“Human rights in Afghanistan are in a state of collapse,” he told the Human Rights Council, before sounding the alarm over ongoing reports of extrajudicial killings, torture and ill-treatment and arbitrary arrests and detentions, as well as serious violations against former Government officials, as documented in a new human rights office (OHCHR) report.
“Compounding all of this is a deeply troubling lack of accountability for perpetrators of human rights violations,” he said.
Women cancelled out
Highlighting the “devastating precedent” set by Afghanistan as the only country in the world where women and girls are denied access to secondary and higher education. Mr. Türk underscored the “long list of misogynistic restrictions” confining the country’s women “to the four walls of their homes”, before asking: “What can possibly come next?”
The High Commissioner insisted that any prospect of a stable, prosperous Afghanistan rests on the participation of men and women.
“Denying women and girls’ rights to participate in daily and public life not only denies them their human rights, it denies Afghanistan the benefit of the contributions they have to offer,” he said.
Constitution on hold
Mr. Türk said that the suspension of the Afghan constitution and of laws protecting women from violence or guaranteeing media freedom, as well as the dissolution of the country’s Independent Human Rights Commission, were elements of the “systematic erosion of the institutions that once provided some protection for human rights”.
The High Commissioner called on the de facto authorities to “change course” and bring Afghanistan back to the international fold with full respect for its international human rights obligations.
He insisted that the UN Assistance Mission in Afghanistan (UNAMA) will continue to monitor and report on the situation, as well as “raise individual cases and urge compliance with international law by the de facto authorities” to the greatest extent possible.
Mr. Türk paid tribute to the work of his human rights colleagues on the ground, especially Afghan female staff.
He also exhorted the international community not to “turn its back on Afghanistan” at a time when rights were being eroded and two-thirds of the population were in need of aid, while humanitarian operations were hindered by the ban on women working for the UN and NGOs.
‘Feeling betrayed’
Mr. Türk’s comments came a day after the Special Rapporteur on Afghanistan, Richard Bennett, delivered a sombre update to the Council.
Many Afghans living abroad “say they feel ‘betrayed’ by the international community”, the Special Rapporteur explained. They are calling for concrete action and some have even started a hunger strike “calling for recognition of gender apartheid”.
In June, Mr. Bennett had said that since systematic and institutionalised discrimination against women and girls was at the heart of Taliban ideology and rule, Afghanistan’s de facto authorities “may be responsible for gender apartheid” which, although “not yet an explicit international crime”, required “further study”.
Repression of minorities
Mr. Bennett also briefed the Council on Monday on the “collapse of civic space” and “absence of rule of law” since the Taliban takeover, the long-term impacts on children’s development and mental health, and the repression and lack of representation of minorities such as Tajiks, Hazaras, Uzbeks and Turkmen.
“I’m concerned about the effect [that the] strong sense of discrimination and exclusion held by large parts of the population may have on the stability of Afghanistan,” he said.
Special Rapporteurs are not UN staff and are independent from any government or organisation. They serve in their individual capacity and receive no salary for their work.
“The draft law could be described as a form of gender apartheid, as authorities appear to be governing through systemic discrimination with the intention of suppressing women and girls into total submission,” the independent experts said.
They stressed that the proposed parliamentary Bill to Support the Family by Promoting the Culture of Chastity and Hijab and existing de facto restrictions are inherently discriminatory and may amount to gender persecution.
“The draft law imposes severe punishments on women and girls for non-compliance which may lead to its violent enforcement,” the experts warned.
It also violates fundamental rights such as the right to take part in cultural life, freedom of opinion and expression, the right to peaceful protest, and the right to access social, educational, and health services, they added.
Mahsa Amini death
“After months of nationwide protests over the death of Jina Mahsa Amini and against restrictive veiling laws, the authorities have introduced a tiered system of punishments targeting women and girls,” the experts said.
The 22-year-old was arrested in Tehran and taken into custody nearly a year ago by the so-called morality police for her alleged failure to comply with the already strict hijab laws.
She reportedly fell ill at a police station with witnesses testifying that she had first been severely beaten, and later died in hospital. Iranian authorities denied that she had been assaulted.
Culture war
The UN-appointed added the proposed new punishments under the draft legislation would “disproportionately affect economically marginalised women”.
The use of culture by the Iranian government as a tool to restrict the rights of women and girls is misplaced, the experts warned, noting that “culture is formed and evolves with the participation of all”.
By using terms such as “nudity, lack of chastity, lack of hijab, bad dressing and acts against public decency leading to disturbance of peace”, the draft law seeks to authorise public institutions to deny essential services and opportunities to those who will not comply.
Directors and managers of organisations who fail to implement the law could also be punished; the independent experts warned.
‘Weaponizing’ morality
“The weaponization of “public morals” to deny women and girls their freedom of expression is deeply disempowering and will entrench and expand gender discrimination and marginalisation, with wider negative consequences for children and society as a whole,” the experts said.
They note that the so-called morality police have also been reportedly redeployed in some areas since early July, potentially to enforce compulsory veiling strictures.
The bill was submitted to parliament by the Government and the judiciary on 21 May. Since then, it has been amended several times, with the latest draft significantly increasing the number of punishments for non-compliance.
“We urge authorities to reconsider the compulsory hijab legislation in compliance with international human rights law, and to ensure the full enjoyment of human rights for all women and girls in Iran,” the experts said.
Experts’ mandate
Special Rapporteurs and other independent human rights experts are appointed to monitor and report on specific country situations or thematic issues.
They serve in their individual capacity, are not UN staff and do not receive payment for their work.
“We are outraged that those searching for forcibly disappeared family members and loved ones continue to be targeted and face violence in Mexico,” they said in a statement, issued in the wake of two recent incidents.
Brutal killing
Human rights defender Teresa Magueyal was shot dead while riding her bicycle in Celaya, Guanajuato state, on 2 May. Her son, José Luis Apaseo Magueyal, 34, disappeared three years ago.
Ms. Magueyal was part of a group formed by families of people who have disappeared and was the sixth volunteer to be killed since 2021, according to media reports.
Two months earlier, Araceli Rodríguez Nava, who is in a tireless search for her disappeared son, was attacked in Chilpancingo, capital of Guerrero state. The incident took place on 4 March.
Both women were beneficiaries of the federal protection mechanism for human rights defenders and journalists, the UN experts said. Although their cases remain under investigation, information about its effectiveness has been scarce.
Ensure freedom and safety
The UN experts urged the Mexican authorities to ensure human rights defenders working on enforced disappearances can operate freely and safely.
They said enforced disappearances and attacks targeting these activists are linked to the presence of organised crime groups, extortion, human trafficking, kidnapping networks, corruption and collusion with authorities.
Furthermore, operating in a constant environment of fear, threat and insecurity has an intimidating effect on relatives of the victims, civil society, human rights defenders, and organisations.
Investigate and prosecute
They added that many of the rights defenders are women and older persons, increasing their risk of being targeted.
“It is extremely worrying that impunity for crimes against human rights defenders and activists continues despite complaints being filed. Prevention measures and protection for victims and targets of the attacks are either not provided, or not effective,” they said.
“The Government of Mexico needs to promptly investigate, prosecute, and impose appropriate sanctions on any person responsible for the alleged violations”.
Adopt all measures
As their statement was issued on the International Day of the Victims of Enforced Disappearances, the UN expert surged the Mexican Government “to adopt all necessary measures to prevent irreparable damage to the life and personal integrity of those searching for the forcibly disappeared, their family members, civil society movements, organisations and public servants.”
They noted that a presidential campaign called De Frente a la Libertadis underway in Mexico that is giving greater visibility to the risks faced by journalists and human rights activists in the country.
They said it was time for authorities to take effective measures to protect human rights defenders searching for truth and justice.
UN Women issued a statement on Tuesday hailing the decision by the global football organization FIFA to suspend Spanish soccer federation president Luis Rubiales for kissing star player Jennifer Hermoso on the lips without her consent, after the national team won the Women’s World Cup earlier this month.
“UN Women, as a supporter of women’s sport and partner of FIFA, welcomes FIFA’s decisive action with regard to the actions of the Spanish football federation president and the launching of a full investigation after a clearly inappropriate act towards a sportswoman at the 2023 FIFA Women’s World Cup final,” it said.
Ninety-day suspension
Spain defeated favourites England 1-0, scoring its first-ever victory at the competition, which takes place every four years. This year’s tournament was held in Australia and New Zealand.
The kiss occurred during the medal ceremony in Sydney on 20 August. Mr. Rubiales said he made a mistake and that the kiss was consensual, but Ms. Hermoso has stated emphatically that it was unsolicited and she felt violated.
Since then, there have been calls for Mr. Rubiales to resign and the winning squad has said it would not play for Spain until he is removed.
FIFA announced on Saturday that he has been suspended for 90 days while disciplinary proceedings are underway.
Red card for harassment
UN Women said it “joins all those asserting zero tolerance for any form of abuse or harassment, at anytime, anywhere in women’s sports.”
“Women everywhere have the right to fully participate in sports without any form of abuse or harassment – be it behind closed doors, in locker rooms, on social media, or on the world stage,” the statement said.
Furthermore, everyone involved in sports, at whatever level, has a duty to play their part.
“We must collectively commit that violence, harassment, and abuse in women’s sport will not be tolerated and cannot continue, so that we can truly say it’s over.”
When the parents of an injured five-year-old boy told Dr. Fai’zah A. Salim that he fell off a ladder, she was not convinced and suspected otherwise.
Trained by UNFPA in the Central Sulawesi capital city of Palu to identify both physical and psychological signs of domestic violence, she referred the boy to a social counsellor. Shortly afterwards, he explained what really happened and how his father had beaten him for mischief.
Recognition is the first step
“Recognition is the first step to being able to help,” Dr Salim said. “We need to do a lot more than treat symptomatic wounds.”
The Public Health Centre, or Puskemas, where Dr. Salim works, is part of a UNFPA pilot programme to combat gender-based violence and other forms of domestic violence.
The programme covers 11 districts in Indonesia, including Palu. Under it, UNFPA supports the Government in policy making and trains health care providers. Local partners are encouraged to advocate for victims to come forward and seek help beyond treating their physical wounds.
The results are significant. In the first three months of 2023, staff at Puskemas Sangurara had already identified seven cases of domestic violence, compared to between one and two over an entire year in the past. “Is it because of the advocacy or because we are better trained to recognize the symptoms of gender-based violence? Probably both,” Dr. Salim said.
Serious concerns about gender-based violence
Despite significant progress in gender equality, including increased access for women and girls to education, employment, and health services, gender-based violence remains a serious public health and human rights concern in Indonesia, said Norcahyo Budi Waskito, a Programme Officer at UNFPA Indonesia. National policies, strategies and legal documents have been put in place.
However, these have not always been implemented at the local level. The Government has recognized the need for a systematic solution to ending gender-based violence and has partnered with UN agencies such as UNFPA and UN Women.
The number of reported cases has increased from around 216,000 in 2012 to close to 458,000 in 2022, according to the National Commission on Violence against Women. This suggests that efforts to encourage more victims to come forward is having an effect.
But, the numbers probably do not represent the full picture, as what goes on behind closed doors in a family home is still considered taboo by many, and reporting it carries a stigma.
Shame is not the only reason that keeps victims from coming forward; there is also a financial disincentive.
Annisa Rahmah, an emergency room physician at Palu’s Anuta Pura Hospital, said some victims choose to walk out once she identifies cases as domestic violence because the treatment would then not be covered by government health insurance.
“It is depressing to see them walk away,” she said. Those who stay get are offered a treatment package, including psychological counselling.
Victim support
Besides training medical staff, UNFPA also supports community groups and non-governmental organisations (NGOs). In Palu, the women’s organisation Libu Perempuan, for instance, has 30 volunteers – from lawyers to psychologists – to help victims. The association also runs a safe house, where currently two families live, and organizes training programmes, including trainings for men on the prevention of gender based and family violence.
United Nations
“It was an important mindset change in society that helping victims is as critical as bringing perpetrators to justice,” says Maya Safira, programme coordinator. All of her colleagues participated in UNFPA courses.
In a country of 280 million people and over 7,500 districts, UNFPA’s training in 11 districts can only go so far. But, UNFPA Programme Officer Budi Waskito said the pilot project offers a model other donors or the Government can replicate.
“We provide a recipe, but cannot cook every meal,” he said.
UNFPA works closely with the Ministry of Health so that the training it offers can be scaled up by the Government. It has helped the ministry develop a training manual for medical staff, response guidelines for hospitals, and guidance for local advocacy programmes.
The Ministry of Health is looking into replicating the success of this project, said Kartini Rustandi, Director of Reproductive Health, Age, and Elderly.
“The Ministry of Health continues to make efforts to accelerate equitable distribution of health facilities capable of managing violence against women and children and capacity building for health workers either through regular budget funds, specific budget allocation, or in collaboration with donors,” she said.
For Dr Faiza, the goal is clear.
“Until we have prevented every case of gender-based violence, we have more work to do,” she said. “And we are doing it.”
Sima Bahous, Executive Director of UN Women, made the appeal in a statement marking two years since the Taliban regained control of the country.
‘Gender apartheid’
“Through over 50 edicts, orders and restrictions, the Taliban have left no aspect of women’s lives untouched, no freedom spared. They have created a system founded on the mass oppression of women that is rightly and widely considered gender apartheid,” she said.
“I urge the Taliban to reconsider and to weigh the cost of these acts for Afghanistan’s present and future.”
Ms. Bahous underscored UN Women’s unwavering and unshakeable commitment to the nation’s women and girls.
Not giving up
She said the agency’s work there is anchored in its fundamental relationships with women, who have described how these “misguided, cruel and ultimately self-defeating” measures have affected their lives.
“Despite these challenges, Afghan women also tell me that they will not give up or give in. They will continue to lead the struggle against their oppression,” she said.
“In the face of the most hostile of circumstances they speak out against the violations, deliver lifesaving services, own and operate businesses, and run women’s organizations. Their bravery must inspire us to greater action, their example to renewed determination.”
Keep applying pressure
Ms. Bahous appealed for greater support to Afghan women – from elevating their voices, priorities and recommendations, to funding the services they need, and supporting their businesses and organizations.
“I urge the international community to continue to apply every pressure and employ every means at their disposal to press for change, including by answering the call of the humanitarian community and fully funding the humanitarian appeal for Afghanistan,” she said.
Uphold human rights
The UN human rights High Commissioner, Volker Turk, used the occasion to remind the de facto authorities of their obligation to uphold the rights of all, including women and girls.
UN human rights staff continue to work in Afghanistan monitoring, documenting and advocating across a range of human rights issues, including fundamental freedoms, the protection of civilians in armed conflict and the rights of detainees.
“We are engaging with the de facto authorities on these issues and remind them of their obligations under international human rights law,” said Liz Throssell, a spokesperson with the UN human rights office, OHCHR, in Geneva.
The High Commissioner urged the international community not to forget the plight of all Afghans.
Women and girls in Kenya’s West Pokot celebrate as the government cracks down on those practising harmful Female Genital Mutilation in the area. CREDIT: Joyce Chimbi/IPS
by Joyce Chimbi (nairobi)
Inter Press Service
NAIROBI, Aug 09 (IPS) – It promised to be the most defining, groundbreaking, and transformative protocol on African women’s rights. Specific in its approach, broad in its reach, and unique in its all-encompassing nature, covering issues such as HIV/Aids, widow inheritance and property disinheritance in a most unprecedented manner.
The Maputo Protocol was designed in line with the realities of the plight of women on the continent. Providing tailor-made solutions to lift women from beneath the crushing weight of a cultural system that disadvantages women from birth. Twenty years on, it is time to take stock.
“The 20th Anniversary of the Maputo Protocol is a historical advocacy moment for women’s rights advocates. It offers an opportunity to demand from African Governments real and tangible change for women and girls in their countries,” Faiza Mohamed, Africa Regional Director of Equality Now, tells IPS.
“By acceding to the Maputo Protocol, lifting reservations, fully domesticating, and implementing the Protocol, and ensuring their compliance with accountability processes. Beyond this, it signifies the generational changes over two decades and points to the need to reflect on future generations and to future-proof the Maputo Protocol and the SOAWR Coalition.”
The Solidarity for African Women’s Rights (SOAWR) is a coalition of over 80 civil society organizations, a pan-African women’s movement that pushes for accelerated ratification of the protocol in non-ratifying states while holding governments accountable to deliver for women in line with the Protocol.
Youth delegates at Maputo Protocol 20th anniversary celebrations, July 11, 2023. CREDIT: Equality Now
Mohamed stresses that the SOAWR Coalition is a remarkable testament to the power of women’s organized movements and their capacity to influence transformative policy agendas, leaving a lasting impact.
“Through its persistent efforts, SOAWR has successfully kept the protocol on the agenda of AU member states, leading to significant influence as 44 out of 55 African states have ratified or acceded to the Maputo Protocol. This achievement has turned the Protocol into a potent public education tool for women’s rights, both at the national and grassroots levels,” she explains.
“Notably, there has been substantial progress in the advancement of national jurisprudence on women’s rights, as well as in the empowerment of women themselves. Thanks to the coalition’s effective public sensitization campaigns, formerly taboo subjects like sexual and reproductive health rights, female genital mutilation, and polygamy have become open and advanced topics in various countries.”
The coalition has demonstrated how much women and like-minded partners can achieve working in solidarity. Additionally, each organization continues to push the women’s agenda forward – pushing and pulling in the same direction, to realize the dream of a society where women are fully represented in every corner of the spaces they call home.
“The Maputo Protocol comes out of the African feminist fire, and we need to keep it burning. That it is one of the most progressive legal instruments that came out of Africa. That it represents our diversity and our strength because we are not a monolith. It also represents the power of collective action and also the dream of the Africa we want,” says Nigerian-born Becky Williams, a young woman who now lives in Uganda and works for Akina Mama wa Africa.
Equality Now is currently advocating for adopting the Multi-Sectoral Approach in implementing the Maputo Protocol. The Multi-Sectoral Approach (MSA) provides a framework for convening different sectors within governments and actors outside of government in a joint effort to implement women’s rights as provided for in the Protocol.
Mohamed emphasizes that if recognized and embraced by governments and civil societies, the Maputo Protocol can be a powerful tool for change as it offers women a tool for transforming the unequal power relations between men and women that lie at the heart of gender inequality and women’s oppression.
To coincide with the Maputo Protocol’s 20th anniversary, SOAWR, Make Every Woman Count (MEWC), and Equality Now released a report titled, “Twenty years of the Maputo Protocol: Where are we now?” Providing a detailed account of progress made thus far, successes, challenges and recommendations.
Regarding rights related to marriage and child marriage, the report finds that several countries have adopted constitutional reforms related to the prohibition of forced marriage. For example, the constitution of Burundi guarantees marriage equality. The constitutions of Guinea, Malawi, Uganda, and Zimbabwe set the legal age of marriage at 18 years. AU Member States have enacted legislation on rights related to marriage.
On economic and social welfare rights, half of the African states maintain constitutional provisions guaranteeing equal remuneration for work of equal value or the right to fair or just pay. More than half of African states have laws mandating equal remuneration for work of equal value.
Regarding health and reproductive rights, almost all African states maintain constitutional provisions related to health and/or health care, and many enshrine the principle of non-discrimination based on health. Notably, six countries, including Angola, Ethiopia, Ghana, Kenya, South Africa, and Zimbabwe, enshrine rights related to reproductive health care, such as access to family planning education or reproductive/maternity care.
Group photo of the delegates at the Maputo Protocol 20th anniversary celebrations held in Nairobi, Kenya. CREDIT: Equality Now
While women’s rights have come a long way, the report stresses that there is a long way to go and makes specific key recommendations, such as the need to address the right to abortion and treat each case as espoused in the Protocol. It also suggests that the Maputo Protocol should be used to protect women and girls’ reproductive health rights and advocates that Member states remove laws that fail to protect reproductive health rights.
It advocates for the passing of family laws to protect women’s rights before, during, and after marriage and establish special courts to deal with complex marriage issues. In addition, it suggests that Governments implement regional and international treaties such as the Maputo Protocol and educate women and girls on these.
It would like to see programmes that allow young women to return to school after giving birth promoted and demands that early marriage be criminalized, and customary law is adapted so that it no longer defines what happens to women in marriage.
It asks governments to provide universal health services and insurance access, especially for pregnant, vulnerable, and/or specially protected women. It requires member states to improve infrastructure, training, and equipment for health services in rural areas.
Equally important, the protocol includes the empowerment of women and girls to realize their sexual and reproductive health rights through awareness campaigns delivered in communities and schools and wishes to see menstrual hygiene management incorporated into national legal frameworks through awareness-raising activities from more actors, especially parliamentarians.
On the occasion of World Breastfeeding Week, Christine explained how she is helping other nursing mothers through a UN-supported programme in the Rhino Camp.
“I feel like the proudest mother in the world when I breastfeed him,” said Christine, from South Sudan. “I know that breastfeeding him will help him grow into a strong and healthy and intelligent boy. He is my future.”
Each morning, inside her small house, she gets herself and young son ready for the day. With 12-month-old Alvin snuggled into a wrap tied across her back, she makes her way to the local health centre just a few minutes’ walk from her house. There she is greeted by a small group of women, most of whom have tiny babies in their arms or on their backs.
Christine comes here each day, where she earns a small income as a community worker, mentoring other breastfeeding mothers. She is here to help give her son the best start at life and to help other women do the same.
Lifeline in fragile settings
World Breastfeeding Week 2023
Breastfeeding is always important, but in fragile settings like this, it’s a lifeline. It not only provides all the nutrients a baby needs for the first six months of life, it’s also free of charge and almost always available.
In 2016, when Christine was a 25-year-old college student and aspiring teacher, rebels attacked her hometown of Yei, in South Sudan. She and her family fled into the bush, but shortly afterwards, her father was killed while looking for medicine for a sick family member. Fearing for their lives, Christine and her family fled to Uganda, eventually settling in Rhino Camp.
Her husband has since returned to South Sudan, but Christine has stayed on. In South Sudan, two thirds of the population are facing crisis levels of hunger, the highest number ever, and there is no sign of the situation improving soon.
She has found some stability in Uganda, for herself and her son. She said she was happy with the life she is building there.
Cash for breastfeeding mothers
Ⓒ WFP/Arete/Siegfried Modola
WFP’s nutrition programme supports breastfeeding mothers through cash assistance and nutrition counselling.
Last year, while heavily pregnant, Christine became one of 13,000 pregnant and breastfeeding women from both refugee and host communities to receive Nutricash.
Part of the Swedish-funded Child Sensitive Social Protection Programme, under which the World Food Programme (WFP) collaborates with the UN Children’s Fund (UNICEF) and the Government of Uganda, the project provides each woman with $13 to help meet food and nutrition needs and $4 that is put into savings.
Christine has used some of her savings to plant avocado trees and cassava. She plans to go back to school one day and become a teacher. She hopes her savings will make this a reality. Other women use the money to buy goats and pay for school fees.
Breaking cycles of poverty
Ⓒ WFP/Arete/Siegfried Modola
Every week, Christine meets with her Joy Care Group, where mothers offer each other support and comfort in addition to sharing experiences about breastfeeding.
“By supporting breastfeeding mothers, through cash and nutrition assistance and counselling, we are breaking a vicious poverty cycle and giving the opportunity to these mothers to send their kids to school, to invest in their small business and in the near future, to become fully self-reliant,” said Abdirahman Meygag, WFP’s country director in Uganda.
After receiving nutrition training from WFP’s partner, Save the Children, Christine started supporting women to breastfeed.
“Some women, especially younger mothers, are often scared to breastfeed,” she explained. “Often, they don’t know how to place their babies, and they want to give up because it’s too painful. They have a lot of chores that cause stress, and they don’t produce enough breastmilk.”
Knowledge is power
Ⓒ WFP/Arete/Siegfried Modola
WFP supports women to breastfeed so that children can have the healthiest start in life.
Breastfeeding is one of the simplest, smartest, and most cost-effective ways of ensuring that children survive and thrive. Breastfeeding has broad benefits, and can help to prevent infant death and childhood illness.
Each week, Christine and members of the Joy Care Group come together for friendship, to share information on breastfeeding and to support and comfort each other.
The women gather under the shade of a tree, holding their babies in their laps as they share their struggles, worries and fears. From time to time, they breastfeed their young babies.
Group member Jemma said knowledge is key.
“I know my child is going to be well and not only my child, but everyone’s child in the group,” she said. “Because we have the knowledge and since we are coming together, every week we learn more.”
Learn more about how the UN supports women and their children during World Breastfeeding Week and throughout the year here.
World Breastfeeding Week
Marked annually from 1 to 7 August, World Breastfeeding Week focuses on the invaluable benefits of nursing. The World Health Organization (WHO) and UNICEF recommend: early initiation of breastfeeding within one hour of birth; exclusive breastfeeding for the first six months of life; and the introduction of nutritionally-adequate and safe complementary, solid foods at six months together with continued breastfeeding up to two years of age or beyond. This year’s theme is on working and nursing.
Here are some quick facts:
More than half a billion working women are not given essential maternity protections in national laws.
Just 20 per cent of countries require employers to provide employees with paid breaks and facilities for breastfeeding or expressing milk.
Fewer than half of infants under six months of age are exclusively breastfed.
Over 820 000 children’s lives could be saved every year among those under age five if they were optimally breastfed from birth to 23 months.
Breastfeeding improves IQ, school attendance and is associated with higher income in adult life.
Improving child development and reducing health costs through breastfeeding results in economic gains for individual families and at the national level.
Two pregnant girls walk through the center of the capital of El Salvador, a country with one of the highest rates of pregnancies among girls aged 10 to 14, and where, as in the rest of Central America, what prevails are conservative views opposed to the teaching of sex education in schools, which is essential to reducing the phenomenon. CREDIT: Francisco Campos / IPS
by Edgardo Ayala (san salvador)
Inter Press Service
SAN SALVADOR, Aug 03 (IPS) – Pregnancies among girls and adolescents continue unabated in Central America, where legislation to prevent them, when it exists, is a dead letter, and governments are influenced by conservative sectors opposed to sex education in schools.
The most recent incident reflecting this situation was the Jul. 29 veto by Honduran President Xiomara Castro of an Integral Law for the Prevention of Adolescent Pregnancy, approved by the single-chamber Congress on Mar. 8 and criticized by conservative groups and the country’s political right wing.
“We don’t know the arguments behind the veto, but we could surmise that the law is still being held up by pressure from these anti-rights groups,” lawyer Erika García, of the Women’s Rights Center, told IPS from Tegucigalpa.
The influence of lobbying groups
Conservative sectors, united in “Por nuestros hijos” (“for our children”), a Honduran version of the regional movement “Con mis Hijos no te Metas” (roughly “don’t mess with my children”), have opposed the law because in their view it pushes “gender ideology”, as international conservative populist groups call the current movement for the dissemination of women’s and LGBTI rights.
In June, the United Nations expressed concern about “disinformation campaigns” surrounding the Honduran law.
The last of the marches in favor of “family and children” took place in Tegucigalpa, the country’s capital, on Jul. 22.
These groups “appeal to people’s ignorance, to fear, to religion, with arguments that have nothing to do with reality,” said García. “They say, for example, that people will put skirts on boys and pants on girls.”
According to the Honduran Penal Code having sexual relations with minors under 14 years of age is statutory rape, whether or not the girl consented.
In 2022, 1039 girls under 14 gave birth.
“The problem is quite serious, and it is aggravated by the lack of public policies to prevent pregnancies among girls and adolescents,” García said.
In the countries of Central America, which have a combined total of some 50 million inhabitants, ultra-conservative views prevail when it comes to sexual and reproductive health and education.
In El Salvador, Honduras and Nicaragua – as well as the Dominican Republic in the Caribbean – abortion is banned under all circumstances, including rape, incest or a threat to the mother’s life.
In the rest of Central America, abortion is only permitted in certain circumstances.
The Honduran president vetoed the law under the formula “return to Congress”, so that it can be studied again and eventually ratified if two thirds of the 128 lawmakers approve it.
Zuleyma Beltrán, 41, talked about becoming pregnant at the age of 15 because there is no proper sex education in El Salvador. A second pregnancy led to a miscarriage that landed her in jail in 1999, where many Salvadoran women who miscarry or have abortions end up due to a draconian anti-abortion law. CREDIT: Edgardo Ayala / IPS
“I didn’t even know what a condom was”
However, having laws of this nature does not ensure that the phenomenon will be reduced, since legislation is not always enforced.
An UNFPA report noted that in this country the pregnancy rate among girls and adolescents dropped by more than 50 percent between 2015 and 2022.
However, “it is worrisome to see that El Salvador is one of the 50 countries in the world with the highest fertility rates in girls aged 10-14 years,” the UN agency said in its latest report, released in July.
Among girls aged 10-14, the study noted, the pregnancy rate dropped by 59.6 percent, from 4.7 girls registered for prenatal care per 1000 girls in 2015 to 1.9 in 2022.
The map of pregnancies in girls and adolescents in El Salvador added that the country “needs to further accelerate the pace of reduction, adopting policies and strategies adapted to the different realities of girls aged 10-14 years and adolescents aged 15-19 years.”
Such actions must be “evidence-based,” the report stressed.
The reference appears to be an allusion to the prevalence of conservative attitudes of groups that, in Honduras for example, reject sexual and reproductive education in schools.
This lack of basic knowledge about sexuality, in a context of structural poverty, led Zuleyma Beltrán to fall pregnant at the age of 15.
“When I became pregnant I didn’t even know what a condom was, I’m not ashamed to say it,” Beltrán, now 41, told IPS.
She added: “I suffered a lot because I didn’t know many things, because I lived in ignorance.”
Two years later, Beltrán became pregnant again but she miscarried, which landed her in jail in August 1999, accused of having an abortion – a plight faced by hundreds of women in El Salvador.
El Salvador not only bans abortion under any circumstances, even in cases of rape. It also imposes penalties of up to 30 years in prison for women who have undergone abortions, and women who end up in the hospital after suffering a miscarriage are often prosecuted under the law as well.
“The State does not provide girls with sex education or sexual and reproductive health, and when pregnancies or obstetric emergencies occur as a result, it is too cruel to them, it only offers them jail,” she added.
Recinos said that, due to pressure from conservative groups, the State has backed down on the strategy of providing sexual and reproductive information in schools.
“Now they are more rigorous in not allowing organizations working in that area to go and give talks on comprehensive sex education in schools,” she noted.
Not even baby formula
In Guatemala, initiatives by civil society organizations that since 2017 have proposed, among other things, that the State should offer reparations to pregnant girls and adolescents, to alleviate their heavy burden, have made no progress either.
These proposals included the creation of scholarships, making it possible for girls to continue going to school while their babies were cared for and received formula.
“But unfortunately we have not been able to take the next step, to get these measures in place,” said Paula Barrios, general coordinator of Women Transforming the World, in a telephone conversation with IPS from the capital, Guatemala City.
Barrios said that most of the users of the services offered by this organization, such as legal and psychological support, “are girls and adolescents who are pregnant because of sexual violence and are forced to have their babies.”
She said that in the last five years some 500,000 girls under 14 years of age have become pregnant, and the number is much higher when teenagers up to 19 years of age are included.
“Today we have half a million girls who we don’t know what they and the children who are the products of rape are eating,” Barrios stressed, adding that as in El Salvador and Honduras, in Guatemala, having sex with a girl under 14 years of age is considered statutory rape.
“Society sees it as normal that women are born to be mothers, and so it doesn’t matter if a girl gets pregnant at the age of 10 or 12 years, they just think she has done it a little bit earlier,” she said.
Patriarchy and capitalism
The experts from Guatemala, Honduras and El Salvador consulted by IPS said the root of the phenomenon is multi-causal, with facets of patriarchy, especially gender stereotypes and sexual violence.
“The patriarchy has an interest in stopping women from going out into the public sphere,” said Barrios.
She said the life of a 10-year-old girl is cut short when she becomes pregnant. She will no longer go to school and will remain in the domestic sphere, “to raise children and stay at home.”
For her part, Garcia, the lawyer from Honduras, pointed out that there is also an underlying “system of oppression” that is intertwined with patriarchy and colonialism, which is the influence of a hegemonic country or region.
“We have girls giving birth to cheap labor to feed the (capitalist) system, and there is a greater feminization of poverty, girls giving birth to girls whose future prospects are ruined,” she said.
In the meantime, to avoid a repeat of her ordeal, Beltrán said she talks to and teaches her nine-year-old daughter about sexuality.
“In order to keep her from repeating my story, I talk to her about condoms, how a woman has to take care of herself and how she can get pregnant,” she said.
“I don’t want her to go through what I did,” she said.
Afshan Bhurgri, a cancer survivor, advises women to listen to their bodies and be aware of the symptoms of cervical cancer. Credit: Zofeen Ebrahim/IPS
by Zofeen Ebrahim (karachi)
Inter Press Service
KARACHI, Jul 26 (IPS) – “Listen to your body, and if there is anything strange happening, do not ignore it,” is the advice of 57-year-old Afshan Bhurgri, a cancer survivor.
Eight years ago, she was diagnosed with cervical cancer at a time when she was “in a good place” in life. Her kids were grown up, and she had more time to herself. A fitness freak, the schoolteacher’s daily routine included going to the gym daily. “I joined a creative writing class as I loved penning my thoughts!” she reminisced.
But then everything changed when she found out she had cancer.
Cancer of the cervix uteri is the fourth most common cancer among women worldwide, with an estimated 604,127 new cases and causing the death of 341,831 in 2020.
In Pakistan, an estimated 73.8 million women over the age of 15 are at risk of developing cervical cancer caused by the human papillomavirus (HPV).
Cervical cancer in Pakistan.
In the absence of complete data, it is estimated that of the 5,000 women diagnosed with this cancer in Pakistan, some 3,000 lose their lives every year due to lack of access to prevention, screening and treatment, thus making it the third leading cause of cancer-related deaths in women of the reproductive age group in the country, after breast and ovarian cancers. Up to 88 percent of cervical cancer cases are due to human papillomavirus (HPV) serotypes 16 and 18, as reported by the International Agency for Research on Cancer.
“We are short on authentic data on the prevalence of the disease burden,” said Dr Arshad Chandio, who works at Jhpiego Pakistan as an immunisation lead. His organisation, which has supported HPV vaccine introduction in seven countries with Gavi support, is partnering with the federal and provincial governments, along with WHO, UNICEF, and USAID, to implement a roadmap for cervical cancer prevention and introduction of HPV vaccine in Pakistan. Cervical cancer is the only cancer that is preventable by a vaccine.
Cervical cancer worldwide.
“Without authentic data, our plan to eradicate this disease will not be watertight,” admitted Dr Irshad Memon, the director general of the Expanded Programme on Immunisation in Sindh.
Dr Shahid Pervez, senior consultant histopathologist at the Aga Khan University Hospital (AKUH), co-chair of the country’s newly established National Cancer Registry, recommends legislation to make reporting of cancer mandatory. “This will be one way of collecting basic data, at one place, which is expected by international agencies to roll out an effective cancer control programme in Pakistan,” he added.
Although Bhurgri had knowledge about cancer of the cervix and went for regular health checkups and screenings, her doctors did not carry out full examinations, which led to the infection turning cancerous. It all started in 2009, five years prior to being diagnosed with cancer when she started noticing a “foul smell emanating from my vagina” after her period became “heavier” than usual.
Cervical cancer warning signs.
“Let alone screening and testing for the cancer, many healthcare professionals do not even know of the disease, or how women get infected,” pointed out Chandio.
“I am an educated person, I could afford to get the best medical help, and I went to three of the city’s top gynaecologists, got pap smears done on their requests over the years, and I was only sent for HPV test when it was too late,” rued Bhurgri. In 2014, a doctor suggested an ultrasound which gave a true picture. A biopsy confirmed she had cervical cancer.
After her biopsy, Bhurgri started reading up on cervical cancer, and one of the indications was the foul vaginal smell.
“It could have been nipped in the bud if only the doctors had carried out a thorough examination,” said gynaecologist and obstetrician Dr Azra Ahsan, president of the Association for Mothers and Newborns, blaming “sheer negligence” on the part of her fraternity.
“A gynaecological consultation must not only be limited to a conversation across the table,” said Ahsan, but should include an “examination on the couch including a proper internal examination, ideally a pap smear and visual inspection,” especially if, like Bhurgri, a patient was complaining of heavy bleeding and a foul smell.
Bhurgri’s journey towards wellness was tough. A radical hysterectomy was recommended, and her cervix, her uterus and her ovaries were removed. Twenty-eight radiations and five chemos later, over a five-month period, she was given a clean chit by her oncologist. The cost of treatment, back in 2014 at a private hospital, was a whopping Rs30,000,000 (USD 1,097) back then.
Screening can save lives
Although Bhurgri’s cancer may have remained under the radar despite regular screening via pap smears, doctors say HPV and pap smear tests are the best way to screen a woman for cervical cancer. They can identify patients who are at high risk of developing pre-cancerous changes on the cervix as well as pick up those who have already developed these changes.
These precancerous lesions can be treated before they turn into cancer. Sadly, in Pakistan, the uptake of pap smears is negligible and estimated to be as low as 2 percent.
According to Dr Uzma Chishti, assistant professor and consultant gynecologic oncologist, Department of Obstetrics and Gynecology, AKUH, Pakistan’s health system is so financially stretched that it cannot afford to provide screening of women by these expensive tests. Instead, she recommends WHO’s recommendations of performing a visual inspection of the cervix by acetic acid (VIA) to screen women to help reduce the incidence of cervical cancer. “VIA is an alternative screening test for low-and-middle-income countries like ours,” she said.
Vaccinations the Best Option
The WHO triple intervention recommendation to eliminate cervical cancer in countries like Pakistan includes scaling up HPV vaccination to 90 percent for girls aged between 9 to 14, twice-lifetime cervical screening to 70 percent and treatment of pre-invasive lesions and invasive cancer to 90 percent by 2030. “All three are essential if we want to eliminate cervical cancer completely,” emphasised said Ahsan.
HPV vaccinations to prevent cervical cancer are the way forward as it provides primary prevention, said Chishti, in the absence of VIA, screenings and pap smear tests. Almost 60 per cent of cervical cancer cases occur in countries that have not yet introduced HPV vaccination. Pakistan is one of them.
Once up and about, the first thing Bhurgri did was get her 14-year-old daughter vaccinated for human papillomavirus (HPV) vaccine. “My older daughter remains unvaccinated as she was 21 then and studying abroad. She needed three shots and could not make it to that timeline,” she said.
In Pakistan, two globally licensed HPV vaccines are available in the market – a quadrivalent vaccine and a bivalent vaccine Cervarix. Gardasil is protective against the HPV serotypes 6, 11, 16, and 18, providing protection against both cervical cancer and genital warts. Cervarix is effective against serotypes 16 and 18, thereby protecting only against cervical cancer.
In 2021, medical students at the AKUH interviewed 384 women attending outpatient clinics between the ages of 15 to 50 to find out their knowledge about cervical cancer. They found that of the 61.2 percent of women who had heard about cervical cancer, 47.0 percent knew about pap smear tests, and among them, 73 percent had gotten a pap test. A total of 25.5 percent of women, out of the 61.2 percent, knew that a vaccine existed for prevention, but only 9.8 percent had been vaccinated against human papillomavirus. The study concluded that a majority of the women interviewed for the study belonged to a higher socioeconomic class and were mostly educated, yet their knowledge regarding the prevention and screening of cervical cancer was poor. “This reflects that the knowledge levels as a whole would be considerably lower in the city’s general population,” the study concluded.
Shamsi highlighted the challenges of discussing HPV in a conservative society where sexual health topics are hardly discussed due to the embarrassment and taboo associated with sexually transmitted infections (STIs). This communication conundrum has resulted in a general lack of information about the disease. “There is a total lack of information about HPV, cervical cancer, and its prevention among the masses,” she said.
But this may change if Pakistan introduces the HPV vaccine at a national level, utilising routine effective and established immunisation delivery strategies. According to Dr Uzma Shamsi, a cancer epidemiologist at the AKUH, implementing the HPV vaccine at a national level in Pakistan could save hundreds of thousands of lives annually.
The benefits are enormous, and hundreds of thousands of lives could be saved each year, she emphasised.
Pakistan is in talks with Gavi the vaccine alliance, to support the country in including the single-dose HPV (two covers four strains) vaccine in its routine immunisation programme. “It will probably take another two years and USD 16 million before we can roll out the vaccine, but when it happens, it will be a country-wide campaign,” confirmed Memon.
Shamsi predicted some tribulation because the primary target group for vaccination is pre-adolescent girls. “A new vaccine for a new target age group comes with its own set of challenges in a society where conspiracy theories about vaccination programmes, stigma and misinformation about cancer and sexual health persist,” she said. And so before the actual rollout, Shamsi emphasised, it was important to increase awareness about the HPV virus, cervical cancer causes, and vaccine’s safety and usage among the general public, patients, and healthcare professionals while actively dispelling misinformation.
Memon agreed that “conversation around the vaccine must begin”. For its part, the Sindh government set aside Rs 100 million ($365,884) for advocacy of HPV vaccine uptake in its current budget. “We will initiate a dissemination campaign once we know when the HPV vaccination programme is to begin,” he said. The Sindh province was also the first to initiate the typhoid conjugate virus vaccine after an extensively drug-resistant virus was found in the province. He was hopeful there would be less resistance to the HPV vaccine after the successful administration of measles and rubella and the pediatric Covid-19 vaccines earlier.
However, said Memon, “We will need more women vaccinators this time as young girls are shy of rolling their shirt sleeves up for male vaccinators.” With up to 125,000 female health workers across Pakistan, who were earlier trained by Gavi for MR immunisation, which is a much more difficult vaccine to administer (being subcutaneous) as opposed to the HPV one (which is muscular), he said, this workforce can be engaged to get trained for this vaccination campaign too.
In the end, however, according to Chandio, “without a strong political will and leadership, a national HPV vaccination programme cannot become a reality in Pakistan to eliminate this largely preventable cancer among women”.
Fighting her cancer has changed Bhurgri in more ways than one. Her message to women is to “not put yourself aside; make yourself a priority.” While she continues to lead a healthy life – going to the gym, eating healthy, resting, she said, “You cannot go on and pick up where you left off”.
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