ICPD25 To Address Harmful Cultures and Gender Based Violence in Fragile Settings

John Wafula, Humanitarian Specialist, UNFPA Kenya having a moment with teenage mothers at Kalobeyei Integrated Health Centre.

Yar Pachong, 20, is a tall dark-skinned South Sudanese refugee living at Kakuma Refugee Camp. While many South Sudanese refugees attribute their refugee status to various conflicts that have ravaged their country, Yar Pachong’s reason for leaving Rumbek, South Sudan is different.

She arrived at Kakuma refugee camp in 2003, at four years together with her mother and younger brother who was one year old.

Her father had paid half dowry when marrying her mother. He was unable to complete the remaining half of the dowry. For this reason, her grandfather wanted to marry off her mother to another man. Her mother was not okay with the idea. Yars’ mother together with her children escaped to Kakuma refugee camp, leaving Yars’ father behind.

Yar was enrolled to school and is now in Form 2. She however is not fully safe. Her uncle had planned to abduct her and marry her off in South Sudan at 15 years. She learnt of the plan and informed relevant agencies working at the camp. The agencies offered protection services to her to keep her safe as she pursues her education. However, she still receives information that her uncle has vowed to abduct her and marry her off.

Adolescents and youth form a substantial proportion of the refugee population in Kakuma refugee camp and as of April 2019, there were a total of 39,960 registered youth of whom 14,546 were female and 25,414 were male.

Yar represents many South Sudanese adolescent girls who live in constant fear of being abducted by their relatives and married off back in South Sudan, for dowry benefits. Early and forced marriage among the South Sudanese refugees is considered a cultural norm as opposed to violation of human rights. Perpetuation of the harmful traditions continue to deny young refugee women opportunities to explore their full potential in life and better their lives.

Daniel Kamerino, a community leader working in Kalobeyei Settlement detects such cases of Gender Based Violence and harmful cultures and helps the affected get necessary support.

“I identify such cases and report to Danish Refugee Council (DRC) who provide protection services to such victims” Said Daniel.

Daniel expressed, besides, early and forced marriages, teenage pregnancy cases is also quite high among adolescent girls at the camp.

“In the recent years, teenage pregnancy cases among our young girls have sharply risen,” he said.

He attributed the rise of the cases to hardships at the camp thereby compelling young girls and women to engage in survival sex. He too sighted drug and alcohol abuse as equal contributors to gender based violence cases at the camp.

Getrude Lebu, Sexual and Gender Based Violence Protection Officer at Danish Refugee Council (DRC), said the agency was prompted to offer services to refugees at the camp following incidences of GBV cases that were happening. DRC provides prevention and response services in Kakuma and Kalobeyei refugee camps.

She particularly spoke of a recently concluded project that DRC implemented together with International Rescue Committee (IRC), UNFPA Kenya, Kenya Red Cross and The People of Japan, between Jan 2018 to October 2019. The project aimed at increasing awareness on GBV and encourage both male and female survivors to report.

“The project led to opening of a 24hr SGBV Support Centre that has enabled survivors to access SGBV services including clinical management of rape and psychosocial support, ” she noted.

Besides the SGBV centre, young people are also encouraged to make use of safe spaces, youth friendly centres and sports centres at the camp.

Significantly, Mr. Kamerino noted that sensitization programs should also target parents and guardians for they often discourage their children from attending counselling and mentoring programs citing that their children risk being taught bad manners.

Besides orienting health care workers on GBV prevention and management, he advocates for sensitization of adolescents on sexual and reproductive health and rights, and behavior change programs, at the camps.

“Access to information is a challenge. The agencies should do more to protect young people,” he concluded.

He emphasized on the need for teachers, social workers, community leaders and counsellors to be trained in Sexual and Reproductive Health, prevention of GBV, life-skills education and protection of adolescent’s girls from early marriage and promotion of education.

On his part, John Wafula, Humanitarian Specialist UNFPA Kenya expressed the need to urgently address the rising cases of teenage pregnancies at the camps, as the current strategies seem to be somehow ineffective.

“The rate of teenage pregnancy is drawing attention of stakeholders, something that we urgently need to address,” Said Mr. Wafula during the evaluation stage of the project.

The ICPD25 Summit

The International Conference on Population and Development (ICPD25) opened in Nairobi on Tuesday with a rallying call for governments and multilateral institutions to promote access to modern contraceptives for women of childbearing age.

Thousands of delegates including world leaders, ministers, heads of multilateral agencies, campaigners and researchers attended the summit that is expected to revitalize the global birth control agenda.

A number of commitments have been made to advance the ICPD Programme of Action’s promise of universal access to sexual and reproductive health, of girls’ and women’s empowerment and gender equality, while leaving no one behind, in particular youth as agents of positive change and the leaders of the generation to carry forward the ICPD Programme of Action and the 2030 Agenda for Sustainable Development.

Among the commitments made at the 3-day ICPD25 Summit is to;

Uphold the right to sexual and reproductive health services in humanitarian and fragile contexts, by

Ensuring that the basic humanitarian needs and rights of affected populations, especially that of girls and women, are addressed as critical components of responses to humanitarian and environmental crises, as well as fragile and post-crisis reconstruction contexts, through the provision of access to comprehensive sexual and reproductive health information, education and services, including access to safe abortion services to the full extent of the law, and post-abortion care, to significantly reduce maternal mortality and morbidity, sexual and gender-based violence and unplanned pregnancies under these conditions.

This year marks the 25th anniversary of the International Conference on Population and Development in Cairo, where 179 governments adopted a landmark Programme of Action which set out to empower women and girls for their sake, and for the benefit of their families, communities and nations.

UNFPA Delivering The Reproductive Health Promise for Kakuma Refugees

Thursday 27^th Sep 2019, 1.00pm, the skies of Kakuma Refugee Camp are quickly gathering dark Columbus clouds, lightening flashes across the hills of Turkana as thunder rumbles through the overcast air, a clear indication that heavy rains are about to irrigate the otherwise severely arid land of Kakuma. The hot humid air suddenly turns into a stormy breeze carrying the smell of rain from the neighboring Kalobeyei Village. Screams of children excited about the anticipated rains engulf the camps’ air.

Inside Kalobeyei Red Cross Maternity Hospital are women celebrating new lives. And heavens are about to shower more blessings upon them. One of the women is a 27-year-old Congolese refugee, Claudine Mukuraneza. She admiringly stares into the beautiful innocent face of her new born baby as she awaits her husband to come and name him.

Claudine Mukuraneza admires her baby delivered at Kalobeyei Red Cross Maternity Hospital

 “He is 4.0kgs!” She excitedly announced.

Quite a healthy one-day-old baby he was! Claudine is so overjoyed that she ignores my curiosity on how the delivery went. Anne, a nurse who is busy attending to other new mothers and their babies nearby discloses that Claudines’ baby was born without any complication.

Claudine attributed her healthy baby’s condition to her adherence to ante-natal visits and consistency in attending health talks at the clinic.

“I came for all my ante-natal visits and health talks at this hospital. I was given iron tablets, multivitamins and was taught hygiene and nutrition. I followed all the advice,” she said.

She also mentioned that safe motherhood promoters regularly visited her at home to monitor her condition and remind her of the next hospital visit.

Claudine is happy that safe motherhood promoters have also helped her space her children well.

“Safe mothers also taught me about family planning methods. I use Norplant. I am happy that this is my third child, and comes three years after my second one. I will continue using family planning,” she stressed.

Rebecca Diing, a community leader and safe motherhood promoter working for Red-Cross Kenya at Kakuma Refugee Camp said her work within the community has been quite significant in the lives of expectant mothers and their babies.

 “I identify pregnant mothers, speak to the them about the importance of antenatal visits and hospital delivery. I also monitor their nutrition and watch out for any danger signs within new born babies,” she said.

During her work, Rebecca battles with cases of women attached to local birth attendants especially ‘new arrival refugees’ who do not know the importance of hospital delivery.

Rebecca is concerned about diverse cultural norms and religious beliefs which influence sexual and reproductive health choices of women within the refugee community.

“Some cultures and religious beliefs prevent women from seeking these services,” she lamented.

Rebecca is happy that training offered by UNFPA Kenya and the International Rescue Committee (IRC) has helped her learn a lot regarding maternal health, family planning and gender-based violence, which in turn has helped women at the refugee camp.

Reproductive Health in humanitarian settings

Sexual reproductive health needs are threatening in emergencies. Mostly affected are women of reproductive age, youth and adolescents. The situation is also acerbated by the unmet need for contraceptives.

The Kakuma Refugee Camp and Kalobeyei Integrated Settlement host about 190,000 refugees, 46% being women and girls of reproductive age. This is a population that is in dire need of reproductive health services right from the moment they are displaced up to arrival and residence in the refugee camps.

John Wafula, Humanitarian Specialist at UNFPA Kenya shared about a project implemented by Kenya Red Cross, IRC, UNHCR, The Government of Japan, UNFPA Kenya, Refugee Affairs Services and the County Government of Turkana West.

“The one-year project that is winding up this month aimed at providing adequate and sustained access to reproductive health and GBV services, and to build the capacity of the community to demand and utilize these services. The project supported about 8000 women to deliver in health facilities in Kakuma and Kalobeyei between Jan 2018-Aug 2019,” said Mr. Wafula.

The agencies sustained medical supplies needed for provision of sexual and reproductive health and also trained health care providers on clinical management of rape and Minimum Initial Service Package (MISP) for reproductive health, adolescent sexual reproductive health, and sensitized the community on services offered at the facilities.

The project not only covered the camp but also extended across the entire Turkana West Sub-county through the work of a robust SRH working group.

Claudines’ nurse (Anne), however shared  that the facility carries out an average of 8-10 deliveries in a day. She is concerned about the need for more ambulances to strengthen referral services for women seeking ANC and delivery services, and establishment of a modern theatre at the hospital since most cases that require surgery are often referred to Lodwar, a situation that compromises the need to deliver services timely.

Mrs. Diing has emphasized strategies that will increase uptake of family planning among men, and measures to address the high rate of teenage pregnancies and school drop-out cases in the camps.

On sustainability, Mr. Wafula is confident that the County Government of Turkana, which has mandate for health, is able to take over the project, following the great involved of the leadership of Turkana West Sub-County in line with the approach to integrate services for the host population and refugees. The project invested immensely in capacity building of community leaders on various aspects of reproductive health for sustained awareness creation and advocacy.

 

Windhoek Summit: An Interview with Dr. Margaret Agama on The Common African Position.

Dr. Margaret Agama speaking at the Common African Position Meeting that was held in Windhoek, Namibia.

The Common African Position (CAP) meeting was held between 4-5th Sep 2019 in Windhoek, Namibia. The consultative meeting was initiated by Africa Union Commission (AUC) and International Planned Parenthood Federation (IPPF). It brought together civil society organizations within five regions in Africa.

I caught up with Dr. Margaret Agama-Anyetei, Head of Health, Nutrition and Population Division, Social Affairs Department Africa Union Commission (AUC) on the sidelines of the meeting to unpack what CAP is all about.

Here is the interview;

Lorna: Why are we having this conversation here today and why is it important?

Dr. Margaret Agama: The conversation is about developing a Common African position on population and development for the African continent. The reason why it is important is that even though there are a lot of agreed tools and commitments that Africa Union Member states have signed and ratified in view of advancing the population and development agenda on the continent, there are still key issues which countries and regions still grapple with. We are keen to hear from civil societies and member states on what they think the issues are and what solutions lie in addressing these issues.

The purpose of developing a common African Position is to identify the divergences, the similarities and commonalities in order for us to come to some sort of agreement as to how we would advance in addressing these issues and in order for Africa to speak with one voice when we negotiate our population and development issues at global fora.

Lorna: How does the AU plan to use the out document?

Dr. Margaret Agama: It is a wide continental consultation, we are beginning with the civil societies in Africa, we will consult governments and we shall consult particular countries like the island states because we know they have peculiar issues that are often drowned out when the continent assembles as a whole, we will consult with member states at a higher political level and inclusive of our negotiators in New York who often negotiate these issues on our behalf. Civil society’s voice is important in this conversation, and this is first of the many consultations that we will feed in the broader agenda.

Lorna; My young cousin living in the village, does this process involve her?

Dr. Margaret Agama; Yes, it has a lot to do with her, because as you have already heard from the conversation that took place today, rapid urbanization is a serious population dynamic issue. Whist at the same time, we know that majority of our young people live in rural areas, what is important and significant is that many services which they demand or need are not reaching them and are therefore migrating. Either they become victims of all the population negatives such as teenage pregnancies, school drop out et cetera, they don’t reach their full potential. Some migrate to the nearest urban centers or to other countries or in some cases to continents in search of meeting their full potential. We expect that civil societies groups who are more in touch with these communities bring their voices and concerns into the room.

We can have a plethora list of all the issues, but what are the key issues for particular countries within regions that are of concern out of the long list, and what solutions can be shared within countries and between countries as well as within regions.

Lorna: Any parting thoughts?

Dr. Margaret Agama: You have to remember that this process is guided by AU Agenda 2063, Aspirations One (1) and Six (6) which advocate for ‘a prosperous Africa based on inclusive growth and sustainable development, an Africa whose development is people-driven, relying on the potential offered by African people, especially its women and youth, and caring for children.

Lorna: Thank you so much for your time!

 

Uganda Churches using the scripture to End FGM..

Photo Courtesy

Uganda Joint Christian Council (UJCC), member churches (Catholic, Anglican and Orthodox) and the Inter-religious Council of Uganda are working to eradicate FGM through their religious leaders.

“Uganda has a rich legal and policy framework that promotes gender equity however, the implementation is poor. We prioritize to build capacity of religious leaders so that they can understand the legal framework and different referral points depending on the nature and magnitude of harm” Said Dinah Akallo, UJCC

Speaking in Nairobi during a recent convention that brought together inter-faith leaders and faith-based organizations from across Africa, Dinah Akallo, UJCC, said that a law passed in 2010 banning FGM in Uganda has helped to bring down the prevalence.

However, she admitted that some communities still continue to perform the rite, although they do so secretly. Anti-FGM crusaders refer to such communities as hotspots.

“Despite several interventions, FGM has remained remarkably persistent in some isolated communities in Uganda, with some communities crossing the border to perform it in nearby countries,” Dinah said.

The church expressed concern over the fact that the act is often performed on minors, and referred to it as a form of gender-based violence that infringes on the sexual and reproductive health and rights of women and girls, and undermines their dignity.

“We use the Bible as our biggest constitution to educate the masses on Gender Based Violence and FGM. God created us in his own image and likeness, besides the Bible does not mention anywhere about female circumcision.” Dinah Said.

According to UNFPA, nearly 200 million girls and women around the world have gone through the cut. The consequences are both physical and psychological and can last a lifetime.

Dinah said the council favors an approach that empowers the communities to decide for themselves to abandon the practice, as this will instill in them a sense of self-sufficiency.

She said, “Our church utilizes their structures in the affected regions to organize community dialogues with cultural leaders and educational forums for parents, so that the issue of FGM, GBV and HIV/AIDS is widely discussed and consensus is reached on locally acceptable solutions to address the problem”

She also said that uncircumcised married women facing stigma opt for this route in later years, because culture attaches significance to a woman mutilated.

“Culture attaches a lot of significance to a woman who is mutilated. An uncut woman has a lot of limitations for example, she cannot fetch water from the stream before other cut women for she is considered young, she cannot milk a cow for she is still a girl, she cannot enter the granary for she is considered unclean. A man married to an uncut woman is not allowed to sit in clan meetings. But again, most women are cut during child birth by midwives,” she said.

The UJCC is also running a project with the government to scale up gender and equity budgeting in local governments.

Some of the strategies UJCC use to eradicate FGM include capacity building for religious leaders, issuing press statements to hold the government to account, engaging with the media on talks shows, i.e. Radio talks shows that are religion based, and educate the masses on the existing laws that protect the victims.  UJCC also instituted gender-based violence monitors within the community to take note of GBV incidents and report to authorities.

The masses need to be educated on the existing laws as majority are still ignorant about them,” said Dinah.

The UNFPA notes that the global target of eliminating FGM by 2030 will only be achieved if efforts are intensified to address the problem.

Over the past three years, UJCC alongside the Church of Uganda and the Ministry of Gender has been staging an annual anti-FGM run during 16 Days of Activism to raise awareness about the dangers of circumcising girls in Kapchorwa District, where FGM is high.

UJCC is committed to improve the health and well-being of its people as part of God given mandate. This has been partly possible through training and capacity building of religious leaders, as the one offered by Faith to Action Network.

 

 

 

 

Malawi, Where HIV Testing and Treatment is Conducted Within Churches..

In Africa, stigma among members of the public remains a key barrier to seeking HIV testing and treatment services within communities they live in. However, the case is different in Malawi as churches have chosen to counter the situation by taking the services to congregants.

According to 2018 UNAIDS data, Malawi has one of the highest HIV prevalence in the world, with 9.6% of the teenage population aged 15-19 years old living with HIV. UNAIDS further estimated that one million Malawians were living with HIV in 2016 and 25,000 Malawians died from AIDs-related illness in the same year.

Pastor Howard Kasiya at the faith leaders convention in Nairobi.

“Our people are dying due to lack of knowledge” Said Pastor Howard Kasiya, the National Coordinator of the Health Commission of the Evangelical Association of Malawi (EAM). Pastor Kasiya was speaking during an interview conducted on the sidelines of a recent inter-faith leaders’ training conducted by Faith to Action Network, in Nairobi, to build their capacity to influence changes in policy and social norms in the State of African Women Campaign.

EAM, a faith-based organization understands that health is a universal need. At the heart of evangelism, they run programs which mainstream interventions for the HIV scourge.

Roughly a third of all new HIV infections (12,500 out of 36,000) in Malawi in 2016 occurred among young people aged 15-14. Early sexual activity in Malawi is high with around 15% of young women and 18% of young men aged 15-14 reporting having sex before the age of 15 , (UNAIDS 2018).

Among their programs, EAM churches have teen clubs for young people and youth living with HIV. They meet twice weekly with support from a trained pastor. Teen clubs help answer various questions that young people have concerning issues of HIV infection and treatment.

Similarly, the adults within the churches and communities have HIV support groups for people living with HIV. These groups are also supported by a church leader.

For effectiveness, EAM has trained several religious leaders, of different ages, to become peer educators and counselors on issues of HIV AIDs and offer psychosocial support. The trained persons facilitate discussions within the groups.

In addition, the churches also offer nutrition services to the affected population.

“There has been an attitude change among boys and men who are often rigid at seeking HIV testing services. Many are now requesting for the services” Said Pastor Kasiya.

On days set aside for testing and counselling services, congregants turn out in good numbers. Pastors, deacons and church leaders often lead the congregants in taking up the services. Counselling and testing for HIV is offered by qualified service providers together with trained youth leaders and church leaders.

 “To deal with stigma associated with people going to public testing services, we decided to bring the services closer to them. Service providers come to our churches to conduct testing services. We make the exercise as comfortable as possible for all,” emphasized Pastor Kasiya.

Pastor Kasiya further noted that HIV prevalence has dropped in Malawi over the past few years, but they as a church cannot ignore the rising number of new infections among young people.

Besides HIV and AIDs, EAM also runs programs around Sexual and Reproductive Health, Family Planning, Maternal and child health, Sanitation and hygiene and nutrition.

“What is very important is that we present all these from a biblical perspective, with supportive scriptures from the bible, as an obligation to God” Concluded Pastor Kasiya.

Achieving this kind of commitment from faith leaders has not been easy. There has been constant training and capacity building of religious leaders, such as the one provided by Faith to Action Network with financial support from the European Union, to make faith actors effective amplifiers of the message that optimum health and wellness are a key part of God’s plan for humankind.

Culture, Illiteracy, Obstacles to Family Planning Uptake Among Refugees In Kakuma.

Mrs. Diing Aten at the “ICPD What has changed conversation”

Uptake of family planning services among men and women living in Kakuma refugee camp and Kalobeyei communities is still low. Reasons for apathy vary; Social cultural beliefs, low education/literacy levels, religious beliefs -all lead to poor health seeking behavior.

“Our culture and traditions are the main reasons why women are wary of family planning services”, said Mrs. Diing Aten during the “ICPD what has changed” conversation event that was held last week in Kakuma.

At the event, women pointed their inability to make decisions in their homes which makes it difficult for them to decide how many children they would want to bear. Such gender inequalities generally place greater constraints on women’s access to Family planning programming.

For Instance, women from South Sudan have little say in their homes. As a matter of fact, they are not allowed to speak before men, or as Diing puts it, “We die with our problems”

However, Diing is happy to have an understanding husband who is warm to the need of spacing their children. At 35, Diing has four children. According to Diing, her age-mates have an average of 6-8 children.

Diing speaking to three of her four children

Unsurprisingly, Diing is a community leader. She is also a member of the community health committee in Kakuma Refugee Camp. She has interacted with various family planning programmes supported by International Rescue Committee (IRC) and UNFPA Kenya.

She too is a family planning champion. “I use my position to reach out to my fellow women and men. I speak to them about the importance of family planning. I have individually convinced about 10 families. I will still reach out to more.” She assertively affirmed. Diing pointed out that besides culture, women fear using contraceptives for they fear that they might make them infertile.

John Mading prides in his big family of three wives and 13 children. He purports that during war, many men, women and children were killed thereby gravely affecting the South Sudan population. He considers having a big family as away of replacing the relatives he lost during war. “We are replacing our lost population” Said the 47-year-old South Sudanese Refugee who has been living in Kakuma for 27 years now.

John Mading together with his last wife and some of his children

On his part, Mading maintains that he is fulfilling the theological command by God “Go ye fill the world” He quoted. Mading believes that children are from God and that men should obey Gods’ command.

In addition, he sighted that his culture despises men with less children, “Men with few children are seen to be weak. In fact, if two/three years go by without your wife getting pregnant, the community speaks ill of you.” Said Mading.

According to Mading, cultures such as wife inheritance among the South Sudanese are in place to ensure that widows bear more children which the late husband would have sired before he departed.

John Madings’ second wife attending to her chores

However, Diing affirmed that awareness and educational programs are active within the refugee community, but the deep-rooted cultural beliefs are a big hindrance to uptake of family planning services.

John Wafula, Humanitarian Programme Specialist, UNFPA Kenya spoke of the above issues as priority matters that will be addressed at the upcoming ICPD+25 Conference, “ it was necessary for us (agencies) to have this conversation with our beneficiaries to illuminate what more can be done to accelerate the ICPD PoA” Said Mr. Wafula

“It is evident that more has to be done especially around the component of advancing gender equality. As the conversation unfolds, we must recognize that reproductive health, women empowerment and gender equality are the pathway to sustainable development” Concluded Mr. Wafula.

Twenty –five years ago in Cairo, Egypt, leaders drawn from 179 countries promised especially women and girls’ reduction in maternal deaths, elimination of violence and ending harmful cultural practices against women, ending unmet need for family planning, and advancing gender equality. This came to be known as the International Conference on Population and Development Programme of Action (ICPD PoA).

 

 

 

 

 

 

Improved Maternal & Newborn Care Has Saved Lives of Refugee Women In Kakuma

Christine Acholi with her new-born baby at Kalobeyei Red-Cross Hospital

“It has been quite a safe delivery” Said Christine Acholi, a South Sudanese Refugee, as she admiringly looked at her 1-day old baby.

The 21-year-old mother who came to Kakuma in 2017 shared her delivery chronicles at a ward, at Kalobeyei Red Cross Hospital. As a second time mother, she compared her first birth experience to her second one; “My first birth was in 2017 when I had just come to the camp. It was at a clinic at this camp, but my delivery experience here is far much better compared to the other one” She noted

Christine’s statement is not far-fetched; The hospital that offers free maternity care to the refugee and host communities was unveiled back in 2017. On entering, there is a reception on the right and a consultation room on the adjacent left. Well-dressed charming nurses briskly whisk their way up and down the neat, wide corridor, symbolizing the volume of work at the facility.

The front of Kalobeyei Red Cross Hospital

The facility has spacious admission and labor rooms, a spotless delivery room fitted with modern equipment, a nursery room tailored with incubators and a spacious ward area where new mothers and their babies are monitored before they are discharged.

“We are very happy about services here,” Said, a content father (Christine’s’ husband) who had just stopped by to check on the wife’s and child’s progress.

Anne Wangui, a nurse that has been working at the hospital for two years said that the hospital admits sick mothers, sick babies and pregnant mothers. It receives an average of 3-4 women a day and performs 90-100 safe deliveries every month.

Since she started working at the hospital, Anne notes that there is an increment in the uptake of delivery services; from 10% in 2018 to 20% in 2019; that more women from the refugee and host communities are accepting maternity care.

“When we started, admission was low, but now more women are coming to the facility,” She said.

“In the last two years, we have lost one woman, a South Sudanese national from the refugee community. She over bled and died before she arrived here. We were however able to save the baby. Had the mother arrived in good time, we would have saved her too” Said, a despaired Anne.

A section of the maternity ward

Anne attributed the increment in hospital deliveries to efforts by Red-Cross Kenya, International Rescue Community and UNFPA Kenya. The agencies have safe motherhood promoters and community health workers who visit homes and monitor pregnancies and deliveries of women.

Anne also noted that technological advancement such as the introduction of the “balloon tamponade” has managed postpartum hemorrhage. As a mater of fact, the facility can manage all deliveries apart from Cesarean Sections. In such cases, patients are referred to other hospitals within the Sub-County of Turkana West.

In addition, 24-hour emergency services have encouraged women to deliver from hospitals. “With the uneven terrain and vastness of Kakuma and Kalobeyei, women had challenges accessing hospitals, but with the introduction of ambulances, women are picked and rushed here whenever they start laboring. The ambulances also rush referred patients to hospitals in case of emergencies” Said Anne.

Anne Wangui, showing visitors around the Kalobeyei Red Cross Hospital

However, Anne endures both religious and cultural challenges from her patients. She noted that most of the patients are from strictly religious and cultural backgrounds. She gave a case of a Muslim woman who, during a blood transfusion, insisted that she could only receive blood from a fellow Muslim.

In yet another case, a patient claimed that her culture allowed her and her baby to bathe a week after delivery. A situation that poses a health risk to both the mother and the child.

She noted that some cultures do not allow women to make decisions. In cases like Cesarean section the women cannot accept the services without their spouses’ consent. In such scenarios, Anne must respect her patients’ decisions, regardless of the risks at hand.

Illiteracy, ignorance and language barrier are common challenges that Anne battles with daily.

The Kalobeyei Integrated Social Economic Development Plan (KISEDP 2018-2022  has suggested activities to improve the healthcare of both refugee and host communities.

The activities include: Scaling up of a strong healthcare financing mechanism for host communities through the transforming health for Universal Care project; Working with NHIF to ensure government and NGO facilities are accredited and start accessing funds provided in the Linda Mama programme; Staffing and equipping of facilities in line with NHIF requirements to accelerate accreditation; Advocating for a policy framework to facilitate the enrollment of refugees/asylum seekers in the National Hospital Insurance Fund; Increasing awareness among communities on need for enrolment for health insurance to avoid high spending on health; Piloting and advocating for mass enrolment of population from both host and refugees in the NHIF scheme.

 

Accelerating The Reproductive Health Promise For Kakuma Refugees

Judith Kunyiha, Assistant Representative, UNFPA Kenya moderating the “What has changed” conversation in Kakuma.

“Before we delivered at home, now we deliver in hospitals ….”

A candid statement by Nyibol, a 34-year-old South Sudanese refugee who came to Kakuma Refugee Camp back in 2005.

“Years ago, women refused to go to hospitals since they preferred delivering at home.  As a result, some developed complications and bled to death while others lost their babies,” she continued.

Reflective in her facial expression, Nyibol confirmed improved uptake of antenatal and post- natal information and services by expectant women. “These days women attend antenatal and post-natal clinics as well as hospital delivery. Women previously feared being operated on if they went to deliver in hospital, which, according to our culture is a sign of weakness,” added Nyibol.

The community leader cited efforts by the International Rescue Committee (IRC) who use community health workers to visit homes and check on the progress of expectant women and new mothers. Introduction of emergency referral services such as ambulances has also helped in reduction of maternal deaths, according to Nyibol.

On community involvement in maternal health, Nyibol underscored the existence of a Community Health Committee that oversees the general health of women and children at the refugee camp. Again, these structures did not exist before.

Nyibol was speaking during a community conversation event held last week at the Kakuma Refugee Camp convened by the United Nations Population Fund (UNFPA Kenya) and partners to build momentum for the 25^th anniversary of the ICPD slated for 12^th -14^th November 2019 in Nairobi.

Refugees from the Kakuma Refugee Camp and the Kalobeyei Integrated Settlement, and host community members from Turkana West Sub County thronged the venue of the meeting.

A South Sudanese Refugee Woman sharing her experience around the “What has changed” conversation in Kakuma.

The interactive community conversation aimed at highlighting the successes and gaps in delivering quality sexual and reproductive health services and protection interventions to refugees and the host community.  As part of build-up activities ahead of the ICPD25 Nairobi Summit, the conversation explored progress towards attainment of the ICPD PoA commitments in humanitarian settings.

While there has been progress in all the areas, women and girls living in Kakuma and Kalobeyei still experience violence, including harmful practices such as forced and child marriage. The women and girls also face the unmet need for family planning which stands at 44%, according to UNHCR data.

Priscilla Nyimal, Member, Youth Parliament Shares her experience as young woman around the “what has changed” conversation

“Where can one get help as an adolescent girl who needs information and services on reproductive health matters, including pregnancy?” asked an adolescent girl from Monreau Shapelle Secondary School in Kakuma. “Sometimes we require a person in whom we can confide personal reproductive health experiences, but this is difficult because lack of privacy, confidentiality, and stigmatization,” she lamented.

To address this need for safe spaces among adolescent girls and young women, agencies present at the conversation such as the Danish Refugee Council (DRC), IRC and UNHCR urged adolescents to use existing youth friendly centres where an array of youth focused services including life skills are provided. In their staunchly patriarchal societies, women and girls are overtly undermined. Or, as a South Sudanese woman explained, “Our culture prohibits us from making decisions without seeking permission from our spouses. I cannot use any family planning method unless my husband allows me”

It was evident that services are in place, but more educational and awareness programmes should be conducted across the communities.

Harriet Awour, Women’s protection and Empowerment manager, Red Cross Kenya, responding to questions from the audience during the “What has changed” conversation in Kakuma.

The development partners committed to engage in concerted efforts to secure sexual and reproductive health rights and protection needs in keeping with the determination to accelerate realization of the ICPD Programme of Action.

Twenty –five years ago in Cairo, Egypt, leaders drawn from 179 countries promised especially women and girls’ reduction in maternal deaths, elimination of violence and ending harmful cultural practices against women, ending unmet need for family planning, and advancing gender equality. This came to be known as the International Conference on Population and Development Programme of Action (ICPD PoA).

Media urged to increase coverage of Reproductive Heath Issues affecting slum dwellers.

Urbanization is an inevitable trend. It takes place at different rates and in distinct places. According to UN Habitat , In developing countries, over 880 Million urban residents live in slum conditions. In Sub Saharan Africa, 59 percent of the urban population live in slums and by 2050, African urban dwellers are projected to increase to 1.2 Billion. Africa is not ready for this level of urban population explosion.

Dr. Esiet Uwemedimo addressing journalists at the media interaction event in Nairobi.

“Residents of Africa’s urban informal settlement represent one population group that is increasingly left behind and at elevated risks for poor sexual and reproductive health and rights outcomes.

For instance, across Africa, unintended pregnancy is among the leading reasons that urban adolescents girls drop out of school. ” Said Dr. Uwemedimo Esiet, Director, Action Health Incorporated, Nigeria

Dr. Esiet spoke yesterday during a media interaction session and launch of the 9th African Conference on Sexual and Reproductive Health and Rights  (ACSRHR), at Sheraton Hotel Nairobi.

He urged journalists to increase reportage of sexual and reproductive health issues that affect women and girls living in urban informal settlements such as; unsafe abortions, maternal mortality and morbidity, sexual and gender based violence, sexually transmitted diseases and HIV/AIDs, unmet need for family planning, harmful traditional practices and early sexual debut, among others.

He further underscored the impact of these issues on the economic outcomes for Africa.

The draft Maputo Plan of Action 2016-2030 notes the need for investing in SRH needs of adolescents, by improving access to and uptake of quality information and services for youth, that also includes family planning through provision of quality integrated youth friendly services.

“We know, you have challenges that you grapple with while covering SRHR stories, reach out to us. We will gladly help you, wherever possible” Reassured Jane Godia, Acting Executive Director, African Gender and Media Initiative (GEM).

Indeed, journalists mentioned of challenges they face while covering SRHR stories including cultural restrictions, respondents fearing stigma, cost of production, sensitivity of some stories and restrictive laws especially on abortion.

Lack of access to sexual and reproductive health services result in unwanted pregnancies and unsafe abortions. Africa is the world region with the highest number of abortion related deaths. In 2014, at least 9% of maternal deaths in Africa were from unsafe abortion. In 2017, about 58 Million women of reproductive age recorded an unmet need for modern contraception.

“Addressing the inequalities of women and girls in these informal settlements across Africa is key to achieving  the 2030 Sustainable Development Agenda and the AU Agenda 2063. As journalists, you have a significant role of bringing attention to these issues for governments and respective institutions to act”.  Concluded Godia

Africa’s population is the youngest and fastest growing in the world. Young people aged 10-24 years currently constitute about a third of the region’s population. The number of youth in the region is expected to grow as fertility rates remain high.

A growing proportion of the urban population are young people born and living in resource-constrained urban slums or who migrate to urban areas in search of opportunities. These urban youth live in an environment that offers limited education and employment opportunities, as well as inadequate housing, health, and social services. The result is an impoverished urban youth population with extremely high rates of unemployment and low educational attainment.

The future of Africa depends on its ability to harness the potential of its young people. Making the right investments in youth – particularly those in urban areas – can enable the region to experience substantial economic growth and sustainable national development for current and future generations (i.e. capitalizing on the Demographic
Dividend).

About the conference;

The 9th Conference on Sexual Health and Rights is a part of long term process of building and fostering regional dialogue/alliance on SRH that leads to concrete actions and enhances stake-holder capacity to influence policy and programming in favor of a sexually healthy conference.

The conference will be held on 12-14 February 2020, in Nairobi, Kenya under the theme ‘Advancing the Sexual and Reproductive Health and Rights of women and girls in urban informal settlements’

 

Setting Reproductive Health Priorities Right, Ahead of ICPD25 Nairobi Summit.

 

Dr. Ademola Olajide addressing participants at the CSO forum.

What has been achieved?
What has not been achieved?
What can be done to accelerate achievement of the International Conference on Population and Development (ICPD) Programme of Action (PoA) commitments?

These are key questions that guided a two- day consultative meeting held in Nairobi on 3-4th July, ahead of the ICPD25 Nairobi Summit.

The meeting convened by UNFPA Kenya and Amref Health Kenya brought together civil society organisations, national government representatives, youth-led organisations, non-governmental organisations and the Danish Embassy to interrogate the commitments that were agreed upon in Ciaro, 25 years ago.

It should be noted that during the 65th Session of the UN General Assembly held in 2011, implementation of the PoA intended to end in 2014 was extended for five more years, as the set commitments were yet to be achieved.

ICPD PoA  appropriately emphasized the importance of investing in women and girls and the principal of reproductive health and rights for all. ICPD further highlights what needs to be done and the necessary accountability systems put in place to ensure that governments and stakeholders realize the commitments.

“As civil society, you have the responsibility to understand the ICPD process, consult extensively among yourselves and come up with clear commitments and a fairly robust way to engage the national government to make necessary commitment and hold them accountable on the commitments made” Said Dr. Ademola Olajide, UNFPA Kenya Representative, during his opening remarks.

“I believe this is the beginning of a milestone in a larger process for civil societies to seek the way forward, redefine how they want to engage and how they want to be engaged” He added.

UNFPA Kenya observes that; over the years, the world has changed for the better. Governments’ efforts to protect the health and rights of women and girls have gained momentum;-

>>Today more women have the means to decide if and when they become pregnant and have access to sexual reproductive health services. Fewer girls are subjected to child marriage, and fewer women die from the pregnancy-related complications. The number of maternal deaths each year, for example, decreased by about 40 per cent over the last 25 years, and today, one in five girls is forced into marriage before age 18, compared with one in three in 1994.

Despite impressive gains, urgent action is required to reduce mortality and morbidity, address the sexual and reproductive health needs of adolescents and young people, prevent the spread of HIV/AIDs and provide reproductive health care to women and youth in emergency situations<<

Statistics by World Health Organization indicate that an estimated 214 million women who want to prevent a pregnancy are not using a modern method of contraception. In developing countries, some 830 women die every day from preventable causes during pregnancy or while giving birth. Every day, 39,000 girls are forced into marriages, and every year 4 million girls are subjected to female genital mutilation.

Dr. Ademola Olajide engaging with Dr. Githinji Gitahi, CEO Amref Health Kenya.

What has been achieved in Kenya, so far.

Besides the progressive reproductive health policies, the government of Kenya under the Ministry of Health has made notable progress at improving reproductive health of women and girls. As such, there is a free maternity care program dubbed Linda Mama initiative; a public funded health scheme that ensures pregnant women and infants have access to quality and affordable health services.

Another notable initiative spearheaded by The First Lady of Kenya, Margaret Kenyatta is the “Beyond Zero Campaign” , a campaign that seeks to bring prenatal and postnatal medical treatment to less privileged women and children in Kenya, by use of mobile clinics.

Stronger political will by the current Administration is being witnessed. At Women Deliver 2019, the president of Kenya, His Excellency Uhuru Kenyatta, pledged to put an end on Female Genital Mutilation and make Kenya an equal society for all as priority for his term. A week ago, the vice president of Kenya, William Ruto, joined UNFPA Kenya, Eco Bank and The Anti-FGM Board in signing of the End FGM Beads Initiative, a key intervention that will empower pastoralist women by promoting the sale of bead products; increase awareness against retrogressive practices and foster sustainable development.

In addition Civil Society organisations also celebrate advocacy gains such as the recent landmark ruling on access to safe abortion in a case against Ministry of Health. The High Court ruled that withdrawing the 2012  Standards and Guidelines for Reducing Morbidity and Mortality from Unsafe Abortion in Kenya had violated both the right to comprehensive and accurate health information and the right to the highest attainable standard of health for women and girls.

Still, more has to be done…

Dr. Ademola Olajide together with members of the Youth Advisory Council-UNFPA Kenya.

To accelerate the promise, civil societies have set a deliberate agenda to have mechanisms in place that will increase political will, invest in innovation and data, create financing momentum, engage with the private sector by ensuring that women and youth are at the forefront of shaping the priorities and agenda.

There too are emerging issues and increasingly opposing voices pushing back progress that has been made over the years, issues ranging from medicalization of FGM, current petition on the FGM law, rising teenage pregnancy, the recent ruling on LGBTQIs, a rapidly ageing population to migration among other issues. To accelerate the promise, SRHR stakeholders have to devise innovative ways to tackle these issues.

This meeting comes ahead of the up-coming ICPD25 Summit that will be held in Nairobi on 12-14 November.