
to life evaluation findings that the project's benefits must be
weighed against the demands it places on participants: Women may
hold up half the sky, but they have to bear the burden of the whole
cow.
VIEWPOINTS:
The need to know
Some 2.5 million Filipinos aged 15-24 have had premarital sex. some
1.8 million do not use contraceptives. Yet, 1.67 million say they
are unwilling or unprepared to become parents. Like it or not, they
need information about sex and contraception, write Corazon M.
Raymundo, Eliseo A. de Guzman, Gilda Salvacion A. Diaz & Clarinda
R. Lusterio of the University of the Philippines Population
Institute. That information better be reliable.
RESOURCES -- Publications, products, and prospects.
NOTEBOOK -- Environmental sins and wins.
=====
> IN BRIEF
Population Award Winners
Senator Leticia Ramos-Shahani of the Philippines and the United
States-based non-governmental organization Pathfinder International
will share this year's United Nations Population Award. The
announcement was made last month by Award Committee chair Julio
Armando Martini Herrera, Permanent Representative of Guatemala to
the UN. Senator Shahani was chosen for her more than 30 years'
leadership in the field of population. In 1988, she spearheaded the
establishment of the Philippine Legislators Committee on Population
and Development. She sponsored the Shahani Bill, intended to
strengthen the country's new population policy and Commission on
Population. She has been widely credited with helping shape the
population policies of President Fidel V. Ramos. She is a member of
the Asian Forum of Parliamentarians on Population and Development,
the Global Committee of Parliamentarians on Population and
Development, and the International Green Cross. She has also served
in the UN and was Secretary-General of the World Conference to
Review and Appraise the United Nations Decade for Women, held in
Nairobi in 1985. Founded in 1957, Pathfinder International has
provided funds, contraceptive supplies, and technical assistance in
developing countries long before the US government began supporting
population programmes. Twenty-nine family planning associations
have been launched with grants from Pathfinder. It has supported
more than 2,000 initiatives in more than 30 countries including
training programmes and integrated family planning, HIV/AIDS, and
sexually transmitted disease prevention programmes. In several
instances, Pathfinder raised private funds to sustain national
programmes when official foreign assistance was unavailable.
The 1996 Population Award laureates will each receive a diploma, a
gold medal, and a monetary prize of US$12,500. The Award is
presented annually by the Committee of the United Nations
Population Award, which this year reviewed the nominations of 16
individuals and eight institutions. The Committee's current members
are: Belarus, Burundi, Cameroon, El Salvador, Guatemala, India,
Japan, the Netherlands, the Philippines, and Zaire.
'Warped' slavery increasing
"Prostitution has become a warped form of slavery," Ivanka Corti,
chair of the UN committee to eliminate violence against women, this
month told a meeting sponsored by UNESCO, the UN Educational,
Scientific and Cultural Organization. Participants in the Paris
meeting on violence against women shared evidence that sexual
exploitation is a "booming" industry -- the "third biggest
international trade commodity after drugs and arms," according to
Asuncion Miura, head of women's affairs for the regional government
of Madrid, Spain. The last few years have seen "an enormous
increase in prostitution, trafficking of women and children for
sex," Janice Raymond of the University of Massachusetts was quoted
as saying by Agence France Presse. Raymond said the problem
"extending freely in countries opening to market economies" such as
Viet Nam and Cuba. Participants said that the huge sums of money
generated by prostitution -- not only for pimps but for hotels,
travel agencies, and the rest of the sex tourism industry -- make
the problem very difficult to tackle. According to Raymond, who
denounced the "unquestioned acceptance of this industry,"
prostitution knows "no borders" and is recruiting "younger and
younger girls," many of whom have already been traumatized by
sexual violence. In the United States, Raymond said, 85 per cent of
prostitutes had suffered sexual abuse. In Spain, according to
Miura, the figure is 95 per cent.
'Don't go wild'
"Don't go wild just because the fasting month will end soon." With
those words, addressed last month to crowds at a Jakarta railway
station, Indonesian State Minister of Population Haryono Suyono
kicked off a family planning campaign for the holidays marking the
end of Ramadan, the Muslim month of fasting and abstention from
bodily pleasures such as sex. Under the campaign, condoms and other
contraceptives were made available at railway and bus stations, at
no or subsidized cost, to the millions leaving the capital for
[Idul Fitri] festivities in their home villages, according to the
[Jakarta Post]. More than three million people take part in the
annual exodus.
Widows' village for Women's Day
The Rwandan government's slogan for International Women's Day -- 8
March -- is [Chaque femme a un toit] ("Every woman has a roof over
her head"). To keep its pledge, it is building a "widows' village"
on the site of a village razed during civil war in 1994. Located 10
kilometres from the capital, Kigali, it is to be called Nelson
Mandela Village in recognition of the South African president's
peace-making efforts. There, according to Radio Rwanda reports
monitored by Agence France Presse, widows will devote their time to
caring for children orphaned during the war. Prime Minister
Pierre-Celestin Rwigema is calling on all Rwandan women to help in
the country's reconstruction, and urged those who were educated to
aid their less fortunate sisters, saying that they were victims of
cultural traditions which enshrined masculine dominance. He also
committed the government to examining changes in women's
conditions. The Association of Rwandan Women meanwhile asked a
visiting delegation of ecumenical women to urge their governments
to return emigres accused of genocide during the war so they can
stand trial before an international tribunal to be based in
Tanzania.
The law's no bar
Laws banning abortion are ineffective at preventing abortions, most
of which -- by virtue of being illegal -- are performed under
unsafe conditions, according to the latest report from the United
Nations Population Division. Latin America has among the world's
most restrictive abortion laws. Yet, "with an estimated 4.6 million
unsafe abortions performed each year, the region has the highest
abortion rate in the world," according to the report, [World
Population Monitoring 1996]. There are some 41 unsafe abortions for
every 1,000 women of childbearing age in Latin America and the
Caribbean, compared to two per 1,000 in Europe, 12 per 1,000 in
Asia, 26 per 1,000 in Africa, and 30 per 1,000 in the former Soviet
Union. Figures are not available for the United States, Canada, and
Mexico. The figure for Africa may be lower than the reality because
of underreporting. Eight of the 33 countries in Latin America and
the Caribbean permit abortion only to save the mother's life. But
the law's no bar. For example, Argentina generally prohibits
abortion. But the study estimates that Argentine women undergo one
abortion for every two live births, giving the country one of the
highest abortion rates in the world. Few illegal abortion cases are
prosecuted, however, because the state must show legal proof of
pregnancy before filing a charge. "It is estimated that a similar
rate of abortions to live births exists in Chile, where abortion is
strictly prohibited," according to a preliminary, unedited version
of the report. "The rising incidence of clandestine abortion has,
in part, been attributed to reductions in health service staff,
particularly midwives, who had been providing the bulk of family
planning services. In both countries, studies have indicated that
complications from unsafe abortion accounted for about 40 per cent
of maternal deaths." In Brazil, where abortion is permitted only in
cases of rape or to save the woman's life, many pregnant women
induce abortion with misoprostol, a drug used to treat gastric
ulcers. "Misuse of the drug has been blamed on inadequate knowledge
of and access to family planning services, the illegality of
abortion, and lax controls on the distribution of prescription
drugs," the report says. By contrast, in Cuba "abortion is
available on request and free of charge, as is the case with all
health care services." The incidence of unsafe abortions is lower
there, but the government considers the current rate of 50 to 60
abortions per 1,000 pregnancies excessive and attributes it to a
shortage of contraceptives. "One of the government's objectives is
to improve national contraceptive technology, in order to achieve
self-sufficiency in the manufacture of oral contraceptives and to
broaden the mix of contraceptive methods through the provision of
intrauterine devices and injectables," the report states. It
defines unsafe abortion as "a procedure for terminating an unwanted
pregnancy either by persons lacking the necessary skills or in an
environment lacking the minimal medical standards or both." The
same definition was used in the Programme of Action of the 1994
International Conference on Population and Development (ICPD).
Asylum restrictions
The number of requests for asylum recorded in the European Union
continues to decrease, according to initial figures for 1995
published last month by Eurostat, the EU's statistical office, in
cooperation with the Secretariat of the Intergovernmental
Consultations on Asylum, Refugee and Migration Policies. The
decrease has been gradual since 1992, a record year with 674,000
requests, compared to 305,000 in 1994. The reduction is mainly due
to restrictive legislation adopted by most EU member states. "The
streamlining of procedures and a restriction of rights have led to
a reduction of waiting periods and probably served as a deterrent
to potential asylum seekers," according to the report, [Asylum
Seekers in Europe 1985-1995]. Since 1990, more requests have come
from European third countries than from any other region of the
world, and the former Yugoslavia heads the list of asylum seekers'
countries of origin.
=====
> NEWS
Maternity: Greater peril?
There are nearly 80,000 more pregnancy-related deaths per year than
previously believed, according to the World Health Organization
(WHO) and United Nations Children's Fund (UNICEF).
Worldwide, some 585,000 maternal deaths occur each year, 99
per cent of them in developing countries, according to a study
released by the two agencies last month.
In the developing world, the maternal mortality ratio, which
represents the risk of dying during pregnancy or childbirth, ranges
from just under 200 per 100,000 live births in Latin America and
the Caribbean to more than 870 per 100,000 in Africa, with the
highest ratios in East and West Africa.
Asia, where 61 per cent of the world's births take place,
accounts for 55 per cent of all maternal deaths. Africa accounts
for 20 per cent of the world's births but 40 per cent of all
maternal deaths. By contrast, the industrialized countries, with
11 per cent of all births, have less than 1 per cent of total
maternal deaths.
Norway, Sweden, and Switzerland have the lowest national
figures. At the other end of the scale are Sierra Leone, with 1,800
maternal deaths per 100,000 live births, and Afghanistan, where the
figure is 1,700. In Sierra Leone, one woman in every seven dies of
pregnancy-related complications.
The new estimates actually are lower than the old ones --
albeit only marginally -- in North Africa, Southern Africa, East
Asia, and Central and South America. Everywhere else, the risk of
pregnancy-related death is "considerably higher according to these
new calculations," according to a WHO-UNICEF statement. "The
situation is particularly disquieting in eastern, middle and
western Africa." In some cases, according to the agencies, earlier
studies had underestimated maternal mortality by nearly one third.
Maternal mortality levels are difficult to assess, according
to the two agencies. Maternal deaths tend to be underreported even
in countries with well-established vital registration systems.
Where births and deaths are not recorded, however, the task of
estimating can be excruciating. It requires knowledge of all deaths
of women in their childbearing years, 15-49, the cause of death,
and whether they were pregnant when they died.
Few countries record births and deaths. Even fewer register
the cause of death, and fewer still systematically note pregnancy
status on death forms. Only about 37 per cent of the world's people
live in places where the cause of death is reported routinely.
The study took two years to conduct. The new estimates of
maternal mortality were arrived at by adjusting available country
figures to account for underreporting and using a simple model to
generate estimates for countries with no data or unreliable
official estimates.
Where data was lacking or insufficient and where vital
registration is poor or lacking, the study adopted methods ranging
from household surveys to detailed investigations into the causes
of all deaths among women of reproductive age. Civil registers,
health facility records, community leaders, religious authorities,
and undertakers were consulted to identify all deaths. Then,
interviews with household members and health care providers were
conducted to classify deaths as pregnancy-related or otherwise.
"Because of the complexity and costs involved," the agencies point
out, "only a few developing countries have managed to carry out
these detailed investigations at the national level."
Female genital mutilation: Political token
In an apparent bid to appease conservative Islamic clerics and
religious scholars, the new Grand Sheikh of Cairo's Al-Azhar
University has reversed his position on female genital mutilation
(FGM), deeming "useful" a practice which denies women of sexual
satisfaction and threatens their lives.
As POPULI goes to print, Egyptian women's health and human
rights organizations are discussing Sheikh Mohammed Sayed Tantawi's
statement and are seeking a meeting with Minister of Population and
Health Ismail Sallam.
Tantawi this month became the head of Al-Azhar, considered the
leading scholarly institution of Sunni Islam, after the death of
his predecessor, Sheikh Gad Al Haq. In 1994, Tantawi endorsed the
International Conference on Population and Development (ICPD)
Programme of Action's call for FGM to be eradicated. This put him
at odds with Haq, who declared FGM a duty for Muslim women.
Tantawi's current position, as reported by the local press,
the [Middle East Times], and the Associated Press, is that FGM is
not a duty but a tradition that ensures "cleanliness if used
moderately and is useful to women as well as men." FGM ranges in
severity from clipping the tip of the clitoris to cutting away all
the outer sex organs. Tantawi reportedly favours a "moderate" form.
In any case, FGM can result in excessive bleeding, infection,
and death. Women who survive the procedure run an increased risk of
complications during childbirth, of dying during delivery or
delivering a dead baby, and of developing obstetric fistulae --
holes between the vagina and the bladder, the rectum, or both which
can render a woman incontinent and incapable of bearing more
children.
The [Middle East Times] attributes Tantawi's about-face to
political pressure from conservative clerics and scholars to assert
his and Al-Azhar's independence from the state. Tantawi, who is
considered a liberal, was appointed by the government. The state-
affiliated institution's opinions and rulings do not carry the
force of law, but they do exert tremendous influence among the
faithful.
Last year, Haq drew the legal ire of Egypt's women's health
and human rights organizations by issuing a [fatwa], or edict,
deeming FGM a duty for Muslim women. The Egyptian Organization for
Human Rights took him to court, seeking compensation for "moral
damage" caused by the edict. Haq died in January, before a ruling
in the case.
-Abid Aslam
'Quality of care': Common courtesy
Going to a doctor or clinic is an intimidating experience for many
women. Health care workers can be notoriously rude, and the more
rural or uneducated the woman, the more strained the relationship
can be.
A pair of workers at the Women's Health Project in
Johannesburg, South Africa have set out to show their colleagues in
South Africa and elsewhere that effective health care involves far
more than technical competence.
"We shouldn't just be talking about diseases and immunization
programmes," says Sharon Fonn, a doctor with the Project. "We also
need to know how people live and what the typical problems of their
lives are." But this applies to health care providers as well as
their clients. "If you're serious about health care, then you
should also be serious about the needs of the health workers."
Dr. Fonn and nurse Khosi Xaba have been conducting workshops
for health care workers in South Africa and, with support from the
World Health Organization, in Senegal, Mozambique, Uganda, and
Zambia.
The main problem for Fonn was how to conduct research in the
somewhat intangible area of provider-client relations. "You can't
just ask a health care worker, 'Do you know clients say health
workers are rude?'," she says.
What's more, she says, conventional research methods such as
questionnaires and focus groups can be confrontational and can
therefore encourage health care workers to avoid the issues. So in
trying to gather information about workers' perceptions of their
clients and to encourage them to change the way they treat them,
Fonn and Xaba tried alternative approaches, including role-playing,
games, and getting people to design their own questionnaire.
Participants in their workshops are encouraged to address such
questions as "Why am I a health worker?" and "How do our clients
see us?"
Says Fonn: "It's amazing what health workers are willing to
say when they feel their problems are being taken seriously and
they are not being blamed." She found workers coming forward to
talk about well-known but generally ignored problems such as over-
charging or not giving patients a full dose of medicine so they
have to come back and pay another fee.
Because women tend to be the main users of health services,
Fonn needed to get participants thinking about women's status in
society and how that affects their relationship with health
workers. To do so, she used poetry to highlight women's lives in
rural areas.
One poem described how men get the best food and how women are
last in line, after the children. "There were some men in the
groups and they all recognized the descriptions," Fonn recalls.
"They could admit it because they weren't being directly blamed."
As women's lives took shape before the health workers, connections
to problems faced by the workers were quick to emerge. For example,
says Fonn, health workers "realized that if a woman is late for an
appointment, it is not because she's trying to irritate the health
worker."
Workshops also deal with the concept of a woman's unmet needs.
"We told a story about a woman's life, a typical sort of life,"
Fonn says. "She goes to school and can't find work when she leaves.
She marries a man much older than herself, perhaps a migrant
labourer. Soon she finds herself with seven kids in a relationship
often characterized by violence." Even if the woman can get to a
source of contraceptives with relative ease, she still needs
emotional support. While not confronting family planning providers,
the workshops have enabled them to recognize ways in which they may
have failed to provide such support and ways in which they might
correct this in the future.
Turning the tables
The focus of the workshops then shifts from clients and the
broader society, to health care workers' own places of work.
Participants analyze the factors that hinder or help them in their
work. Much of the discussion focusses on conditions in the
workplace: long hours, service deliverers' position in the health
care hierarchy, and staff relations.
Fonn and Xaba found, particularly when they extended their
research to other African countries, that delays in salary payments
have a major impact on motivation and work performance.
"People said that if their salaries don't arrive they have to
take on other work, which means they aren't available for health
work. Others would charge clients more money in order to
compensate," says Fonn. The result is an image of "unreliability
and corruption" which undermines women's confidence in the health
care system.
So what's to be done, workshop participants are then asked. In
a remote hospital in South Africa's eastern Transvaal, community
health workers and nurses decided to resolve tensions between them
by instituting weekly meetings to set mutual objectives and review
their performance. In other places, workers have decided upon
changes they can make as individuals or have demanded structural or
systemic changes in the way health care programmes are devised and
health workers managed.
"It's not impossible to make workers accountable," says Fonn.
"We just need effective management."
She concedes, however, that the impulse to change is not
always sustained. The method appears to work best where there is
political will and the health system is already under review. And
because the method is about the quality rather than the quantity of
health care;, changes require a "hard slog."
Meanwhile, she hopes the information she is gathering from the
workshops will have an impact on donors. "There's a tendency to pay
for programmes like immunization, because they are cheaper" and
easier to quantify. But unless there is an adequate health care
system and support for health care workers, such programmes can
prove a waste of time and money.
"Donors must realize that health care is part of a system that
includes communities," says Fonn. "It is slow and expensive, but
anyone wanting a quick fix is dreaming."
-Donna Hornby/Panos
AIDS: A score for the immune system?
New AIDS research reveals that the body's immune system can
sometimes keep the AIDS-causing human immunodeficiency virus (HIV)
in check and opens up new possibilities for research into AIDS
therapy.
After becoming infected with HIV, people often remain healthy
for two to 10 years. Researchers have now identified molecules that
might explain why some people take longer to develop the symptoms
of AIDS.
How long a person who is HIV-positive can remain healthy is
linked to the number of HIV particles in their blood. A low number
of particles translates into a relatively good prognosis; the
higher the number of particles, the less optimistic the outlook.
For those who develop AIDS more slowly, the secret may reside
in what are called CD8 T-cells. These cells constitute the body's
primary defence against viruses. They recognize and kill virus-
infected cells and they produce molecules, known as chemokines,
that cause inflammation by recruiting other cells into the fight
against the infection.
These CD8 T-cells are known to produce many different
chemokines. Researchers now have shown that four of these
chemokines are active in reducing the rate of HIV production by the
cells that harbour the virus. The anti-HIV chemokines are called
Interleukin-16, RANTES, MIP-1 alpha, and MIP-1 beta.
The effects of Interleukin-16 were discovered by a team based
at the Paul Erlich Institute in Germany. Work on the others was
carried out by a collaboration of American and Italian scientists
at the Institute of Human Virology in the USA and the San Raffaele
Scientific Institute in Italy.
As AIDS progresses, the levels of these anti-HIV chemokines go
down, the number of virus particles goes up, and the immune system
begins to fail.
These discoveries open up new possibilities for research into
AIDS treatment and suggest that the chemicals might help the search
for drugs to reduce virus levels in AIDS patients.
"However," says Anthony Fauci at the National Institutes of
Health in the USA, writing in the journal [Nature], "more than a
decade of experience with HIV has taught us to be conservative in
our projections for success."
For one thing, because the ordinary function of these
molecules is to produce inflammation, it probably will not be
possible to administer them directly.
"The risk of terrible side-effects would be too great," says
Paulo Lusso, senior author of the work on chemokines. "But if we
could understand how these molecules work, theoretically we could
design new drugs that would produce the same effects against HIV
but would be safe and not cause widespread inflammation."
It is not known how these molecules fight HIV. It is possible
that they act directly on infected cells and keep the virus from
growing, the scientists say. Or they may produce their effects by
acting on other cells, which in turn slow HIV production.
Nevertheless, "this is finally a score for the immune system,"
says Lusso. "So far its role in AIDS has been downplayed. It always
seems to be the loser," he adds, pointing to the virus's ability to
escape the effects of most drugs and vaccines investigated so far.
"Now the body itself seems to be doing something that might be
effective, at least in some phases of the disease."
Fauci, however, says he believes that these molecules may be
helping the virus in the long run. By controlling the HIV level,
the anti-HIV chemokines may prolong the period during which an HIV-
positive person remains free of disease. During this symptom-free
stage, the person is more likely to pass the virus on to others.
"It's out of the question that these factors have emerged
specifically to suppress HIV," he says.
-Helen Epstein/Panos
Female sterilization: Chance of surprise
One in 50 American women who underwent surgical sterilization
became pregnant within 10 years, a higher rate than anticipated by
doctors, according to health officials in the United States.
Although sterilization remains a highly effective method of
contraception, say staff at the Centers for Disease Control and
Prevention (CDC), women who have been sterilized and who develop
the signs of pregnancy should not ignore them, particularly since
one third of them may face potentially life-threatening
pregnancies.
"While it's uncommon, it's not as uncommon as we thought that
a woman would get pregnant even many years after the procedure,"
Bert Peterson, chief of women's health and fertility at the CDC
told the Associated Press.
Sterilization is the most popular contraceptive among American
women, some 10 million of whom have undergone the procedure. In
developing countries, many population programmes have relied
heavily on the method.
Until now, doctors had estimated that about one in 250 women
would get pregnant within a year of being sterilized. No one had
conducted a large, long-term study, however. The CDC studied 10,685
women for 10 years and found 143 pregnancies. One third of these
were ectopic pregnancies, in which the foetus grows outside the
uterus. They are life-threatening if unless discovered and tended
to early.
Women who were sterilized before age 28 were at highest risk
of pregnancy, presumably because they had more childbearing years
ahead of them than women who were sterilized at older ages,
Peterson said. Among women who used the two most risky
sterilization methods, 5 per cent of young women got pregnant,
compared with fewer than 1 per cent of women sterilized between the
ages of 34 and 44. The choice of method made no difference among
women over 34.
The fewest pregnancies overall -- 7.5 per 1,000 -- occurred
among women sterilized during conventional surgery right after
delivering a baby. In this procedure, the doctor slices the
fallopian tube and ties off each end.
Many women prefer less invasive procedures in which doctors
work through a tiny incision in the abdomen. Through it, the doctor
can plug the fallopian tube by burning it with an electric current
or applying a metal clip or silicone rubber band. The electric
"bipolar coagulation" method was the most risky, with 54
pregnancies per 1,000 young women, according to the study.
The risk was small to begin with but grew with each passing
year after sterilization, perhaps because the damage done to the
fallopian tube is not as great as believed by the doctor performing
the procedure, or simply because an opening develops and grows over
time.
The overall risk of pregnancy after sterilization is 1.8 per
cent, the CDC concluded. That compares favourably to the 2 per cent
risk estimated for the intrauterine device, or IUD, Norplant
implants, or oral contraceptives, Peterson said.
The findings mean that young women in particular must be fully
informed about the various sterilization methods available and the
corresponding risk of pregnancy, according to gynaecologists.
By contrast, the one-year failure rate for vasectomies is one
per 1,000. Long-term failure rates may be higher, but unlike female
sterilization, there are medical tests to determine whether a
vasectomy was performed properly, Peterson told AP.
The EU and ICPD: Slow on the uptake
There is growing concern among the members of the European
Commission on Women over a perceived inadequacy in the role the
European Union (EU) is playing in financing implementation of the
Programme of Action of the 1994 International Conference on
Population and Development (ICPD).
Nearly two years after the Conference, "the results are very
disappointing, both in terms of the global situation as well as in
terms of the efforts made to realize the accepted goals," according
to a Commission report quoted in the [NGO Newsletter] published in
the Netherlands by the World Population Foundation.
The Commission is drafting a resolution which, among other
things, calls for more joint financing of population and
development programmes and for non-governmental organizations
(NGOs) to be given more direct access to EU initiatives and
funding. The resolution is to be voted on in the Commission and in
the European Parliament, where the vote is tentatively scheduled
for June.
In 1994, the European Parliament adopted a resolution
supporting the ICPD consensus and allocating funds to reproductive
health projects and programmes. The European Commission proposed
increasing its financial contribution to ICPD implementation to 300
million Ecu (European currency units) by 2000 and 50 million by
1995. By the end of last year, however, few project proposals had
reached the EU, according to the Commission on Women report.
The report and resolution are aimed at speeding up
implementation of the Programme of Action and giving NGOs a tool to
get access to EU funding, according to the NGO newsletter.
If the European Parliament adopts the resolution, it will
reaffirm the following beliefs:
> that "population policies must be an integral part of
economic, social, and cultural development, their main objective
being to improve the quality of life for everyone and to preserve
it for future generations";
> that "freedom of choice regarding reproduction is a
fundamental human right"; and
> that "women's access to health services, reproductive health,
and family planning is still inadequate."
The draft resolution "recommends that financial cooperation
should take more account of the need to improve the status of women
and to encourage their initiatives." It "requests that the European
Union, in accordance with the decisions taken in Cairo [at ICPD],
should promote the joint financing of development programmes which
take into account their impact on the existing disparities between
men and women and should ensure that this criterion is included in
any evaluation of the programmes implemented."
Furthermore, the draft resolution states that "the efforts
already undertaken by the Union should be stepped up, coordinated,
and geared to the developing countries, as well as to the countries
of Central and Eastern Europe which are encountering particular
economic and social problems, not forgetting certain countries in
Western Europe whose social security and health systems are
deteriorating."
NGOs, according to the draft resolution, "should be given more
direct access to Community initiatives and funding." And "the
initiatives taken by each Member State with a view to achieving the
objectives established in Cairo" should be the subject of an EU-
wide study.
Food and poverty: Hunger pangs
The United Nations Year for the Eradication of Poverty -- this year
-- follows a series of warnings about a downturn in the first
indicator of welfare: food in the stomach.
Leading the doomsters is the Washington-based Worldwatch
Institute, which foresees scarcities in the years ahead.
Constraints are emerging that make it difficult to expand food
output, says Lester Brown, the Institute's president. He points to
the substantial loss of cropland to industrialization and
urbanization, stagnation in the size of global fish catches,
declining investment in agricultural research, and unquenchable
demand for water. And the singles out "the China factor" for
special concern: In the past two years, the world's top food
producer has become its second largest grain importer.
Another US-based organization, the International Food Policy
Research Institute (IFPRI), warns that without major changes in
food policy and a resurgence of agricultural research, tomorrow's
world will be even more dangerous than today's, with surpluses in
the West but with poor countries making little progress towards
food security. In November 1995, a conference staged by IFAD, the
International Fund for Agricultural Development, came to much the
same conclusion.
The UN's Food and Agriculture Organization (FAO) -- sponsor of
this year's World Food Summit in Rome -- predicts that more food
will be available for many people in developing countries by 2010
but emphasizes that the expected overall improvement masks many
trouble spots.
FAO expects little progress in improving nutrition in sub-
Saharan Africa, which could have 300 million undernourished people
2010, against 180 million today. Even in South Asia, where FAO
forecasts the percentage of chronically undernourished people will
be halved, the drop would still leave 200 million very hungry
people.
Despite the dimensions of the problem, the dream of food for
all is considered achievable. As UN Secretary-General Boutros
Boutros-Ghali points out, "the world now produces enough food to
feed its population."
A more equitable distribution of food could bring immediate
results, which is where the concerns of the Food Summit coincide
with the concerns of the Year of Poverty: People go hungry because
they cannot afford to buy food or lack the means to grow it. "It is
now well recognized that the failure to alleviate poverty is the
main reason why undernutrition persists," according to a FAO
statement.
But redistribution may not be enough to ensure the future.
Production must continue to outrace population growth, with little
prospect f new land to extend growing areas.
"The challenges facing us now are greater than the ones facing
us in the 1960s before the Green Revolution," says Gurdev Khush of
the International Rice Research Institute in the Philippines.
"Then, there was scope for increasing the total area under
cultivation." This is no longer so, he says.
And as the evidence increases of the environmental damage
caused by modern agriculture, experts say, research will have to be
carefully directed at more sustainable farming methods. Sensitive
social and political factors will also have to come to the fore --
among them, land reform and stronger support for women in
agriculture. IFPRI describes the women's representation in
agricultural research and extension services as "minuscule." It
estimates that women farmers' yields in Kenya alone could rise 24
per cent if they all had primary education.
Money has to be found to do all this, and the experts are
quick to point out that investment in agriculture has an enormous
knock-on effect for the rest of the economy: It provides not only
food, but jobs and income. "In the majority of developing
countries," says FAO, "increasing food production is among the
principal means for combating poverty."
-Panos
US press: Papal bull
Where matters Roman Catholic and the press in the United States are
concerned, it's a man's world. This, according to media consultants
Douglas Gould & Co. of New York.
The company, which specializes in media campaigns on gender,
reproductive health, and other social issues, studied 231 articles
from 12 major newspapers and wire services before and during Pope
John Paul II's visit to the US last October. The study,
commissioned by the Washington, DC-based non-governmental
organization (NGO) Catholics for a Free Choice (CFFC), was released
this month.
Of all the people who were quoted on a broad spectrum of
topics, only 36 per cent were women. Men accounted for 69 per cent
of all printed quotes, comments, and mentions. Among people
identified as experts, 79 per cent were men, and they garnered 78
per cent of all expert quotes.
Indeed, were it not for their protests, women might have been
ignored altogether. To the extent that women were quoted at all,
they were "most often quoted as experts in several stories about
protest marches organized by activist groups outside" papal masses,
according to the study.
And what are the issues of the day in this man's world?
According to Gould & Co., 38 per cent of the stories reviewed
typically dwelt on such issues as the Popemobile, police security,
and custom-made papal furniture. A staggering 80 per cent of all
quotes included worshippers' emotions on seeing the Pope, vendors'
predictions about the sales of papal memorabilia, Vatican
spokespersons' comments on the Pope's schedule or feelings towards
America, and ticket agents' comments about the brisk demand for
papal mass tickets.
The "substantive issues of importance to the Church" commanded
a scant 20 per cent of all quotes, according to the study. Gould &
Co. defined these issues as including abortion, women's status in
the church and society, ethnic diversity, poverty, immigration, the
priesthood, homelessness, euthanasia, contraception, disability,
and human sexuality and sexual morality. These issues were touched
upon in only 28 per cent of the stories studied and were the main
subject of a mere 24 per cent of all the stories.
Perhaps the imbalance was because women, who make up some 48
per cent of all reporters and editors in the US, accounted for only
21 per cent of the by-lines. Alas, not so, according to Gould &
Co.: "Unfortunately, women reporters didn't quote female expert
sources more often than did their male counterparts. For the most
part, there was neither a significant increase in the number of
women quoted as experts nor more attention paid to the issues
affecting women in stories written by female reporters."
For comparison, the study looked at five diocesan newspapers
published in or near the communities visited by the Pope. These
Church publications quoted women 31 per cent of the time, compared
to 36 per cent in the secular press, and gave them 25 per cent of
all printed quotes compared to 31 per cent in the secular press.
The study did not examine the complexion or complexity of
opinions represented in secular and sectarian papers.
And the parade continues. On Sunday 19 November, about a month
after the Pope's visit, the [New York Times] ran a front-page story
on the Vatican's decision to declare its ban on women's ordination
to be infallible doctrine. The [Times] reporter, described by CFFC
as "one of the best known and most experienced religion writers,"
quoted five individuals, not one of whom was a woman. Strange,
since he had covered a national conference on women's ordination
just the week before.
-Abid Aslam
=====
FEATURES
Uganda's Sabiny People: REACHing for a Healthier Future
by Elaine Eliah
-----
Elaine Eliah is a Uganda-based correspondent for [The East
African].
-----
Uganda's day begins at Mt. Elgon, the sun climbing over the Kenyan
border high enough to soak the Karamoja plains and filter through
the mild alpine air of Kapchorwa district. Along a hairpin dirt
road nearly impassable during the rainy season lives a small tribal
population of Sabiny people, of whom there were some 116,000 when
the 1991 census was taken. The isolated Sabiny cling to age-old
traditions as tenaciously as their banana fields and wattle-and-
daub homes cling to the volcanic mountainside.
In December of every even-numbered year, adolescents are
prepared for passage into adulthood with feasting and dancing,
fasting and secret briefings. All this leads to a public
celebration on the day their genitals are cut. The Kapchorwa
council collects an initiation fee, the local equivalent of
US$1.00, to purchase antibiotics for initiates.
The Sabiny have made national and regional headlines over the
years for their strict adherence to the tradition of genital
excision as a rite of passage into womanhood. In the early 1990s,
attempts to enforce compliance with international health and human
rights norms merely provoked cultural indignation and resistance.
Where outsiders have failed, the community itself is now
succeeding. Kapchorwa is home to a bold yet culturally respectful
initiative aimed at elevating the issue in the community's own
agenda and eliciting a community response to it.
That initiative is REACH, the Reproductive, Educative, And
Community Health programme, which provides a forum for information
and discussion among local community and political leaders, health
professionals, parents, and adolescents themselves. Through
workshops, participants explore the hazards of female genital
mutilation (FGM), with an emphasis not only on the dangers to the
young girls undergoing the rite, but also on the future health of
mothers and infants, especially during labour and delivery.
The programme also offers a reproductive health package
including training and supplies for traditional birth attendants
and reproductive health and family planning services and peer
education for parents and adolescents. It is supported by the
government, non-governmental organizations, and international
institutions including Britain's Overseas Development Authority,
CARE International, and UNFPA.
REACH represents "a landmark and a turning point," says
Gertrude Kulamy, a Member of Parliament from Kapchorwa.
The turning point, says UNFPA Country Director Francois Farah,
lies in distinguishing between cultural practices and the values on
which they were founded.
REACH seeks to avoid fuelling unnecessary sensitivity about
the issue. Thus, for example, participants coined a new phrase for
FGM: "female genital cutting." The familiar euphemism "female
circumcision" was rejected as obscuring the severity of the
procedure, which is not analogous to the simple foreskin removal
involved in male circumcision. But "female genital mutilation" was
thought to imply excessive judgement by outsiders and insensitivity
toward individuals who have undergone the procedure.
There is more at stake than semantics. In Kapchorwa as
elsewhere, the international women's health and human rights
movements have brought attention to bear on the practice. But, the
evidence suggests, they have not succeeded in curbing it. Indeed,
efforts to impose a ban on FGM have, instead, provoked a
resurgence.
Restraint and resurgence
By the 1980s, with the influx of outsiders to the region, and
with the Sabiny themselves leaving Kapchorwa to pursue higher
education, the practice was beginning to lose favour. Perceiving a
threat to their culture, local elders and officials voted to make
genital cutting a requirement for all women living in the district,
not just Sabiny women.
Susan Ojangor, the first Sabiny girl to ever finish secondary
school, married outside the tribe and returned to live in the
district with her husband and children. In early 1989, she and Jane
Kuka were senior members of the National Council of Women in
Kapchorwa. They faced mounting community pressure for those who had
escaped the December 1988 initiation season to comply with the
decree. Today, local officials deny Ojangor and Kuka were ever in
danger and claim the women's social and political status spared
them from forced initiation. But both women recall blatant threats
which, they say, prompted them to flee to the safety of Kampala,
Uganda's capital.
Urgent pleas for intervention from parliament, the cabinet,
and even President Yoweri Museveni himself seemed, at first, to
yield results. Government ministers were airlifted by helicopter to
the trouble zone. Minister of Labour and Social Welfare Steven
Chebrot, himself a Sabiny, remembers one of the elders commenting,
"You don't fly here to rescue our cows from the Karamajong, but to
rescue our women." That very night, while the party of ministers
waited, the local council rescinded its decree.
The following year brought a resurgence of the practice.
In 1990, Elizabeth Madras, now with the health ministry's AIDS
control programme, worked for the Inter-African Committee on
Traditional Practices Affecting the Health of Women and Children,
an Ethiopia-based non-governmental organization founded in 1984 to
fight FGM and other traditions harmful to women and children. Dr.
Madras visited Kapchorwa that year and spoke out strongly against
genital cutting. The Sabiny, fearing that the government might
actually outlaw their culture and traditions, increased the number
of initiations performed that year. Ever younger candidates were
initiated early lest an enforced ban prevent their initiation in
the future.
Madras returned to the district in 1994 with a camera crew
from Uganda Television. The TV crew's presence caused fear and
misunderstanding in a district where only the largest town had
electricity, and then again, for only four hours a night. When the
entire cutting ritual was aired on national television in all its
graphic detail, women's groups launched protests and lobbied
government ministers to enact a ban. In an unexpected twist, the
broadcast and campaign for a ban prompted dozens of Sabiny women
who had previously resisted the cutting to embrace the knife in an
effort to defend their culture from such outside condemnation.
A constitutional debate ensued in parliament. Supporters of a
ban invoked Article 33 of Uganda's newly-passed Constitution, which
states that "laws, cultures, customs or traditions which are
against the dignity, welfare or interest of women or which
undermine their status, are prohibited by this Constitution." Their
opponents countered with Article 37, which asserts that "every
person has a right as applicable, to...practice...and promote any
culture [or] cultural institution...in community with others."
A community organizes
Against this backdrop, REACH was born.
In January, William Cheborion, chairman of the Kapchorwa
Elders' Association, proposed replacing the practice with a
symbolic gift-giving while preserving the singing, dancing, and
other traditional festivities which mark a girl's initiation as a
full-fledged member of the community.
Coming as it did from a custodian of community culture,
Cheborion's proposal has nurtured discussion of how best to honour
cultural values while altering the rituals through which they are
expressed. As Susan Ojangor, the district's first female high
school graduate, put it: "Formerly, when a king died in Toro
district, nine subjects would be killed to accompany his highness
to the great beyond. Today, the Toro bid their ruler farewell with
nine symbolic coffee beans."
Cheborion, Ojangor, and other participants in the first REACH
community workshop had just come face to face with biological and
reproductive health facts previously unknown to many of them. They
seemed most taken by information presented by Dr. Chebrot, the
native Kapchorwan obstetrician turned cabinet minister. He used
simple language to describe the inelasticity of scar tissue and how
it can impede childbirth, even to the point of causing the death of
mother, infant, or both, and explained how the tearing that can
accompany difficult and painful births often results in a lengthy
healing process and an increased risk of obstetric fistulae and
lifelong incontinence.
Although most Sabiny had witnessed or heard of cases where
excessive bleeding or infection had led to an initiate's death, the
connection to maternal and infant mortality touched a particularly
sensitive nerve.
As a first step toward abolition, and to allow time for a girl
to consider her options, workshop participants recommended setting
a minimum age of consent for initiation. They settled on 18 years,
the same age as for marital consent in Uganda. Meanwhile,
representative girls from throughout the district will be trained
to spread word in their neighbourhoods of the harm done by cutting.
The district School Health Education Programme plans to instruct
boys and girls on the issue and provide them with comprehensive
information on reproductive health.
But for these plans to succeed, girls must be able to enrol
and stay in school. The community is seeking a reduction in school
fees to offset families' tendency to allocate their limited funds
for schooling for sons at the expense of daughters.
That may not be enough. Community members identified another
group which must be made sensitive to the need for change: the so-
called Guardians. These women prepare girls for the initiation
ceremony and tend their wounds afterwards. As most of the
initiation rite is shrouded in secrecy, these women are guardians
of the mystique. They have no small stake in maintaining the aura
that transforms them into celebrities for a month every other year.
In a larger sense, participants mused, perhaps Sabiny women
themselves present the greatest obstacle to eradicating genital
cutting. Recent initiates may resent being among the last of a
dying tradition: Perhaps something in human nature finds validation
in seeing others follow in one's footsteps, even when the path is
one of pain and suffering. And they may fear that their husbands
will be seduced by the sexual desires of unaltered women. Indeed,
traditional songs evoke the social turmoil an uninitiated woman
brings to the village in which she lives.
REACH's success, community members concluded, hinges on its
ability to change the attitudes of the entire community. In the
absence of such change, women would face continued social pressure
and discrimination, much of it perpetrated by women. Uninitiated
women are not allowed to enter the granary, to milk cows, or even
to collect cow dung. At the well, they must wait until all the
other women have drawn water. They are perpetually called girls,
never women, and thus are forbidden to speak at community
gatherings. They are not permitted to serve elders nor even to pour
hot water for beer, traditional roles for a wife.
Under such circumstances, ten married women recently returned
to their homes to be cut. Ostracism from their new husbands'
villages had made their lives so difficult, they said, that they
chose not to wait for December. Two of them suffered life-
threatening bleeding after the cutting.
Looking ahead to December, Cheborion encouraged community
members to gather to recognize the season of initiation. "The
occasion of the Sabiny girl becoming a woman needs celebration," he
said. "But when it's time for the cutting, you just go home." When
some suggested a symbolic, more benign blood-letting ritual,
Cheborion remarked: "There has already been too much cutting."
Never before had a recommendation for change come from within
the Sabiny community itself, let alone from such an esteemed
source.
As if to second Cheborion's recommendation, parliamentarian
Peter Kamuron committed himself to throwing an initiation party for
his two daughters come December. But they will not be cut; instead,
he will give them each a cow.
SIDEBAR: Examining a tradition
The Sabiny practise female genital cutting to mark a girl's passage
into the responsibilities of womanhood and, supposedly, to prepare
her for marriage, which often takes place soon after initiation. It
is said that by undergoing the rite, a girl simultaneously
demonstrates bravery and her ability to keep an oath of secrecy,
since many of the rituals surrounding initiation are hidden from
public view.
In seeking to change the ritual, reformers have had to try to
understand how it became a tradition in the first place.
Sabiny legend holds that a young girl was once stricken by a
long period of disease, causing her to become thin and weak. A
witch doctor prescribed the venting of "bad blood" through genital
cutting. As the legend goes, the girl was cured. Over time,
according to one theory, the practice grew into a routine,
preventive measure.
Another theory is that the practice has its roots in a time
when the Sabiny were hunters. Men would be gone from their villages
for long periods of time, and it was believed that social stability
would be enhanced if women's sex drive could be controlled. Female
genital cutting, according to this view, gained currency as a means
to keep women faithful to their husbands.
The Sabiny have long since given up the hunting life for a
pastoral existence.
Steven Chebrot, a Sabiny obstetrician and Uganda's Minister of
Labour and Social Welfare, is one of the community's leading
reformers. As the conditions governing life change -- and
particularly as old ailments yield to improved prevention and
treatment, he says -- certain traditions become unnecessary.
Take the old Sabiny custom of removing two incisor teeth.
As Dr. Chebrot tells it, when he was a young boy, the only
thing that saved him from social pressure to have his incisors
removed was his father's threat that the tooth-puller would be
jailed if he so much as touched the boy.
Later in life, Chebrot learned that the ancient practice once
served a real purpose: In the time before antibiotics and
immunization, tetanus and its resultant condition -- lockjaw --
were common. The Sabiny discovered they could sometimes save a life
by knocking out a few teeth and using the opening to force feed the
patient. Routine tooth-pulling became a preventive measure and
then, another milestone on a young Sabiny's road to adulthood.
But with the advent of immunization and the spread of
education, the practice has all but disappeared. Today, he says,
toothless gaps are only evident among the aging.
- E.E.
=====
FEATURES
Uganda's Heifer Project: Bovine Blessings?
by Joke van Kampen
-----
Joke van Kampen is a media adviser with the Netherlands-based World
Population Foundation.
-----
The road to the village in Jinja District, Uganda was muddy and
bumpy. A four-wheel drive was no luxury and our host, Elizabeth
Kyewalabye, district head of the Heifer Project, had exchanged her
high heels for tough rubber boots.
The village comprised about a dozen little houses. Most were
made of clay but some were built of wood and iron. Its centrepiece
was an enormous cow evidently in the prime of health. The cow's
proud owner, a woman named Betty, had been informed that she would
be visited this afternoon by seven journalists from Western Europe
on a field trip to gain background information on family planning
and other development projects.
Betty's three children were hiding in the house. The simple,
ramshackle dwelling was smaller than the cow's shed, which had
separate day and night stalls and a "dining room." The house was
surrounded by fruit trees and a "Kleenex tree," whose leaves were
used to clean the children's faces when they eventually filed out
after studying this strange group of visitors.
Betty was one of the first beneficiaries of the Heifer Project
in this district, having received her cow more than three years
ago. The project is an integral part of Uganda's strategy to
improve the status of women. Administered by the government and
supported by the World Food Programme, UNFPA, and others, it
provides selected women with a heifer, training in its upkeep, and
some supervision. The women sell the cow's milk and churn the
proceeds into their families' income and their children's future.
In time, the heifer is inseminated. The resulting calf goes back to
the project and in turn is given to another woman.
The project has given women access to cash and the power to
decide what to do with it, according to the findings of an
independent evaluation conducted last year. It is an example of
what Vice President Specioza Wandira Kazibwe, speaking in Beijing
at the Fourth World Conference on Women, called much-needed
"tangible economic projects in the hands of women."
As Betty and the evaluation report showed, however, the women
have had their hands full.
To begin with, the project is about a lot more than cows,
milk, and money. The women beneficiaries are meant to act as
"agents of change" in their communities. They are expected to be
local role models by keeping their houses clean and healthy,
improving their children's diets, using family planning, and having
a better -- or more equal -- relationship with their husbands. In
consequence, not just any woman can qualify to receive a cow.
Applicants must submit a written statement describing their
motivation to participate. In a country where the vast majority of
women are illiterate, that same vast majority is effectively
excluded.
What's more, the project's insistence on "zero grazing" for
environmental reasons increases women's workload. This in a country
where women are believed to perform 80 per cent of the work despite
suffering malnutrition and the worst effects of bearing children
too many times. Before she could receive the cow, Betty said, she
had to grow grass and demonstrate that she had enough to feed the
hungry beast. This involved waking up even earlier than before to
cut the grass and feed the cow before producing breakfast for her
husband and children. According to the evaluation report, she was
relatively lucky: Overworked already and lacking proper tools, some
women have hurt themselves seriously, cutting off fingers while
cutting the grass.
Another shortcoming is that the project helps only one family
in the community. Making sure its bovine blessings are shared by
the whole community is not a matter of course. Just to maintain
cordial relations with her neighbours, Betty said she had to
balance her behaviour very carefully.
"The neighbours get the milk cheaper than we sell it on the
market. And if they have sick children, I give it for free," she
said. "But still, people are jealous of us, of the new house we are
going to build and of the things we are able to buy."
Having a good relationship with their community is crucial if
the women are to act as agents of change. Not only was taking care
of the cow time-consuming for Betty, but the project included all
kinds of group activities, from meetings on how to take care of the
cow's health to meetings on family planning and child spacing.
And if neighbours have to be placated, so too must husbands.
By and large, women are not allowed to own or inherit land or other
capital. Rather, their possessions remain in their fathers' hands
until being turned over to husbands; more often than not, they are
lost altogether when their husbands leave them or die. In the
countryside, women are expected to kneel when they talk to their
husbands. In some parts of the country, the rites of marriage may
include rape and girls are subjected to female genital mutilation.
Indeed, the situation of women in parts of the country is so grave
that participants in a recent women's NGO workshop expressed
serious concern at the cultural and economic obstacles confronting
the government's firm political commitment to enhancing their
status.
Against this backdrop, women like Betty have had to overcome
their husbands' objections to taking on the cow -- often, this has
meant accepting sole responsibility for it -- and have strived to
ensure its benefits to the household accrue quickly.
The benefits are meant to include better nutrition and
reproductive health, including family planning.
Although the use of family planning is not an official
selection criterion for participating in the Heifer Project, rumour
has done its work. Everybody seemed to be well aware of the
political correctness of being willing to use family planning.
According to the evaluation report, some 40 per cent of the women
said they were practising family planning, as compared to the
national contraceptive prevalence rate of five per cent reported in
the 1995 State of World Population report. Nearly half of the women
were able to show the registration card they received on their
first visit to the family planning clinic.
Betty, too, had begun using contraception. "Maybe I want one
other child, but I will wait until my youngest is two or older,"
she said.
She expressed enthusiasm for the project's impact on her
marriage, as did many women interviewed for the evaluation.
"My husband did not come home often because I was always asking for
money to buy salt and he did not always have it," she said. "Now he
comes home every weekend. He sees that I make an important
contribution to the family income, and he respects me for that. He
also helps me with the grass cutting when he is at home."
Another woman told evaluators: "I no longer have to kneel down
for my husband begging for money, on top of which I would be
insulted." Others said they had gained the freedom to go to
meetings by themselves.
Some women, however, complained that their husbands had taken
the cash with the excuse that it was not acceptable in their
culture for women to go to the market. In a bid to correct the
problem, the project required women to keep detailed records of
their cow's yield, the market price of milk, amounts sold, and
resulting income.
Subsequently, some men told evaluators that they no longer
dared to take the money away for their own use for fear the cow
would be confiscated. The problem persists, however, where the
women do not formally own the cow.
Of course, some men have shown greater enlightenment -- or
shrewdness -- than others. Some participants said the project had
"reduced men's economic burden" since the women assumed
responsibility for paying school fees and buying day-to-day
household needs. In one case, a woman said she was happy to receive
a cow because, "by the time I received the cow my husband had taken
another wife. But I have the money now to cook him great meals and
even to buy him things he likes, so he is more with me now."
As Francois Farah, UNFPA's country director in Uganda mused,
"meeting the practical needs of women is not automatically the same
as meeting the strategic needs of women."
Nevertheless, Betty said she loves her cow. With its milk she
has made more money in a week than her husband does in a month as
a metal worker. Her earnings have enabled the couple to buy
building materials to improve their house -- improvements they
could only have dreamed of before getting the cow; enabled her
children to attend school regularly; and allowed her to buy
blankets and mattresses so the children no longer have to sleep on
the clay floor, where they were bothered by insects.
To her visitors it was clear that Betty and her aggressive cow
formed a central enterprise in the little village. It was also
clear why Betty came through the selection process. Clearly a
determined young woman who would not let anyone stand in her way,
she named her cow "let them talk." She explained: "The cow is on
zero grazing. One of the conditions of the project is that we had
to raise grass before the cow arrived. We also had to build the cow
a proper house. When I did that the neighbours were laughing at us,
they did not believe that we were really about to receive a cow."
Then the cow arrived, and the rest is local history.
The sun had begun to set when we left Betty, her children, and
the crowd of neighbours who had gathered to join in the discussion.
As we left, we saw her begin to prepare the evening meal for her
children. We knew that after that she had to look after the cow,
wash some clothes, and record the day's milk yield in her book. She
had said she expected her husband home late that night and planned
to cook him a meal, too. After carefully washing the cooking
utensils as prescribed during a project workshop on hygiene, she
would go to bed last. To get up first the next morning. As usual.
=====
VIEWPOINTS
Teen sex: The need to know
by Corazon M. Raymundo, Eliseo A. de Guzman, Gilda Salvacion A.
Diaz & Clarinda R. Lusterio.
-----
Corazon M. Raymundo is the director of the University of the
Philippines Population Institute. Eliseo A. de Guzman is an
associate professor at the Institute and Gilda Salvacion A. Diaz
and Clarinda R. Lusterio are, respectively, researcher and research
associate.
-----
Many of the problems young people in the Philippines face stem from
their inability to deal adequately with their sexuality. Parents
may not approve, indeed many may find it hard to believe, but many
of their sweet 16-year-olds have already lost their innocence, and
they need help in dealing with the possible consequences.
Sixty per cent of Filipinos aged 15-24 have gone out on a
date, according to the 1994 Young Adult Fertility and Sexuality
Study. Eighteen per cent -- or 2.5 million -- have engaged in
premarital sex. Yet, 74 per cent of them -- 1.8 million -- do not
use any contraceptive method to prevent pregnancy. This although
the great majority -- 1.67 million -- say they are unwilling and
unprepared to become parents.
What options will they have if they become pregnant? How can
they be helped to avoid such an unwanted situation and be enabled
to enjoy their youth, pursue their ambitions, and prepare for their
future without the burden of premature parenthood?
Most Filipinos aged 15-24 -- 84 per cent of those surveyed
nationwide -- have heard of at least one method of family planning,
yet only 4 per cent can be considered knowledgeable about
contraception. These lucky few tend to be older and educated, had
population education while at school, and obtained their
information on sex from teachers, doctors, or the media.
This knowledge is key, and it is especially important for
younger people who are just beginning to date. This is particularly
so since, once young people become sexually active, the influence
of religion and the family in shaping their decisions is greatly
diminished.
In general, boys and girls first go out on a group date when
they are about 16 years old, and on single dates up to a year
later. Some, however, start dating in their pre-teen years. And
that traditional hedge against early sex, the chaperon, seems to be
falling out of fashion: Only about one quarter of all first single
dates are chaperoned, and today's chaperon is usually a friend who
comes along just so the parents or partner will agree to the date,
and who eventually leaves the couple to themselves.
As to actual contraceptive practice, boys report a higher
level of use than do girls. Boys, it seems, are more careful to use
a contraceptive for their first rather than a subsequent sexual
encounter. By contrast, most girls say that their first sex was
unprotected and that they were more careful during succeeding
sexual contacts. Particularly disturbing, of those young women who
went to the extent of having sexual intercourse on their first
date, 17 per cent said it happened without their consent.
The reasons given for not using a contraceptive method were:
they did not expect to have sex; they did not know how to use a
method; their partner objected; it was impossible to use any method
under the circumstances; and contraception took the fun out of sex.
Some think contraception is wrong or dangerous to their health. And
there are those who don't take precautions because they think a
girl cannot get pregnant after having sex just once.
Indeed, close to half the young people surveyed did not know
that a woman can get pregnant from a single act of intercourse;
that it is the timing, not the number of contacts, that is more
critical. Combine this wrong notion with the spontaneity of the sex
act among teenagers, their low motivation to protect themselves
from pregnancy, and poor access to the information and means to
help them to do so, and you have an increased risk of unintended
pregnancy from a one-time sex encounter.
Among those who practised some form of contraception, the most
popular methods were withdrawal and condoms the first time. The
likelihood of contraceptive use increases with education. Among
boys, in particular, having had population education in school is
a significant contributor to the decision to use a contraceptive,
as is their fathers' guidance. Girls' most reliable sources of
information are books, family planning literature, and friends --
not their mothers.
Whether or not young people practice contraception, and
whether or not adults accept or approve of this, the stark fact is
that a large number of adolescents are already sexually active, and
many of them are not equipped to handle the consequences of sex.
Sooner or later -- and again, whether adults like it or not --
young people will seek information about sex because they are
interested and because they need it. The information they get
should be comprehensive and should come from a reliable source.
Correct and adequate information will help teenagers to understand
their sexuality more fully and manage it more effectively. Young
people must have more access to instructional materials on sex,
family life, and reproduction. Equally important, however, the
people on whom they rely for guidance -- parents, teachers, older
friends, and institutions such as the Church -- should also make
themselves more readily available to inform and advise young people
on their growing sexuality and their new sexual responsibilities.
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> RESOURCES
Taxing Forgiveness
Income taxes should be replaced with environmental taxes "to
reverse the trends that are leading to hotter summers, falling
water tables, continuing deforestation, accelerating species
extinctions, and rising food prices," according to [State of the
World 1996] from the Worldwatch Institute, a Washington-based
research and advocacy organization. "If governments gradually phase
in comprehensive environmental tax codes and eliminate massive
subsidies for destructive activities, such as mining, overfishing,
and fossil fuel burning, they can easily cut annual personal and
corporate income taxes by US$1 trillion," the report claims. The
chief environmentally destructive activities to tax, it says, are
"the emissions of heat-trapping carbon dioxide, the clear-cutting
of tropical and temperate forests, the manufacture of throw-away
products, the generation of toxic wastes, the depletion of
groundwater supplies, and conversion of cropland to non-farm uses."
Environmental taxes will "force markets to reflect more clearly the
true costs of products or services." At present, "markets rarely
tell the truth since they omit many costs." Burning a gallon of
petrol in the United States costs the driver only about US$1.20,
but it can cost the country an additional US$3.00 in medical bills
and property damage from smog and other side-effects. Similarly,
when the affluent in food-scarce countries convert cropland into
golf courses, "it raises food prices, increasing malnutrition among
the poor." By forcing it to tell the truth, environmental taxes
will serve as "a means of steering the market in an environmentally
sustainable direction." Thus, such taxes will "yield a triple win:
a win for the environment, a win for the economy, and a win for
future generations. If we do not quickly restructure our fiscal
systems to protect the economy's environmental supports, the
generations to come may find it difficult to forgive us." For more
information, contact: Worldwatch Institute, 1776 Massachusetts
Ave., NW, Washington, DC 20036-1904, USA. Telephone: (202) 452-
1999. Fax: (202) 296-7365.
Learning About Sexuality
"Family planning and reproductive health programmes have rarely
considered sexuality, gender roles, and power in designing and
providing services," according to Sondra Zeidenstein and Kirsten
Moore, editors of [Learning About Sexuality: A Practical
Beginning]. "Sex has been perceived as too 'private' and gender
roles as 'impossible to change,' and socially and politically
'sensitive,' at least within the context of clinically oriented
service delivery programmes. Although a large body of research
tells us about the many factors affecting contraceptive use and
choice, risk of sexually transmitted disease and cervical cancer,
and unwanted pregnancy, we are just beginning to understand how
these outcomes are profoundly affected by dynamics of sexuality and
gender." Hence this book, which sets out to "outline areas of human
interest that, so far, we have failed to relate to in a
programmatic way," according to Halfdan Mahler, former Secretary-
General of the International Planned Parenthood Federation and
author of the book's foreword. Published by the Population Council
in collaboration with the International Women's Health Coalition.
For more information, contact: The Population Council, One Dag
Hammarskjold Plaza, New York, NY 10017, USA. Telephone: (212) 339-
0500. Fax: (212) 755-6052. E-mail: <pubinfo@popcouncil.org>.
Making Good on Commitments
For the first time, sexual and reproductive health and rights are
formally a part of the global agenda for social equality,
development, and peace, according to Family Care International
(FCI), publisher of [Commitments to Sexual and Reproductive Health
and Rights for All: Framework for Action]. The non-governmental
organization (NGO) says this recognition that sexual and
reproductive health and rights are "part of human rights and
fundamental to development" is "one of the most significant signs
of progress" in the "ambitious and progressive commitments to
people-centred development" made by governments through, for
example, the Convention on the Rights of the Child, the
International Conference on Population and Development's Programme
of Action, and the Declaration and Platform for Action of the
Fourth World Conference on Women. FCI's [Framework for Action] is
a "concise compilation of the international commitments made to
improve this fundamental aspect of development and of the actions
that will be needed in the areas of policy, legislation, research,
services, training, and public information and education." It sets
out to provide an overall framework for national plans and outline
the steps needed to ensure universal access to sexual and
reproductive health care. It also lays out priority issues
including: the equal rights of girls; the health and well-being of
adolescents; the elimination of gender violence; the need for male
participation and shared responsibility; safe motherhood and
eliminating unsafe abortion; family planning; and services for
sexually transmitted diseases and HIV/AIDS. Intended for anyone
interested in national strategy development or advocacy --
including officials, NGOs, women's groups, researchers, donors,
multilateral agencies, and the media -- the [Framework for Action]
is published in English, French and Spanish. Single copies are
available free of charge, additional copies at a cost of US$2.00
each to Europe, North America, and international organizations and
US$1.00 each to developing countries. For more information,
contact: Family Care International, 588 Broadway, Suite 503, New
York, NY 10012, USA. Telephone: (212) 941-5300. Fax: (212) 941-
5563. E-mail: <fci@chelsea.ios.com>.
New Workshops
The Centre for Development and Population Activities (CEDPA) is
offering two new workshops in its 1996 training programme for
international development professionals. A worskhop on "Youth,
Leadership, and Reproductive Health" will be conducted in English
in Washington, DC on 15 June-5 July and is designed to enable the
leaders of organizations that serve youth or want to include youth
initiatives in their work to build their capacity to design
appropriate programmes. A workshop on institution building for
civil society, ["DEveloppement institutionnel pour une sociEtE
civile,"] will be conducted in French on 9 September-11 October and
is designed for senior-level managers or administrators working in
or with NGOs in community-based development. The workshop's goal
will be to enhance participants' skills and management approaches
to increase their organizations' accountability and credibility as
providers of family planning, reproductive health, and development
services. These workshops are in addition to CEDPA's core
workshops, conducted in English, on "Women in Management:
Leadership Training for the '90s" (13 May-14 June) and "Institution
Building: Strategic Management for the '90s" (8 July-9 August). For
more information, contact: Workshop Coordinator, CEDPA, 1717
Massachusetts Ave., NW, Suite 200, Washington, DC 20036, USA.
Telephone: (202) 667-1142. Fax: (202) 332-4496. E-mail:
<email@cedpa.org>.
Laws and Women's Bodies
The Center for Reproductive Law & Policy has published [Women of
the World: Formal Laws and Policies Affecting Their Reproductive
Lives], a review of measures governing the lives of more than a
billion women. Copies of the document are available from the
Center's International Program. The Center's Communications
Department is offering [Legislating a Tragedy], an information
packet and short video prompted by "the unprecedented nature of
efforts to ban particular abortion techniques." It "features two
courageous women who learned late in their pregnancies that their
foetuses had anomalies incompatible with life and made the
difficult decision to terminate their wanted pregnancies." For more
information, contact: Center for Reproductive Law & Policy, 120
Wall Street, 18th floor, New York, NY 10005, USA. Telephone: (212)
514-5534. Fax: (212) 514-5538.
Development in Practice
[Development in Practice], the multi-disciplinary quarterly
published by Oxfam UK and Ireland, is a "forum for practitioners,
policy makers, official aid agencies, NGOs, and academics to
exchange information and analysis concerning the social dimensions
of development and emergency relief work." Articles reflect "a wide
range of institutional and cultural backgrounds and a variety of
professional experience." Now in its sixth year, the journal has
readers in some 100 countries. The editor welcomes contributions
"from any source, and particularly from development
practitioners...is pleased to hear from previously unpublished
writers, and authors whose first language is not English." The
journal is published in English but will accept manuscripts in
French, Portuguese, or Spanish. Prior to submitting a manuscript,
writers are asked to apply for guidelines from: The Editor,
[Development in Practice], Oxfam, 274 Banbury Road, Oxford OX2 7DZ,
UK. Fax: +44 (0) 1865-312600. E-mail: <oxfamedit@gn.apc.org>. For
subscription information, contact the Carfax Publishing Company at:
PO Box 25, Abingdon, Oxfordshire OX14 3UE, UK. Fax: +44 (0) 1235-
401551. E-mail: <sales@carfax.co.uk>. (In North America: 875-81
Massachusetts Ave., Cambridge, MA 02139, USA. Fax: (617) 354-6875.
In Australia: PO Box 352, Cammeray, NSW 2062, Australia. Fax: +61
(0) 29958-2376.)
Population, Migration Concisely
The United Nations Population Division has produced [Concise Report
on the World Population Situation in 1995], a svelte 44 pages, and
[International Migration Policies 1995], a wallchart. For more
information, contact: Population Division, Department for Economic
and Social Information and Policy Analysis, United Nations, New
York, NY 10017, USA.
Map the World
[The World Bank Atlas 1996], a collection of maps, tables, and
charts, covers three broad areas -- "the people", "the economy",
and "the environment" -- and is organized in three main sections of
the same names. Maps illustrate such issues as population growth
rates, life expectancy at birth, illiteracy rates, gross domestic
product (GDP), share of investment in GDP, annual water use per
capita, and change in forest cover between 1981 and 1990. For more
information, contact your local World Bank office or: World Bank,
1818 H Street, NW, Washington, DC 20433, USA.
=====
> NOTEBOOK
Sins and wins: Selected environmental injustices against
communities, and community-based conservation and development
initiatives
Sins:
Siberia, Russia Logging by Russian, Japanese, South
Korean, and U.S. firms has destroyed the
resource base of the Udege people and
caused severe soil erosion and siltation
of rivers.
Wales, UK Government encouragement of open-cast
coal mining has wrought water pollution
and increased pulmonary disease in local
communities.
Orchid Island, Taiwan A nuclear waste dump has stood here for
13 years, and the drums containing the
waste have begun to rust. In the mid-
1970s, the government had told the Yami
people, who live here and lack formal
education, that the facility they were
building would be a fish cannery.
Oriente region, Ecuador Oil exploitation has devastated the
environments of several Amazonian
peoples, leaving water supplies with 10-
1,000 times the level of contamination
allowed in the U.S..
Mdulumanja, Malawi In 1991, the owner of a hotel on Lake
Malawi evicted an entire fishing village
for the sake of tourist development,
bulldozing more than 70 homes and
offering no relocation plan.
Wins:
Andhra Pradesh, India The Deccan Development Society organizes
village women to establish credit
programmes, cultivate and use medicinal
herbs, adopt organic farming techniques
and multicropping, and plant trees.
Peruvian Amazon The Yanesha Indians run COFYAL, a
sustainable forestry cooperative which
earns them a living from forest product
exports to Europe and the U.S. while
protecting the rainforest from clear-
cutting.
Cairo, Egypt The Association for the Protection of the
Environment coordinates garbage
collectors' efforts to earn a living by
recycling paper, using organic wastes as
fertilizer, and weaving rugs from
discarded scraps of cloth. Mostly women,
the garbage collectors have organized
vocational training and family planning
programmes for themselves.
California, USA In early 1995, the 10 tribes of the
InterTribal Sinkyone Wilderness Council
won back some 1,600 hectares of ancestral
redwood rainforest from the state
government. They plan to create a
wilderness park complete with four
traditional villages, as a model for
sustainable land use.
Nepal The Annapurna Conservation Area Project
involves communities in efforts to
increase tourism's benefits while
decreasing its environmental impact, by
improving local lodging services, using
kerosene instead of trees for fuel, and
enforcing a Minimum Impact Code for
trekkers.
Source: Worldwatch Institute, Washington, DC, [State of the World
1996]. For more information, see "Resources."
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