Category Archives: International

How the Female Condom Can Help the Women of Chile

Huge strides have been made in the understanding of how behavior drives HIV-infection. Notably, much of the coverage of how social constructs (and contexts!) contribute to the epidemic revolves around prevention education in the scope of proper – male – condom use. No doubt, comprehensive interventions in this arena have been instrumental in curbing infections. But it’s worth noting the limitations of this approach given the changing face of the virus.

Chile, a country with a prevalence of 28,963 notified people living with HIV (and an estimation of about twice that actually living with the virus), like many countries, is seeing an increasingly feminized epidemic.

Unfortunately (and perhaps unsurprisingly), most prevention and education frameworks neglect to take into consideration why this is.

In many cases, and specifically in Chile’s, women are contracting the virus via their husbands in relationships presumed to be safe and monogamous, and in which the negotiation of condom use on the part of the woman immediately presumes she is adulterous.

More nuanced approaches to prevention need to be undertaken with the understanding of how relationship dynamics – and the social climate in terms of perceptions of HIV+ individuals – contribute to the spread of the virus.

The International Community of Women Living with HIV/AIDS Chile is doing just that.

ICW Chile primarily works with women who contracted HIV from their husbands, have been subsequently widowed due to the illness, and are now attempting to forge their own way. This is difficult in a place where the stigma of HIV weighs heavily enough for most women to expect job termination if they disclose their status. While treatment is readily accessible – the Ministry of Health provides ARTs for all those in need, an initiative not to be understated – the social ramifications prompt many women to remain silent.

An organization dedicated to education, awareness raising, commemorations, and training in areas of women’s sexual and reproductive health and empowerment (and, importantly, with a board made up entirely of HIV+ women), they are embarking on an undertaking addressing the need for women to be able to protect themselves – by providing them with female condoms.

Female condoms aren’t entirely absent in Chile – but they can hardly be considered accessible when only one organization in Santiago is selling them – at $6 a piece. Of importance to note, they are desired – one organization that represents 2,000 sex workers in Santiago has shared that of the approximately 70 women a week coming to them for contraceptives and protection, female condoms are consistently requested.

The reason? They are often able to negotiate male condoms with clients, but not with their partners or husbands, putting both parties at risk. Female condoms can be inserted before sex by the woman herself, which precludes a negotiation conversation that comes with the use of the male condom (and is often ultimately refused).

This is where ICW Chile comes in.

Female Condom

The ICW Chile has already forged some of the essential partnerships to get this initiative off the ground. Groups like Fundacion Margen (a sex workers’ rights and advocacy group), in addition to their own five sub-regional teams around the country are prepared to help with raising awareness for the campaign as well as actually distributing the female condoms. Two HIV/AIDS organizations and two transgender health groups are also supporting ICW Chile’s efforts, and the Santiago Chapter of the National Women’s Service (SERNAM) has also offered their assistance. Creating a robust community of like-minded organizations, with resources and ties to mobilize is no doubt important here – but without the product, these connections run the risk of withering.

Luckily, one gift that’s helping them get off the ground is from the Female Health Company, one of the two primary female condom manufacturers, which recently pledged to donate 1,000 female condoms to the campaign, an instrumental and desperately needed move.

But it’s not enough.

When you reflect on the numbers above, it’s clear that ICW Chile needs our help in procuring the goods – and we’re going to make it as easy as possible to assist!

The goal is to distribute 30,000-35,000 female condoms in the next six months, and reach out to 60,000 people educationally. Showing a dedicated interest to the Chilean government, by region, and indicating how many people would utilize the female condoms if they were accessible (financially as well as physically!), could help prompt a firmer commitment from the Ministry of Health to provide female condoms on the scale of male condoms.

They’ve set up an Indiegogo page that details what your gift can provide, what you’ll get in return, and some of the important facts we’ve highlighted here. (I’m donating in the name of my mom for Mother’s Day!) They’ve gotten some buzz already, and this is a bandwagon worth jumping on.

I urge you to check out their Twitter and Facebook pages as well, and share widely with your networks. We’ve all seen what social media networks and crowd-funded projects can achieve, and I can think of no better project right now needing our crucial support.

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Filed under Epidemiology and Population Health, Feminism, Health Behavior, Health Education, International, Public Health, Reproductive and Sexual Health, Women's Health

Fostering Social Entrepreneurship in Rwanda

This post also appears on the Spark blog. It serves as a profile of one of Spark’s most recent grantees, an organization I happily support, The Komera Project.

It’s not every day that you get to see the foundations of graduate school flourish into a burgeoning non-profit organization halfway across the globe. So, when one of my close friends from graduate school told me in 2008 that she was starting an organization in Rwanda where she had been living, I was of course eager to support her. And the more I learned about Rwanda and the work her organization was undertaking, I became invested in seeing its success grow.

Named The Komera Project (in Rwanda the word “Komera” means “be strong, have courage”), Margaret Butler developed the idea to start the group over the course of her many runs through the Rwandan countryside. She noticed that sometimes girls from the local villages would jump in and join her on these runs until she realized that her behavior wasn’t going to be considered socially acceptable. Combined with the fact that Margaret was seeing first hand how most girls did not make it to secondary school, she decided to host a girls-only ‘fun run’ one day to promote the education and rights of these girls. As they started off, supporters shouted “Komera!” to the girls, and the group was born.

Image

Working with the local government, schools, and some on the ground staff from Partners in Health based in Rwanda, Margaret steered the first of Komera’s 10 girls onto their fully funded secondary education path. Komera has since grown to over 60 scholars, and has expanded their reach beyond just funding the girls’ schooling. They now also provide mentorship, a leadership program, and now a social entrepreneurship program.

Some context and understanding of Rwanda is essential to underscore how significant this is. Only 17% of girls in Rwanda go to upper secondary school (high school). 87% of the country lives in rural areas. All Komera scholars are from these rural areas and live on about $1 a day from families working as subsistence farmers or tin miners – so these girls would be farming, mining, and/or working in their households if not in school. Komera focuses on supporting the girls in grades 10-12, since the majority of girls begin dropping from school in grade 10. Komera never takes on a scholar unless they have the cash to fully fund them for those three years – this cost is $500 a year for tuition, uniforms, boarding, all school supplies, and personal supplies like hygiene products.

By 2010, the focus at the Komera Project had shifted from primarily scholarship to figuring out how to keep the girls in school and create a real Komera community, and that’s when the themes of mentorship and leadership came into play.

The transition into boarding at school can be really difficult for the girls, especially since they are spread between 13 different schools. In Rwanda, once you have the funds to pay, the local government decides what school you will go to, so while Komera would prefer all the girls to be in the same 4-5 schools, that isn’t possible. However, they are all in the same district (there are 30 districts in the country total).

To help combat some of the difficulties around these transitions, Komera provides school-based volunteer mentors for all the girls – female staff or teachers who meet one-on-one with the scholars every week. They actually use curriculum to cover topics like health education, financial literacy, what their rights are as women in Rwanda, to any personal concerns they may be having. The girls also meet with the Komera social worker (one of only two paid Komera staff members!) regularly when she visits each school throughout the year. Their next goal is to launch a university mentoring program, and they have started to do some outreach to universities in Kigali (the Rwandan capital) to see if there is interest among Rwandan university women to mentor these girls.

Leadership is another key component of the Komera Project. The Komera scholars attend Leadership Empowerment camp during their month-long summer break, where they take part in the now-annual Girls Fun Run and participate in workshops focused on topics like English-speaking skills, how to use computers, and sex education. These have been essential for the girls, because these month-long breaks can be vulnerable times for the girls who go back home. Most stay with extended family, get pulled back into working with the family and can potentially be convinced that they need to leave school – especially true for the nearly 20% of girls who come from families who don’t fully support their education efforts.

In regards to the new Social Entrepreneurship Program that Spark is helping to support, most recently the idea of sustainability has come up – how does Spark keep the momentum of being a Komera Scholar going once the girls graduate from secondary school? This was particularly pressing since 15 girls will be graduating in 2013.

The girls had been requesting a social entrepreneurship type training for some time – wanting to learn the skills necessary to starting and maintaining a business, a non-profit or grassroots venture. When asked about social entrepreneurship training, all the girls said that they had never even considered how they might be able to give back to their community or considered themselves leaders, and they were really excited about the idea of learning how to create something to benefit and incorporate their community.

The winter break, in November-December hasn’t been able to be filled by Komera because they haven’t been able to fund camps both in May-June when they have the leadership and empowerment camps as well as during the winter months. Finding funding for this new social entrepreneurship training became essential, as well as a way to get a tested and evaluated curriculum in their hands.

A local Rwandan group, Global Grassroots, has been offering entrepreneurship, business training, and skills-based workshops for women in Rwanda since immediately after the genocide – and they’ve been doing so pretty successfully. They have agreed to modify their program for a weeklong intensive program for teen girls, as well as moderate the weekly follow-ups. This will be called the “Girls Academy for Global Conscious Change.”

The girls will work in groups of ten, separated by interests – they’ll select a topic they want to focus on, like health, education, water, and they will learn how to craft a mission statement, develop a program goal and implementation plan, and how to write and follow a budget. They will be given small grants of $50, which will be managed by the social worker and through each phase can retrieve part of the money for supplies, then implementation or advertising. The goal is to have them create these mini-organizations and incubate them throughout the school year, with the hope of maintaining it beyond that year, turning it into a profitable business, and growing it beyond their immediate school community.

When I heard that this was their well thought out plan, I thought Spark would be the perfect place for Komera to seek funding help to cover the costs of the girls supplies, food, transportation, and personal supplies throughout the training. The perfect way to blend two of the organizations that are most dear to me.

The Komera Project embodies the exact kind of values and practices that Spark looks for in grantees, and I look forward to what these budding entrepreneurs are up to in just a few years.

Check out their Facebook and Twitter pages, and visit their site to learn more about Komera and meet some of their scholars.

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Filed under Education, Feminism, International

Countries Facing a Critical Healthcare Worker Shortage

A fantastic interactive graphic by the Guardian highlights which countries are in the most dire straits. Check it out here, and hover over a country’s name to get the statistics.

Some of the facts I found most interesting:

The Democratic Republic of the Congo has one physician and five nurses per 10,000 people and the infant mortality rate is 199 deaths before age five per 1,000 births.

Tanzania has less than one physician and two nurses per 10,000 people and an infant mortality rate of 103.

Chad also has less than one physician and three nurses per 10,000 people, and an infant mortality rate of 209.

Highest infant mortality rate? Afghanistan.

Check it out.

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Filed under Epidemiology and Population Health, International, Public Health

Integrating Family Planning and HIV Services Benefits All

Some pretty great research is cropping up at the 2012 International AIDS Conference, and it’s hard to pick just one finding to reference, but I do love infographics and I do love family planning – so I found something that combines the two! Population Action International, a truly fantastic research and advocacy organization focused on women’s reproductive health access and care, and they make a great point about the advantages and importance of providing both family planning and HIV services at the same time and in the same place. They point out that mother-to-child HIV transmission can be reduced, stigma may decrease, and both time and money are save. Take a look:

Combining HIV and family planning services (courtesy of Population Action International).

Another issue at hand is that of the relationship between a provider and a patient or client. Family planning clinics have a better chance of establishing long-term relationships with women – particularly if women have multiple children – given that they also sometimes aid in pre- and post-natal care or help connect women to those services, which increases the likelihood of women who test HIV+ to getting the treatment they need. Again, all in one place!

Follow along at #AIDS2012 on Twitter to stay abreast of everything going on in D.C.

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Filed under Health Education, International, Public Health, Reproductive and Sexual Health, Women's Health

Maternal Health and the Status of Women

Both globally and domestically, maternal health and the standing of women are inextricably linked. If women do not have the means and access to give birth safely, with trained and educated midwives, physicians and nurses, with appropriate prenatal education and care, it is often indicative of the standing of women in their communities and countries overall. Women’s inequality is also linked to the soaring population growth in developing countries, which will pose a range of new challenges for the next few generations.

Some may point to the United States as an anomaly, citing women’s increasing economic and financial independence, education, and leadership roles in America, while in terms of maternal health rankings, we remain pathetically far down the line for our resources (49 other countries are safer places to give birth than the U.S. – despite us spending more money on healthcare than anywhere else). Of course, the recent and incessant attacks on allowing women to access credible, accurate, up-to-date and comprehensive sexual and reproductive health education and services makes this statistic not entirely…surprising, shall we say.

So, I found the incredibly detailed and visually impressive infographic by the National Post, pulled from spectacular data and research done by Save the Children to be particularly fascinating. What they did was combine information on the health, economic, and education status of women to create overall rankings of the best and worst countries for women, splitting the countries into categories of more developed, less developed, and least developed, and the countries were ranked in relation to the other countries in their category (the divisions were based on the 2008 United Nations Population Division’s World Population Prospects, which most recently no longer classified based on development standing). While these divisions and the rankings can certainly be contentious and may incite some disagreement (nothing unusual there, these kind of rankings usually are), I thought the results were interesting. Some highlights – Norway is first, Somalia is last. The United States was 19th, and Canada was 17th (Estonia fell in between us and the Great White North) in the most developed. Israel is first in the less developed category, and Bhutan is first in the least developed category. The full report with data from Save the Children is also available, if you want to learn more about the information combined to make this image. Take a look:

A Woman’s Place – Courtesy of the National Post

One thing that I thought was particularly great was that the researchers combined women’s health and children’s heath data to create rankings specific to being a mother, when that category is sometimes only assessed based on access to reproductive care.The specific rankings of maternal health highlights largely mimics the overall standing of women, as seen here – Norway is number one, again, and Niger falls into last place:

Mother’s Index, Courtesy of Save the Children

I think these images and graphs are particularly moving given one of the top health stories coming out of the New York Times today, which showed that a recent Johns Hopkins study indicated meeting the contraception needs of women in developing countries could reduce maternal mortality (and thereby increase the standing of women in many of the nations doing poorly in the above ranking) globally by a third. When looking at the countries in the infographic that have low rates of using modern contraception and the correlation between that and their ranking in terms of status of women, it’s not surprising what the JH researchers found. Many of the countries farther down in the rankings have rates below 50%, and for those countries filling the bottom 25 slots, none of them even reach a rate that is a third of the population in terms of contraceptive use – which of course in most cases has to do with availability, not choice. Wonderfully, the Gates Foundation yesterday announced that they would be donating $1 billion to increase the access to contraceptives in developing countries.

Also of note, and in relation to maternal and newborn health, is a new study recently published by Mailman researchers that showed PEPFAR funded programs in sub-Saharan Africa increased access to healthcare facilities for women (particularly important for this region, as 50% of maternal deaths occur there), thereby increasing the number of births occurring in these facilities – reducing the avoidable (and sometimes inevitable) complications from labor and delivery, decreasing the chance of infection and increasing treatment if contracted. This has clear implications for children as well (and why I think this study relates to the National Post infographic and the NY Times article), since newborns are also able to be assessed by trained healthcare workers and potentially life-threatening conditions averted – including HIV, if the newborns have HIV+ mothers and need early anti-retroviral treatment and a relationship with a healthcare worker and system. And it goes without saying that if a new mother is struggling with post-delivery healthcare issues, including abscesses and fistulas, or was dealing with a high-risk pre-labor condition like preeclampsia, the child will have an increasingly difficult early life, perhaps even a motherless one.

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Filed under Child Development and Child Health, Health Education, International, Politics, Public Health, Reproductive and Sexual Health, Women's Health

Child Mortality – What Are the True Biggest Causes?

A great image from Population Services International‘s most recent issue of their magazine, Impact, from the cover article written by Desmond Chavasse, Ph.D, Vice President, Malaria Control & Child Survival, PSI, about causes of child mortality globally.

Causes of Child Mortality – Image courtesy of Population Services International

One of the purposes of the image, of course, is to show the stark contrast between directed funding for treatment and eradication of certain diseases and the number of children afflicted with these illnesses. How does this impact our understanding of global health and of the marketing around certain hot topic health issues and ways in which donors feel as though they are contributing to a decline in preventable deaths?

When I worked in development for HIV/AIDS organizations, it was fascinating to speak with donors about their reasons for giving and their understanding of the prevalence and incidence (and the general audience grasp of the word incidence, which is the measure of risk of contracting a certain illness or disease within a specified time frame) of HIV. Contrast this with the understanding of malaria, TB, diarrhea, deaths due to childbirth complications (for the mother and the infant), and the gap between perception and reality was startling. In no way do I want to deny the importance of consistent development support for all diseases on a global scale, but I do think there is something lacking in terms of the education around these issues for donors and even some advocates.

Solutions? Come chat with me on Twitter.

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Filed under Child Development and Child Health, Health Education, International, Public Health

The Changing Face of Development in the Fight for Gender Justice

As International Women’s Day approached, I was thrilled to attend a panel at the United Nations, “Youth Approaches to Funding Gender Equality and Women’s Human Rights,” with the Executive Director of an organization I am very excited to be a part of, Spark, as one of the speakers. Shannon Farley was joined by Mia Herndon from the Third Wave Foundation and Amina Doherty from the Young Feminist Fund. These dynamic leaders provided what turned out to be unique though complementary perspectives on engaging youth in development strategies, and I came away feeling revitalized and encouraged that Spark’s work is at the forefront of essential evolution in philanthropy and development.

While powerhouse young women lead each of these organizations, their differences should be noted. Spark, at 7 years old, is the middle child of the organizations, and the only one that operates within a member-driven framework, allowing those active members to vote on grantees and possible themes. Granting more than $1 million since its inception, a great feat since most gifts are seed money of the couple thousand dollar range, Spark’s offering of extensive pro-bono services to granting organizations also sets us apart – that and statistic of having nearly 50% male members. FRIDA is the new baby in the gender equality, women’s rights development world, and they interestingly refer to themselves as a “learning fund,” as each organization that applies for funding does some fairly in-depth research on other groups with whom they are competing for funds. Of the more than 1,000 applications from over 120 countries this year, FRIDA selected 125 ‘short-listed’ groups who then voted for a group in their region other than themselves who they felt deserved the grant based on their work and application. Lastly, the Third Wave Foundation, which has been around for 15 years, funds work that benefits 15 – 30 year-old women and transgender youth. They emphasize leadership development and advocacy, and given their size, are also able to offer multi-year ‘arc’ grants, supporting groups as they get off the ground, giving them a big financial push during subsequent cycles, and tapering off as the group begins to grow.

Despite these differences in age, funding history, and model of grant making, one can see the overlaps. My favorite element of the panel was discovering throughout the presentation how similar the roots of the missions of these groups are – interactivity, democratic funding policies, involvement of the grantees and groups for whom they are advocating, and leadership that represents the interests of the grantees. Each of these groups – and this is what I think draws many to Spark in the first place – emphasizes the input of passionate members or supporters who are emotionally and mentally invested in working for justice, and who may have previously been rebuffed in other volunteer development efforts. Equally important, they value the participation of those on the ground seeking to be funded. Panelists actually articulated how important the flow of communication was in the funding process, not only to ensure that the funding organizations were really sound in their understanding of the grantees, but also so the beneficiaries feel as though they are being heard and understood throughout the process. This is actually fairly empowering. This kind of communication between funding agencies and grantees used to be unheard of – grant applications would be filled out on one side, and grant-making decisions would be made on the other side, often with grantees not feeling as though they were making meaningful connections with funding organizations that would enable them to better articulate their needs.

These newer models can bring up questions of validity for some, and this query was posed by an audience member who asked the panel about issues of monitoring and evaluation (M&E), and how that was considered within these newer frameworks. This garnered perhaps my favorite answer, which was that one of the ways M&E can be handled is by changing the definition of what a successful program or initiative looks like. One of the ways these newer development organizations does this is by defining at the outset what success looks like to the grantees and how that will be measured, and emphasizing those goals in the evaluation process as opposed to adhering to strict, traditional methods that may not be appropriate measures for many of the newer, innovative groups that are seeking funding.

Piggybacking on this part of the conversation, panelists were asked about what they saw as the primary benefits and drawbacks of not working within the more traditional development models. Luckily, and unsurprisingly, these leaders focused mainly on the positive. Working within newer models allows them to take risks; to explore relationships with new groups and leaders that older, more established organizations may not have the time or framework to take on; and to nurture long term relationships with groups that can use the leadership guidance and seed money granted by organizations like Spark to get off the ground and be ready to present themselves to progressively larger funds. Essentially, these groups – Spark, the Third Wave, and FRIDA – are building a foundation to get a foot into the door of the local and global conversations about eradicating injustice for groups that may have been historically overlooked.

As the landscape for women’s rights and gender disparities shifts, this kind of risk-taking is essential in assisting burgeoning efforts of organizations that may have been traditionally ignored.

While each of these organizations emphasized the need for young women’s leadership and articulated how their models centered on the unique and essential perspectives of young leaders, the speakers also championed the importance of inter-generational work. When concern was raised by an audience member over being dismissive of the work of older activists and development organizations, panelists were adamant about the fact that their communities were grateful for the work that had come before them, and the wisdom that is often culled from creating partnerships with leaders who have been involved in gender equality development work for years.  The experience of these more senior leaders is not only valuable in gaining insight into what isn’t working and why within traditional giving pathways, but collaborating with them often leads to grant-making opportunities for these newer funding organizations. Shannon’s remarks specifically about how larger, older funds had passed on applications to Spark that are more suitable for our funding model than theirs was met with nods of appreciation from many in the audience – an audience that was in and of itself diverse in age and funding experience. And of course, having big voices in the field champion the work of newer organizations for their innovation certainly doesn’t hurt when trying to increase our donor circles.

I encourage my readers to check out Spark, and consider becoming a member. It’s an incredible organization that offers great opportunities for young leaders to get involved. In light of International Women’s Day, I’d also encourage you to check out these other fantastic on-the-ground groups doing fantastic work for gender equality and justice (some of them Spark grantees!):

The Komera Project: Education for girls in Rwanda, financial and mentoring assistance, started by Margaret Butler.

CAMFED: Investing in girls’ education in Africa

She’s the First: Education investment in the developing world

Plan International: Children’s rights and development around the globe

No coincidence that these organizations tend to focus on education access! Have organizations that you’re passionate about and want me to include in this list? Send ‘em my way!

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Filed under Defining Gender, Education, Feminism, International, Politics

Reader Roundup (It’s Been a While…)

I am currently very guilty of completely falling behind on my (totally self-prescribed) schedule of at least weekly, hopefully twice weekly, original writings. I’m in a major data analysis crunch in my dissertation, and the stats interpretation is taking up a healthy number of my hours everyday. That being said, I’ve tried to keep up with my reading schedule, and with that in mind, I’ve done a little round up of some great articles I’ve read in the past couple weeks that I think some of my readers might enjoy. Without further ado:

For those of you interested in adolescent development, the Wall Street Journal had a great article about how the teen brain works, and how it’s changed: What’s Wrong With the Teenage Mind?

ESPN had a section on their website specifically devoted to viewers being able to comment on how much they hated female commentators. So, there’s that: ESPN Allowed People to Complain About ‘Female Commentators.’

Great details from the Huffington Post about what is at stake in an election year for women’s health, and how women’s health is used as fodder for politicos: What Does an Election Year Mean for Women’s Health and Rights?

Gail Collins, who I am a huge fan of, takes this to task as well, questioning how the allowance for employers who oppose birth control to deny coverage for female employees can be seen as a risky precedent: Tales From the Kitchen Table

Mother Jones, with excellent reporting as always, details The Republican War on Contraception – it’s even more frightening when all the facts are compressed into one terrifying testimony.

The International Center for Research on Women has a new series: HIV and AIDS: Are We Turning the Tide for Women and Girls? The chronicle case studies of women driven efforts to prevent HIV infection, projects that adapt to the need of the communities they work in (I’m always amazed that this essential element of global development remains sometimes misunderstood and underestimated), and innovative new endeavors is some great coverage on current global health initiatives aimed at reducing HIV infections and AIDS progression.

What interesting pieces have you read lately?

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Filed under Child Development and Child Health, Education, Feminism, Health Education, International, Politics, Public Health, Sexism

I’m Rarely Speechless.

But I was reminded of an instance this past fall when I was. You know what’s one of my least favorite things to witness? People in positions of power, authority or supposed trust mocking those who come to them for help, advice, guidance, or wisdom. Last year, there was a pretty striking example of this in Spain, which got a fair amount of attention abroad but received minimal coverage here in the States. It was brought to my attention by Stephanie, and I’d shelved it for a few months since I had a lineup of things to chat about, but it most definitely deserves attention. I will say that this is old news, and I usually try to only post about current events – but it’s only old news in the world of Internet, as it happened a few months ago (September-October 2011). I think the issues it brings up are obviously still relevant and the fact remains that it never should have occurred to begin with.

The Spanish Society of Obstetricians and Gynecologists published a comic strip in their newsletter depicting images of physicians mocking patients – the physicians are always male gynecologists, and the patients are always female, and always drawn as unattractive with exaggerated features and shown with enlargement of their reproductive organs and functions. The comics mock women for uterine prolapses, for being informed about the birth process, for wanting to following non-interventionist labor procedures, imply that sexual interest is behind a doctor pap-smearing a patient every three months, mock elderly women and portray women with questions as insufferable. The link to the images is here (you will have to select that you want to see the pdf in the upper right corner of the page) – but I want to give warning that the images are graphic and can be extremely insulting. The words are in Spanish, but even if you don’t have elementary skills in the language the images do a pretty sufficient job of getting the message across.

There was obvious outcry, and petitions passed by many, to denounce the comics and ask them to be removed. But I remain absolutely flabbergasted that these were ever drawn at all, much less published by an organization that ostensibly commits itself to women’s and maternal health. Communicating with one’s physician is difficult enough for many people (men and women alike), and by publishing this, the SSOG has confirmed what are the worst fears of many – that their doctor doesn’t respect them, thinks they are foolish, thinks that their reproductive health needs are disgusting or gross, assumes sexual activity equals promiscuity, dismisses them if they have questions or are informed, that their doctor finds alternative therapies laughable and unsound, and that they as patients do not deserve to be treated with dignity – not to mention reinforcing the age-old stereotype of male gynecologists being driven by sexual interest instead of scientific, medicinal inquiry (and in this instance, the woman on the receiving end of a doctor’s inappropriate pursuits lauds HPV as a virus community comprised of an elite ‘club’ of women who are sexually active). It is particularly trying that the implications of the  gender binary here was so clear – the males were the physicians, in charge, in the know, firmly in the power position, and the females were weak, uninformed, unaware, and their reproductive health was repellent and the stuff of slapstick humor. It’s just an egregious example of an abusive power dyad.

This kind of impression can completely shut down any channels of communication, limiting the physician-patient relationship in its ability to be a health education opportunity, an encouraging behavior change environment, and most importantly, a place of trust and confidence. I wanted to highlight this issue mainly because of these points – that the physician-patient relationship has always had real promise, but that it cannot be effective if it isn’t mutually respectful and the patients aren’t seen as worthy of having dignity. That this was published in 2011 is to me a devastating indication of how in some areas, this seems very far off.

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Filed under Defining Gender, Feminism, Gender Stereotyping, International, Public Health, Sexism

Feminism in Zambia: Finding an Unexpected Champion

Our last guest post this month is by Stephanie Reinhardt. Stephanie is a Program Officer with Jhpiego and is currently working to support HIV/AIDS and maternal health programs in east and southern Africa. Growing up in San Francisco and joining forces with Larkin Callaghan at the age of 4 has left her overly opinionated and easily distracted by all the exciting things around her. Hey look – a baboon just walked by my office window! When she’s not bouncing around the globe, she’s very busy procrastinating.

Gabriel, a Zambian taxi driver who works outside an overpriced hotel in the capital Lusaka, drove me to a township on the outside of town last week. We started with the usual conversation.

“Where are you from?” he asked.

“California,” I responded, “though I’m starting to feel like Zambia is my second home”.

I’ve been to Zambia six times in the past four years supporting public health programs run through Jhpiego, an affiliate of Johns Hopkins. After some discussion about various locations in the US he had learned about from other passengers, he jumped into his favorite story about American history to see if I knew it as well.

After slowing his taxi to traverse a particularly rough patch of potholes, Gabriel looks at me and said, “Well, you know about the Gremich sisters?” (Upon further research, I learned the correct spelling of Grimké sisters). I shook my head no, which gave Gabriel the green light to dive into his story:

“During the time of slavery in America (perhaps in California, or Texas or wherever), there were two sisters who wanted to put an end to slavery.”

I jumped in to briefly describe (with my best recollections from high school) the divisions between the north and the south that eventually led to the civil war, which I explained, for future reference was on the east coast of America, so I would guess that the Grimké sisters were probably from a state like New York. (Turns out they were from South Carolina, but later joined abolitionist circles in Philadelphia, New York and New Jersey.)

Gabriel gave me a polite nod, but the civil war was clearly not his target conversation. With the eagerness of a school kid sitting in the front row, he continued his story, which he credited to a book he had read called, No Fear of Trying. Gabriel’s eyes grew large as he told the story of these sisters’ amazing bravery to publicly speak out against slavery. He looked at me and repeatedly tapped the top of the steering wheel with his palm to emphasize the profundity of this story. “These were the first women to speak at a podium…to men. Women did not do that at that time.” He described the message of equality and freedom that they took all the way to the US government. “People thought that women should not give public speeches to men. Lots of people threatened them and told them to stop, but these women were so brave, ” he continued. I was nodding in agreement, but apparently not giving the reaction he wanted.  “Isn’t that amazing?” he exclaimed. “It’s great!” I responded.

Despite a few factual inaccuracies (that the Gimké sisters final speech ended slavey, and this all took place in the 1950s), Gabriel’s story is pretty spot on. The Grimké sisters grew up in South Carolina with all the advantages of a privileged class awaiting them.  Unlike many other northern born abolitionists, the Grimké sisters had seen slavery first hand and felt compelled to not only put an end to the practice, but to put an end to racial and gender discrimination – an idea radically progressive for their time. They promoted extremely advanced messages for both racial and gender equality. Angelina Grimké letters demanded “educational reform, equal wages and an end to other forms of discrimination against women.”

What fascinated me most about Gabriel’s story was not that I was previously unaware of this significant historical biography (I am never shocked by the amount of information I don’t know or frankly, don’t remember). Rather, I was completely taken aback by his emotional response to this story. He loved these women for their bravery to stand up to men and wanted to share it with anyone who got in his cab.

Zambia is not a country known for its progressive gender relations. Women unfortunately still live very much as the mercy of their husbands, cultural laws and the State. As explained in a 2002 OMCT report on violence against women in Zambia:

Women in Zambia currently face many obstacles to the realisation of their human rights including high rates of violence against women in the family, in the community and by the State, discrimination in the application of customary laws relating to family and inheritance rights, low levels of representation in political and other decision-making structures, a lack of access to education and employment opportunities, poor health care services and the limited availability of affordable contraception.

The 2007 Zambian Demographic Health Survey (DHS) included an assessment of women’s empowerment by asking questions on employment and decision-making.  While great variations exist with regard to education level and location, overall 37 percent of men think that decisions about how to spend the wife’s cash earnings (if she has employment outside of the home) should be made mainly by the husband.  These views extend to a woman’s body as well – 46 percent of men think that the husband alone should make the decision on the number of children to have.  Only 64.8 percent of currently married women responded that they are the primary decision makers or make joint decisions with their husbands regarding their own health care.

So, given this context, I was baffled. I wondered if I had stumbled into the cab of an outspoken Zambian male feminist. As Gabriel’s taxi approached our destination, I probed him on his thoughts on women’s rights in Zambia. “Oh,” he responded, “we have learned a lot from Americans. Everyone is equal here.” Then he dropped the famous development buzz word “gender” and it was all over. “Yes, we have learned gender is important, so now we are all equal.” Ack.

I was hugely disappointed. My image of this Zambian male taxi driver in a superhero outfit championing women’s rights quickly vanished. I thanked him for the ride and started to get out of the car. As I was about to depart, he pulled out a small piece of paper and said, “You work in health? Can I ask you a question?” I nodded, and he continued: “My wife has decided that we should only have three kids, and so we want to stop now that we have three. Can you look at this list and tell me what you would recommend?” On the piece of paper was a list of family planning methods that they had received from their local clinic. I sat with him and explained the differences between some of the short term methods and the long term methods. I also described the vasectomy process should he be interested in the procedure. I explained that if his wife wants no more kids, a long term method, such as an IUD might be best, as it offers protection for 5-7 years. He smiled and responded, “Great, thank you. I will tell my wife this information and see what she wants to do.”

Maybe we have our champion after all.

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Filed under Feminism, Health Education, International, Public Health