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“It was Worth the Sacrifice:” Kenya’s Dr. John Nyamu on Why He Spent a Year in Prison

1:59 pm in Uncategorized by RH Reality Check

Written by Mary Fjerstad for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Cross-posted with permission from Ipas.

This article was also published in Medical Abortion Matters (November 2012).

Until 2011, abortion was illegal in Kenya except to save a woman’s life. For years the climate of fear and secrecy surrounding abortion hurt women, their families, and health-care providers. Unsafe abortion in Kenya still causes an estimated 30 percent of maternal deaths and countless other injuries.

Now, a newly ratified Kenyan constitution allows for legal abortion on much broader terms — and, when the new law is fully implemented, it stands to dramatically increase women’s ability to exercise their reproductive rights.

Ipas’s senior clinical advisor Mary Fjerstad recently sat down with Kenya’s much-respected Dr. John Nyamu to discuss the long and difficult path he and so many other Kenyans have traveled to get where they are today.


Mary Fjerstad: Doctor Nyamu, would you tell me what the situation was like in Kenya when abortion was considered a criminal act? [Editor's note: Before constitutional reform, abortion in Kenya was highly restricted with few legal indications for having the procedure.]

Dr. John Nyamu: Most health-care workers were afraid of talking about it openly. Abortion was never performed in government hospitals unless the life of the woman was in real danger. Even then it was very bureaucratic as one doctor could only do the procedure with permission in writing from two other doctors; one doctor had to be a psychiatrist and the other doctor had to be a senior doctor in the hospital. Abortions were performed by D&C or induction. In reality, these legal abortions were provided almost exclusively at Kenyatta National Hospital, provincial hospitals and very rarely in district hospitals. (Kenyatta National Hospital is the major teaching hospital in Nairobi).

There were wards in hospitals where women who had unsafe abortions were treated for uterine and bowel damage due to perforations and developed sepsis, brain damage and many women died.

There was tremendous secrecy about abortion, women were aborting late. The penalty for a doctor who performed an [illegal] abortion was 14 years [in prison]; pharmacists could be imprisoned for three years for giving abortifacient medicines and women themselves could be imprisoned for seven years for having an abortion.

Some private clinics were providing safe abortion. They were harassed regularly by local police, usually by extortion. They were used virtually as the personal ATMs of the police [ATM = Automatic Teller Machine, a banking machine from which you can withdraw cash using a bank card]. A policeman would say, “I’m short of cash, give me your cash or I’ll arrest you.” The entire staff, including nurses, doctors and women seeking abortion could be arrested. Due to the fear, the providers kept servicing [the police] to buy their freedom.

Your case was profiled by The Center for Reproductive Rights’ paper in 2010, “In Harm’s Way: the Impact of Kenya’s Restrictive Abortion Law.” Can you briefly describe what happened to you that led to this paper?

In 2004, [data were shared] which showed worrying trends and consequences of unsafe abortion in Kenya. This was followed by a major crackdown on clinics, hunts for women who had abortions, some clinics were closed and I was targeted. There were 15 fetuses found along a major road with some documents from a hospital I had worked at previously but had since closed. My clinic was raided and two nurses and I were arrested. This appeared to have been very well organized with all the media including print, radio and TV present to report on the matter.  When we were asked to pay bribes, we refused — because we knew the fetuses were not from our clinic and the documents were planted on the road — and we were locked up. [Editor's note: subsequent pathology examinations found that the fetuses were still-born fetuses, not aborted fetuses.]

The three of us were ultimately charged with two counts of murder, rather than an abortion-specific offense. Since murder is a non-bailable offense in Kenya, we had to stay in remand prison pending our trial. We all spent a year in prison. One of the nurses was six months pregnant and delivered while she was in prison. One of the nurses still works for me and the other got her green card and has since immigrated to the United States.

A senior doctor, a gynecologist, was instructed by the Director of Medical Services of the Ministry of Health to accompany the police and inspect the two clinics operated by Reproductive Health Services. The purpose of the inspection was to verify if there was any abortifacient equipment. He gave witness in court that the two facilities had legal equipment normally found in a gynecologist’s clinic and he would be surprised if he did not find it as he uses the same equipment for his work. The police forensic department was asked to look for DNA on the equipment from the clinic. DNA was taken from any instruments or equipment with blood on them — even the couches and lab coats were confiscated. The results from the government chemist found that there was no DNA linkage between the fetuses found on the road and any blood specimens from the clinic. The doctor also found that the clinic was duly registered and all staff had proper and up-to-date licenses.

The case was eventually ruled as improper [Editor's note: They were acquitted of all charges]. With that ruling, the attorney general decided not to pursue prosecution due to lack of evidence.

Was it horrible being in prison for a year?

Yes, it was horrible, but it was worth the sacrifice. I was held at the Kamiti Maximum Prison, which is where the hard-core criminals are remanded. I was confined in a small cell for a whole year. I really felt persecuted, but as I said, it was worth the sacrifice.

Why do you say it was worth the sacrifice?

My arrest and imprisonment was in the media virtually every day. The publicity was an opening for people to realize the magnitude and consequences of unsafe abortion in Kenya; women were dying in great numbers. Before that, abortion was never spoken of in public. There are only about 250 OB/GYNs in Kenya; some districts have none. The media sensation from this case galvanized the Kenya Obstetrical and Gynaecological Society (KOGS), the National Nurses Association of Kenya, the Federation of Women Lawyers, human rights advocates, women’s rights organizations and many others to form an alliance of reproductive health rights advocates.

This alliance exists to date and is known as the Reproductive Health and Rights Alliance (RHRA). The RHRA is an advocacy platform to agitate for the reduction of maternal mortality and morbidity due to unsafe abortion. This alliance also offers technical support to abortion service providers through Reproductive Health Network (RHN). The public became aware of abortion and the toll of unsafe abortion. The window was open to the public to realize the terrible toll of unsafe abortion in Kenya.

This debate extended to the drafting of a new Constitution in 2010. The Constitution says that “every person has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care.”

My arrest, imprisonment and [the resulting] publicity generated a public awareness that led to a transformation in the understanding that safe abortion is essential to preventing maternal morbidity and mortality.

Is there any further action in your own case?

Yes, I have since sued the government for malicious prosecution and subsequent confinement for one year in remand prison. The case has been in court for the last six years without yet being assigned a hearing.

What does the expansive definition of health in the new constitution mean in terms of when an abortion is considered legal?

Abortion is legal if the pregnancy endangers the life of the woman; as an emergency treatment; or when it endangers health, with health defined broadly: physical, social and mental. If in the opinion of a trained health professional an abortion is provided in good faith (in other words, where the pregnancy jeopardizes the woman’s physical, social or mental health), it is legal. [Editor's note: Under the new law, a woman can make her abortion decision with one health-care provider; others are not required to be involved or sign off on the decision.]

What categories of health-care providers can perform legal abortion?

Physicians, nurses, midwives and clinical officers [who have completed training to perform abortion services] can now perform legal abortions.

What are the next steps in transforming the policies to establish safe, legal abortion in Kenya?

Ipas and other organizations took the lead in writing a document called, “Standards and guidelines for reducing morbidity and mortality from unsafe abortion.” The title is taken from a similar document from Zimbabwe and is brilliant. Kenya, like other countries, wants to achieve the Millennium Development Goal of 75-percent reduction in maternal mortality; this can’t be achieved if safe abortion isn’t available.

The other milestone on transformation is the revision of codes of ethics and scope of practice for all the professional associations in Kenya. These have been done and are waiting to be launched.

This transformation to legal abortion access in Kenya is a testament to very brave, inspired people dedicated to the common good who have sacrificed a lot. How have all the changes we’ve discussed affected providers of safe abortion and women?

Providers are now aware of the enhanced protections that have been offered by the constitution. This in turn has increased access to safe abortion services and thereby enabled women to realize their reproductive health rights. In addition, incidences of provider harassment are now on the decrease.

 

Crazy About Contraception (One Way or Another)

11:32 am in Uncategorized by RH Reality Check

Written by the IPPF Live for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Published in partnership with the International Planned Parenthood Federation (IPPF) Live blog.

When it comes to contraception, if you only ever listened to some of the nation’s more eccentric political operators, you might think American attitudes just a tiny bit odd. Not wishing to offend anyone, of course, but you could try these pronouncements for size:

“Back in my day, they used Bayer aspirin for contraceptives. The gals put it between their knees, and it wasn’t that costly” (great gag).

“Contraception is a licence to do things in a sexual realm that are counter to how things are supposed to be” (and how are things “supposed to be” precisely?).

And of course, as one famously liberal-thinking radio host opined, any woman who supports free access to contraception is clearly “a slut and a prostitute.” (Ah, maybe you’ve got some unresolved psychological issues there, my friend?)

The above comments come from men (presumably when they were chatting over dinner with a T.Rex and a Brontosaurus). However, what will have passed them by is the post-Ice-Age historical story, which shows how contraception can change (and is changing) the world.

Like all good stories, it begins with “once upon a time.” Once upon a time, women’s capacity for education, economic empowerment, and domestic and political independence was truly stymied by the demands of giving birth and raising (maybe) a dozen children on scant resources. Men, as a result, enjoyed more or less absolute power in legal and social affairs. But these days the story is (slowly) shifting.

The facts and figures from the United States demonstrate the power of contraception to change a society.

Pre-contraception (made widely legal in 1965), men greatly outnumbered women in U.S. colleges (65-to-35). Today, women outnumber men (57-to-43). Pre-contraception, there were no female CEOs of Fortune 500 companies. Today there are 18. Pre-contraception, there were 20 women in the House of Representatives, and one female senator. Today, there are 76 and 17, respectively.

If a sad and stark counterpoint to this tale is required, consider this: Countries with low contraceptive usage have the lowest levels of female literacy. Countries with the highest fertility rates have the highest poverty rates, the lowest female life expectancy, and the fewest female rights. And so … one in eight Sierra Leonean women die in childbirth, women in Chad would be lucky to live beyond the age of 55, and girls as young as age nine are routinely forced to marry men as old as age 50, in any number of countries.

So, there is no fairy-tale ending to this fable (as yet). September 26th is World Contraception Day. It’s a day that seeks to draw attention to the vast difference that proper contraceptive education, supply, and use can make in women’s lives and the prosperity of societies. It seeks to drive forward the widespread adoption of contraception, in order to promote the greater good of individuals and the economic welfare of the world.

Then again, we could forget all that silly nonsense and just stick with doing things “the way they are supposed to be.” We could abstain and stop being sluts and prostitutes, just as those deep political thinkers (see above) advise. After all, lack of access to contraception works so well in Sierra Leone, doesn’t it? Er. …

Forced Pregnancy Testing: Blatant Discrimination and a Gross Violation of Human Rights

10:38 am in Uncategorized by RH Reality Check

Written by Onyema Afulukwe for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Earlier this month, news spread of a Louisiana charter school’s policy that would have allowed faculty to force any student suspected of being pregnant to take a pregnancy test — and, if the test came back positive, to force her to go on home study.

Forced pregnancy testing in schools is a gross violation of young women’s fundamental human rights. Through legal advocacy, I have been working to get it recognized as such and outlawed — in Tanzania, Kenya, Uganda, in my home country of Nigeria, and in other countries in the African region where it occurs. It is a shock to see a practice I’ve come to associate with schools in the developing world being replicated in the United States.

I have seen the consequences firsthand, and they are devastating. In secondary school, the older sister of a classmate, who was a year ahead of us, was found to be pregnant and expelled by school administrators. We eventually learned that she was the victim of a rape which occurred in her home, but she was too terrified to tell anyone what had happened. As is the case with many victims of this injustice, no other schools would accept her. Her hopes for a better future were doomed.

In Tanzania, where nearly 44 percent of girls have either given birth or are pregnant by the age of 19, school administrators across the country force schoolgirls to undergo demeaning pregnancy tests often just before completing primary school — around the age of 11 — and with increasing, and random, frequency throughout secondary school. Some girls must strip to their underwear to reveal physical signs of pregnancy. Others are coerced into taking urine-based pregnancy tests. No one can refuse to be examined or tested.

The impact is staggering, long-lasting, and far-reaching. About 8,000 girls are expelled or drop out because of pregnancy in Tanzania every year. Too often families abandon their pregnant teen daughters, forcing them to live on the streets with their babies. Faced with the possibility of homelessness, some young women succumb to pressure from their families to seek financial support through early or arranged marriages. The impact of these violations to their rights to health, education, privacy, and freedom from discrimination ripples throughout young women’s lives. Many female leaders of human rights advocacy groups still remember, over twenty years later, how humiliating and disempowering it was to experience forced testing even though they did not turn out to be pregnant.

Government officials do next to nothing to improve the situation despite its epidemic proportions; nearly 60 percent of the country’s adolescents have sex before 18. And in a double standard that’s all too common in many places throughout the world, while young women are stigmatized and penalized for pregnancy, the men and boys involved are rarely identified and face few consequences for their role.

In the United States, the reaction to the news about the Louisiana charter school was swift. Under threat of a lawsuit by the ACLU, the school reversed course and amended its student pregnancy policy, which no longer includes the invasive forced pregnancy testing it initially announced. The revised policy now assures female students the opportunity to continue schooling on campus throughout pregnancy and the option for homeschooling. This is a just and appropriate result.

Nevertheless, the emergence of this idea in an American school should trouble anyone concerned with the protection of our fundamental constitutional and human rights. And it should serve as a reminder of the importance of guarding vigilantly against violations of these rights not just in the developing world, but also — sadly, it seems — in the U.S.

Who Owns the Farm? Land Rights Push in China Leaves Women Without a Plot To Stand On

2:56 pm in Uncategorized by RH Reality Check

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Written by Jessica Mack for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

In the Masterpiece series “Downton Abbey,“ Lady Mary Crawley, the eldest daughter of an Earl, cannot inherit the eponymous estate because she is a woman. She finds this demeaning and frustrating, but her future will be well taken care of regardless. This isn’t the case for millions of women around the world, who struggle to access, own, and inherit the tiny plots of land on which they live and work.

In China, women actually have equal rights to inherit and own land, yet rarely ever do. A recent survey in 17 Chinese provinces, undertaken by the global land rights group Landesa, found that only 17.1 percent of existing land contracts and 38.2 percent of existing land certificates include women’s names.

A gap-filled land registration system has meant that the country’s 700 million mostly poor and rural farmers often lack the legal documents for the land on which they toil. Rapid urbanization has set in motion a pattern of “land grabs,“ depriving an estimated three to four million farmers of their land every year.  While land rights in China remain a broad-scale class issue, of the few that do have legal protection for their land, hardly any are women.

“Women in rural China are still in a vulnerable position,” says Xiaobei Wang, a Gender and Land Tenure Specialist for Landesa. “Most of them are not fully aware of their legal rights on land or the importance of including their names in legal documents so they seldom assert their rights in land registration by requesting that their names be included.”

These are timely findings given that a nascent land rights revolution in the country has begun. In late-2011, the continued struggles of dispossessed farmers came to a head with an historic village rebellion, signaling to the Chinese government and to the world that something finally had to change. Now, government officials are rolling out a massive initiative to register each plot of land with certificates of ownership in the hopes of protecting poor farmers. Read the rest of this entry →

Ethiopia Gets On the Pill, and That Matters for Africa

11:47 am in Uncategorized by RH Reality Check

Women in Addis Ababa (photo: fiverlocker, flicker)

Women in Addis Ababa (photo: fiverlocker, flicker)

Written by Jessica Mack for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

African countries are too often lumped together as one big composite of grave statistics and chronic epidemics. Because of this, it’s especially important that the global development and reproductive health communities recognize and amplify those success stories that can be told.  Especially when these stories are designed and driven by local efforts.

Less than 20 years ago, contraceptive use in Ethiopia among married women of reproductive age was a measly 3 percent, and maternal mortality rates were among the highest in the world. Today, contraceptive use is at 29 percent, double that of just five years ago and higher now than the level of contraceptive use in Sub-Saharan Africa as a whole. It’s an exponential increase in record time. Maternal deaths have also dropped, and now occur at less than half the rate they were just a few decades ago.

“Government ownership is critical [for improving reproductive health],” says Dan Pellegrom, President of Pathfinder International, which has worked in the country since 1964.“ And Ethiopia’s government took ownership.” That ownership took the form of renewed commitment to women and girls, and creative collaborations with aid agencies to make long-acting contraceptive methods in particular more available. (Injectable contraceptives are by far the most popular method countrywide). A waiver of the 2007 import tax on contraceptives also increased the flow of supplies throughout the country.

It may or may not be a coincidence, but Ethiopia is one of the world’s largest recipients of humanitarian aid, which supports a range of sectors from health and agriculture to democracy building. This latter point deserves a caveat, since Human Rights Watch has been vocal in its accusation that the Ethiopian Government has co-opted donor funding as a tool to maintain the power of the ruling Ethiopian People’s Revolutionary Democratic Front (EPRDF). Investigations are still ongoing. Read the rest of this entry →

Breaking the Cycle of Unwanted Pregnancy and Unsafe Abortion: A Call to Action

1:31 pm in Uncategorized by RH Reality Check

Written by Elizabeth Maguire for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

This article is adapted from remarks made at the International Conference on Family Planning, Dakar, Senegal.

Millions of women in Africa and the developing world suffer and die needlessly from unwanted pregnancy and unsafe abortion. As we know, 215 million women want to space their births but do not have access to contraception, or contraception may fail – but for a variety of reasons, women are do not have access to the care that they need.

Actions to break this cycle are a major focus at the International Conference on Family Planning now underway in Dakar, Senegal, and we are pleased that participants will be sharing successful strategies for giving women ready access to contraceptive information and services and to life-saving treatment for complications of unsafe abortion. Thanks to many organizations and governments represented at here, we have seen major progress in both these important areas.

But much remains to be done and a much more comprehensive approach is needed. Even the best contraceptive and postabortion services are not enough to prevent women from suffering and dying from unsafe abortion. A third component that is often stigmatized and neglected even in the context of reproductive health programs is safe, legal abortion.

Unsafe abortion is a major – and entirely preventable — public health crisis. But eliminating it requires a comprehensive, holistic approach addressing all three of these components.

African women are at particularly high risk of unwanted pregnancy and unsafe abortion, because unmet need for family planning is higher here than in other regions of the world. An estimated 47 million women in sub-Saharan Africa want to limit or space births but cannot obtain the information and care they need to do so.  Each year, over 6 million women risk their lives with unsafe abortion because they have no other option; of this number, 29,000 die needlessly, or in other words, hundreds of thousands in the space of a decade.  Africa accounts for more than half of all abortion-related deaths in the world.

These statistics – and the human stories that lie behind every number – are simply intolerable. Evidence tells us that abortion is one of the safest of all medical procedures when performed by trained health care providers in sanitary conditions and, with medical abortion pills, an early abortion is safe in the hands of women themselves with medical back-up nearby.

Globally, all but a handful of countries have at least one indication for legal abortion. In Africa, every country permits abortion at least to save a woman’s life, and, in more than 40 percent of African countries, in cases of rape, incest and fetal impairment.

But safe services, even to the extent of the law, are unavailable or inaccessible in most parts of Africa.

Today, we call on the global family planning and health community to take three steps that are completely feasible to help break this cycle. 

  • First, stop avoiding discussion of abortion. It is part of many women’s lives and always has been. Not talking about it will not make it go away.  We are glad this conference has made the space to talk about abortion. This must be the beginning of a greatly expanded dialogue on this critical issue.
  • Second, do a better job of ensuring that every woman who has an abortion or is treated for complications is offered contraceptive counseling and a choice of methods – on site and ideally by the same health workers who provided the abortion or postabortion treatment.
  • But we cannot simply hide behind postabortion care as if the job is done.  A third and most important step within the power of family planning programs and providers is to ensure that each woman experiencing an unwanted pregnancy receives counseling, and, if she wishes to terminate the pregnancy, is referred for a safe, legal abortion in the same or a nearby facility.  Currently, few programs require or train family planning providers to offer such counseling or referral.

In summary, the family planning community – and the wider global health community – must honestly confront the realities of unwanted pregnancy if we claim to value women’s lives and well-being and if we truly respect their rights. We must ensure that women everywhere have access to a full continuum of care:  contraceptives, postabortion care and safe induced abortion. 

Sacrificing Women’s Rights For “Popular Rule:” Why Equality is Essential

9:34 am in Uncategorized by RH Reality Check

Written by Marianne Møllman for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Over the past week Libya’s interim prime minister Abdel Rahim al-Keib has made numerous statements about human rights, at times announcing high priority to the protection of rights in his administration, at others hinting that some Libyan citizens (notably women) shouldn’t expect too much.

Judging from experiences in other countries women may not fare better after a dictatorship or autocratic rule than before it.  In 2009, Afghan President Hamid Karzai signed a bill that made women subordinate to men, allegedly in an attempt to win votes. And earlier this year, peaceful female demonstrators in Egypt were submitted to forced virginity tests and brought before a military court a full month after Hosni Mubarak had resigned.

Setting aside for a moment the question of whether the current political set-ups in Egypt, Libya, or Afghanistan are more democratic than what came before, it is valid to ask whether women’s rights often are sacrificed for the sake of popular rule.  In last month’s Tunisian election, the Islamist party Ennahda won approximately 40 percent of the votes, making many worry that this country, with arguably the most advanced legal protections for women rights in the region, might slide backwards. Others countered that Islamism and feminism aren’t necessarily opposites but can, in fact, be linked.

The truth of the matter is, however, that without certain potentially unpopular back-stops to protect the rights of the disempowered, majority rule (or ruling party rule) does not always protect equal rights for all.  Indeed in the most extreme cases, state officials accused of wanting to annihilate entire groups of people within their own country can be democratically elected.

It is noteworthy that governments seeking to limit the human rights of a particular group often use the same justifications, regardless of geography or political set up.  The two most popular excuses are these: 1) our culture does not support that kind of thing; or 2) we just have a different way of doing it. 

When the first type of justification is used—such as for example in the case of rampant and very violent homophobia in Uganda and Nigeria—any criticism is highlighted as external interference with “our way of life” and ascribed to neo-colonialism or worse. This happens whether the criticism comes from in- or outside the country itself.

When the second type of justification is used—such as for example when Princess Loulwa Al-Faisal of Saudi Arabia said that women in her country are better off than in the west because “men have a duty to look after them”—those who push for more inclusive policies are simply seen as misguided: they just don’t understand.

To be sure, notions of equality, including gender equality, as a social good have not been static throughout history and the expression of what equality looks like varies a lot even within countries.  While I believe that equality is absolutely essential to human dignity, I therefore accept that this belief has not always been as broadly accepted as it is now.  

But perhaps the more interesting question in the juxtaposition of women’s rights (or gay rights, or ethnic minority rights) and democracy is not whether some people’s rights are sacrificed for popular rule (they are), but rather whether they should be as a matter of principle (I think not).

For me this is more than just a question of conviction.  Equality has proven to be intrinsically linked to happiness, health, and peaceful societies.  In comparative studies, those societies with more equitable distributions of wealth do better than more unequal neighbors on a number of social parameters such as infant mortality, crime rates, and individual contentment.  Moreover, we already know that where violence against women surges, general violence is likely to grow too.

So next time someone questions the support for the rights of a specific group of people, you might want to ask them if they support those same rights for themselves.  Not to show them up by highlighting their hypocrisy—though that might be an added benefit—but rather to make the point that we are all interdependent. Libya’s prime minister would do well to remember that too.

Underreported and Unchecked: Sexual Violence Against Somali Refugee Women

8:32 am in Uncategorized by RH Reality Check

Written by Yifat Susskind for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Amal* left her village in Somalia when she realized that there was nothing left there for her. There was no food and no water. So she gathered her emaciated children and began the long trek to the refugee camps in northeastern Kenya. She thought that being forced to leave her home would be the worst thing to ever happen to her.

That was until she was attacked and raped by bandits on the way.

I recently returned from Kenya, where Somali women and families are seeking refuge by the thousands. I met with Hubbie Hussein Al-Haji of MADRE’s sister organization, Womankind Kenya, a grassroots women’s organization of Somali pastoralists. We talked about the most urgent needs for famine refugees—for food and water—and about how MADRE and Womankind Kenya can work together to provide for them.

And Hubbie told me about Amal and other women like her, who are arriving in northeastern Kenya traumatized not only from famine and displacement—but also from being raped along the trek.

Sexual Violence Rising in Famine-Struck East Africa

Women and girls seeking refuge at displacement camps must walk for days, along the long and dangerous routes to the Somalia-Kenya border. Bandits and Al-Shabaab militia patrol much of southern Somalia and have infiltrated deep into Kenya, often attacking women and their families to steal the few possessions they have. In Amal’s case, they took the only piece of gold jewelry she had ever owned. She had been hoping to trade it for food.

In these attacks, women have been raped. Even once they arrive at the displacement camps in Kenya, they are not safe. They need food and water, but there is not enough to go around. Many are turned away for lack of resources, relegated to the outskirts of the camps. There, local communities are struggling, not only to sustain themselves through drought and famine, but to offer aid to even harder hit famine refugees from Somalia. The women of Womankind Kenya come from these very communities and have long been mobilizing to confront this famine.

Even as refugees fight to survive, the threat of sexual violence persists. Women and girls are especially vulnerable when they venture out in search of firewood for cooking. As more refugees pour into the area, women must walk farther to find wood, putting them at greater risk of rape. In the area of Dadaab, now the biggest refugee camp in the world, violence against women and girls has quadrupled in the past six months.

Grassroots organizations like Womankind Kenya are a lifeline for rape survivors, especially those who have been turned away from the camps. These women are isolated and vulnerable, cut off from the communities of support they might once have had. Womankind Kenya can do more than meet their pressing needs for food and water. They can speak to women in their own language, breaking through their isolation to offer them care and a new source of support to lean on.

Looking Forward

We’ve seen this surge in sexual violence after disaster many times before. We saw it after the 2004 Indian Ocean tsunami, after the massive flooding of 2005’s Hurricane Katrina and after the catastrophic 2010 earthquake in Haiti. In each of these cases and many more, major disasters uproot communities and leave women and girls vulnerable to violence, including rape and sexual assault. In the chaos and loss of social cohesion that routinely follow disaster, women and girls in places as far afield as Somalia, Nicaragua or the United States are rendered more vulnerable to sexual attack.

To combat this rise in sexual violence, MADRE partners with local women’s organizations around the world that know well the gender-specific threats women and girls face after conflict and disaster – organizations like Womankind Kenya.

Now, Hubbie explained to me, Womankind Kenya is working to fill the gap in access to counseling services and medical care for rape survivors. MADRE is working with them to set up a mobile clinic to bring essential services to refugee women and their families. They will collaborate with local doctors and nurses, who they have worked with before, to reach out to women who need care. They will help women overcome fear of stigma by offering counseling and medical services that respect women’s privacy, and they will help women find their path to recovery.

When the women of Womankind Kenya reached out to Amal, she had all but given up hope. She had just arrived and was living at the edge of a camp. She had nothing, after having been robbed by her attackers. Womankind Kenya gave her emergency food and water, and what’s more, they listened to her story. It was only a first step but an essential one—for Amal and all of the refugee women and girls traumatized by rape.

*Not her real name

Supporting Family Planning Abroad: A Sound Investment for the US and A Way to Save Lives

10:34 am in Uncategorized by RH Reality Check

Written by Maureen Greenwood-Basken for RHRealityCheck.org. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Currently, more than 215 million women around the world want access to quality reproductive health care but don’t have it. On Monday, July 11th, we recognized World Population Day, and I was reminded that this unmet need is only likely to increase when the world’s population crosses the 7 billion mark in the fall. Global investment in international reproductive health and voluntary family planning is one of the best ways to save maternal and infant lives, and build sustainable communities.

According to the Council on Foreign Relations’ recent report, Family Planning and U.S. Foreign Policy,” meeting the unmet need for family planning would result in a 32 percent decrease in maternal deaths, reduce abortion in developing countries by 70 percent, and reduce infant mortality by 10 percent. However, the reproductive health needs of many women in developing countries remain unmet. Sometimes, this occurs even when subsidized contraceptives are sitting unused and expiring in warehouses miles away.

Continue reading…

Rep. Carolyn Maloney: Why the U.S. Should Address Obstetric Fistula and How

8:44 am in Uncategorized by RH Reality Check

Written by Rep. Carolyn Maloney for RHRealityCheck.org – News, commentary and community for reproductive health and justice.

Pregnancy shouldn’t leave a woman with a disability and ostracized from her community.  And Congress should ensure investments for the more than two million women worldwide that have obstetric fistula and that we do what we can to prevent new cases from occurring. Fistula results from prolonged labor without medical attention due to the pressure created internally from obstructed delivery, which kills tissue where a hole between the woman’s vagina and rectum develops, leaving her without control of her bladder and and/or bowels for the rest of her life without treatment.  It often results in the death of the infant.  Many women with obstetric fistula are abandoned by their husbands and families because they are considered “unclean” due to the leaking of urine and/or feces.  Left without support, the women are often forced to beg or turn to sex work to survive.

Fistula was once common throughout the world, but over the last century has been eradicated in Europe and North America through improved medical care. For example, New York’s hospital for fistula patients, now the site of the Waldorf Astoria Hotel, closed in 1895 because of diminishing cases.  But still in 2010, from Bangladesh to Botswana, women continue to face these challenging deliveries and the complications associated with them, including obstetric fistulas.

I met the inspiring Catherine Hamlin and invited her to brief my colleagues about her amazing work at the Addis Abba Fistula Hospital.  I was so moved to learn from her first hand about the unnecessary suffering of women in Ethiopia and how Dr. Hamlin’s life work has been devoted to their repair and treatment.  This only strengthened my resolve to address this issue – not only to treat these women but also prevent it happening to others. … Read more