PSN has contributed to parliamentary hearings on maternal morbidity being undertaken by the All Party Parliamentary Group (APPG) on Population, Development and Reproductive Health.
Maternal morbidity: common yet overlooked
Maternal morbidity refers to illness and injuries related to pregnancy and childbirth. While maternal morbidity leaves 10 - 20 million women and girls every year with long-term physical, psychological, social and economic problems, many conditions and complications are treatable and preventable.
For this reason, in July 2008 the APPG on Population, Development and Reproductive Health launched an inquiry to increase understanding of this injustice, and to promote action to address this common yet overlooked health issue.
In September PSN and roughly fifty other individuals and organisations responded to the APPG's call for evidence and submitted written evidence to the hearings. On 8 December PSN’s Karen Newman also provided oral testimony to the hearings at Westminster.
PSN’s input to the hearings argued that the high incidence of preventable maternal morbidity in developing countries must be viewed as a violation of women’s rights, and focused on the opportunities that exist to significantly reduce maternal mortality by increasing access to voluntary family planning programmes.
UPDATE May 2009
The APPG’s report of the maternal morbidity hearings Better off Dead? has been published and is available here.
SOURCE: The Guardian
Cities such as Mumbai and Dhaka are referred to as metacities: cities so big that they stretch the megacity definition.
Rise of the metacity
Dhaka has seen its population double in the past 15 years, Mumbai in the past 25. Both are chasing the magic 20 million mark, when they become "meta", and both have swelling slums cramming the inner city, and extending around the periphery. Over half Mumbai's population lives in slums. In some parts they say there are 50,000 people living to one square kilometre. People living this close get sick, and pregnant.
Mehrunisa and Zosna, two women in their 30s living a country apart, are both expecting babies. It's Zosna's second, and Mehrunisa's fifth. Zosna, who lives in a Dhaka slum, is apprehensive about giving birth. Mehrunisa just wishes the whole thing wasn't happening. She lives in Shivaji Nagar, a slum on the outskirts of Mumbai, 12 miles and a world away from the cool marble of the mayor's residence. It's built on the city's biggest dump and crawls with flies and goats. The huts seem to grow out of the filth and trash, flapping with loose plastic and Vodafone adverts torn from walls to make roofs. Scraps of tarpaulin wave like flags in the wind. She is sanguine about her new child: "I have no choice now."
Choice is a rare commodity here. Shivaji Nagar is a socially conservative, predominantly Muslim slum, where husbands and mothers-in-law rule and an unwritten code says that women should be having children. Contraception and abortion are viewed with profound suspicion.
Nasimbee, a neighbour of Mehrunisa, lets rip. "Why should I have another child?" She's already had five and now does her family planning on the sly. It's not hard, she says, since her husband "lost his brain" to drink and drugs: "He won't find out, he can't find out." These women are conducting a covert operation, fighting their husbands, their culture, the system. And once they've battled with the family, problems await.
Mehrunisa has stomach pains and wants to get an ultrasound, but can't afford it. Even if she could, the machine in the municipal hospital has been broken for years. Anita Shenoy, a tired-eyed doctor at the single public clinic that serves the 600,000-strong slum admits they struggle to meet demand: "There is a big queue here in the morning ... people can't wait." Instead they go to private clinics but these, she adds, are often bogus — fake doctors with made-up qualifications trying to make a quick buck by selling sham drugs.
A thousand miles north, the Dhaka slum rises out of water, not rubbish. Shacks are built on bamboo stilts, and black streams froth with pollution beneath. The local ward commissioner Anhaj Mahmud has a mantra for what's happening on his patch: "Population and corruption, corruption and population." His brother Mohammed, a wealthy property developer, is more specific: "Me? I have one son, one daughter. Look over there, they have six ..." But Zosna and her neighbours have a different take: "We all know that two children is a happy family." After two, they have an injection or go on the pill. Their mothers, they say, had five or six children. Not them. These women are lucky though — they live within reach of a Marie Stopes clinic that doles out contraception and advice.
Everyone agrees with the ward commissioner on one thing. Corruption is everywhere, from the party leaders banged up on corruption charges, to the forestry department official who was busted with wodges of cash stuffed in his pillowcases. Department for International Development health adviser Fran McConville describes the country as a "paradox". Bangladesh has made extraordinary social progress, especially in health. But this is thanks to what she describes as a "phenomenally strong NGO community": in other words, despite the government, not because of it. It's a picture the director general of family planning seems happy to endorse.
She says the government has a "lack of manpower" in the slums and that it's up to the NGOs.
Masudus Salehin, a Marie Stopes programme manager working in the Dhaka slums, feels the weight of this responsibility, and questions whether the government shouldn't carry more of it. "We're not able to reach all the houses ... there are lots of gaps." He knows there are still women who have no idea how much easier they can make their lives by choosing how many children they have, and when. In Mumbai, Dr Shenoy echoes his frustration. If there could be another public clinic, if services could be made more available, it would be different.
But in the Victorian corridors of the Municipal Corporation of Mumbai, the agenda seems to be elsewhere. Dr Phatak raises his voice: "The slum dwellers aren't as poor as you think. They can easily earn 100 rupees [a little over a pound] a day." He claims they have "the easiest interface with the municipal health structure" and that the corporation's focus is not on primary healthcare and local clinics where women like Mehrunisa could get vital family planning advice, but on rural services and the hospitals in central Mumbai.
His solution for the slums is to wish them away. It's a policy of repulsion. "We don't give them facilities. We make it difficult for them to live here. But we can't remove them and throw them away because our country today allows people from anywhere to go anywhere so it is very difficult to uproot these people." He looks almost wistful.
Awaiting prosperity and recognition
Mehrunisa does not want to be uprooted. This is home, dump and all. And the slums will never magically vanish; Mumbai is a magnet to people all over India. They're going to keep coming, and they're going to keep having children.
Dr Phatak hopes that Mumbai's "prosperity" will match its population. It might. But the women in the slums won't see much of it. For that to happen the corporation must first recognise them, then accept that this city is their home, and then provide them with the services they so desperately need.
PSN Co-ordinator Karen Newman recently addressed delegates at the EuroNGOs annual meeting in Lyon, France as part of a debate examining the the capacity to approach population growth issues and their interface with climate change, from a rights-based perspective.
The EuroNGOs AGM held in Lyon France was attended by over 40 NGOs, funding bodies and academics working in the field of sexual and reproductive health and rights, development and population issues.
The conference theme was The interface between Population, Environment and Poverty Alleviation. The event therefore provided an opportunity to address the relationship between climate change and population growth, at the same time as discussing possibilities and challenges for sexual and reproductive health and rights advocacy against the background of the 1994 UN International Conference on Population and Development (ICPD) and the Millennium Development Goals (MDGs).
Preparing for ICPD at 15
Building upon the strategy workshop held earlier in the year, EuroNGOs used the conference agenda to extend the debate on the relationship between climate change and population growth, to other organizations and stakeholders.
The event also presented an opportunity for members to coordinate efforts in the forthcoming year over the ICPD at 15 strategy and the planned international events to mark the date.
Considering the ethical issues
At the event PSN's Karen Newman delivered a presentation on Ethical Dimensions of Addressing Population Growth Issues.
Karen's presentation is available here.
SOURCE: Irin News
Being an exhausted mother of 10 children by your early thirties is not unusual in rural Madagascar, but a PSN-backed movement is now underway to try and provide women with a contraceptive choice.
Balancing family planning and conservation
"I often get women in the clinic who have had eight or more children and are desperate to stop," said nurse Rebecca Hill, who has been running a family planning clinic in Andavadoaka, a remote village in southwest Madagascar, for the past six months. "They are all too pleased to have a break, and family planning can allow that to happen. But there is a huge unmet need for these facilities here, and that needs to change."
Madagascar, an island renowned for its unique biodiversity, is struggling to balance the demands of conservation with the needs of a rapidly growing population that has doubled in the last 25 years, reaching 19.6 million in 2007, according to UN figures. It is expected to hit 43.5 million by 2050.
Urgent need for family planning in rural areas
Family planning initiatives in the cities have met with some success, but there is still a significant lack of contraceptive services in rural areas. "Reaching isolated communities is the real issue," Andre Damiba, country director for Marie Stopes International (MSI), a reproductive health agency, told IRIN.
According to the government, in some parts of the country 70 percent of 16-year-old girls have already given birth to their first child. In recognition of the problem, the Ministry of Health has taken the unusual step of changing its name to include family planning.
The government has also made family planning one of the eight pillars of the Madagascar Action Plan (MAP), an ambitious economic and social development strategy recently launched by President Marc Ravalomanana.
The MAP sets two ambitious goals for family planning: reducing the average size of the Malagasy family "to improve the wellbeing of each family member, the community and the nation"; and comprehensively meeting the demand for contraceptives and family planning. It plans to do this by making contraceptives more widely available, providing educational programmes and reducing unwanted teenage pregnancies.
But the impact of the government's efforts is yet to be felt in the remote villages of southwest Madagascar. Here, isolated coastal communities - among the poorest in the country - depend on dwindling marine resources that are under direct pressure from population growth in the villages, and health care and family planning services are extremely limited.
"A woman in the village of Andavadoaka who wanted to access contraceptive services faced a 50km journey on foot to Morombe, the nearest town, or would have to pay for passage on a passing ship," explained Dr Vikram Mohan, founder of the clinic in Andavadoaka. "In cities there are good contraceptive services available; in remote areas like ours most organisations can't offer a service."
''We are raising awareness not just about women's rights, but about their economic and social interests and about how they can take control of their lives''
Efforts to ameliorate pressure on the fragile ecosystems
The Andavadoaka clinic is funded by a British charities, Blue Ventures Conservation (BVC) and Population and Sustainability Network. The link between population growth, the lack of family planning facilities and the increasing pressure on fragile natural resources prompted the organisations to establish the small clinic.
"The work being done by BVC to enable coastal communities to manage their resources sustainably ran the risk of being undermined by the mushrooming population of the community," said Mohan. "In addition, an awareness of sexually transmissible infections and a willingness to take precautions was low."
A recent UNAIDS survey in Madagascar found that only 12 percent of young men aged between 15 and 24 used a condom the last time they had sex with a casual partner. For women, the figure stood at 5 percent.
Damiba believes that intensive awareness raising campaign are needed, especially in rural areas where conservative traditions prevail. "It is only through the sensibilisation of communities that we can get behavioural change," he explained. "As long as people's behaviour doesn't change there is no way of reaching the goals laid out by the government in the Madagascar Action Plan."
For this reason, family planning is about more than just promoting the use of contraception; it is also about empowering women to make fundamental decisions that affect their health and lives. "Society here still lacks some understanding of what women's rights are," said Damiba. "We are raising awareness not just about women's rights, but about their economic and social interests and about how they can take control of their lives."
The women are learning fast. "Family planning is good for us," said Veleriny, a member of the Andavadoaka women's association. "It allows us to control when we give birth. Here some women become pregnant every year."
The government uses the media to promote contraception, and international partners have become more active. "Access to family planning facilities is improving," Lalah Rimboloson, deputy director of US-based Population Services International (PSI) in Madagascar, told IRIN. "Between 2004 and 2006 we saw a significant increase in the use of family planning. The government is encouraging organisations like PSI to increase their work."
But national statistics do not always reflect the situation in remote areas. In 2007 the UN Population Fund (UNFPA) estimated the national fertility rate was 4.94 children per family. At the Andavadoaka clinic, nurse Hill estimates that in the remote coastal villages of the southwest it is as much as 8 to 12 children per family.
"We must have services made available permanently to those people who need them," urged Damiba. "Services must be permanent, not just available once in a while," otherwise real progress risks being limited to urban areas.
But the ambitious goals will be hard to meet. "I think that the targets of the MAP are reachable," said Rimboloson, "but not with the government's efforts alone; it has to be with all partners involved in family planning in Madagascar."
Damiba agreed. "Even a small impact in a remote community can have a ripple effect in terms of helping to spread understanding and raise awareness of the issue. Everything counts. Family planning is really needed here."
Population and Sustainability Network was pleased to join other international organisations co-sponsoring this years World Population Day event held at the Houses of Parliament on the 14th July 2008.
The event which was hosted by IPPF and the All Party Parliamentary Group on Population, Development and Reproductive Health marked World Population Day with addresses by Gillian Merron, MP, Parliamentary Under Secretary of State for International Development, and Sarah Brown, Chair of the White Ribbon Alliance.
The event was attended by organisations working in the field of sexual and reproductive health and rights, Ministers, Parliamentarians and Peers, Ambassadors and other high level decision makers and sought to raise the profile of population growth issues and the implications for poverty alleviation efforts and international development.
Other Co-Sponsors included FPA, Action Aid , Human Rights Watch, Marie Stopes International, White Ribbon Alliance and Women and Children First.
Transcripts of speeches made at the event are on the IPPF website.