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 27th 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.

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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.

 

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

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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.

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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.

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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.

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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).

 

 

 

 

 

 

Accelerating The Reproductive Health Promise For Kakuma Refugees

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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 25th anniversary of the ICPD slated for 12th -14th 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.

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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.

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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.

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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).

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

 

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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.

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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…

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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.