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Sexuality Education in Côte d’Ivoire Revamped by the Zero Pregnancies in School Campaign

Youth pregnancies in Côte d’Ivoire declined by an astounding 20 percent since the Zero Pregnancies in School Campaign began in 2013, according to the United Nations Population Fund. This campaign is part of a nationwide plan, supported with technical and financial assistance from UNFPA, to enable young people to make informed decisions about their sexual and reproductive health.

During the 2012-2013 academic year, 5,076 students became pregnant in primary or secondary school, reported the Ivorian Ministry of National and Technical Education. While the teen-age birth rate globally is 50 per 1,000 girls, in Côte d’Ivoire, the number is 125.

The 2013 UNFPA State of World Population report found that 7.3 million girls, 18-years-old and younger, give birth each year in developing countries. This reality is both a health issue as well as a development issue. Many pregnant girls are forced to drop out of school creating downward-spiraling repercussions of limited prospects.

“It is deeply rooted in poverty, gender inequality, violence, child and forced marriage, power imbalances between adolescent girls and their male partners, lack of education, and the failure of systems and institutions to protect their rights,” said Dr. Babatunde Osotimehin, UNFPA Executive Director.

The high birth rates in Côte d’Ivoire undermine the country’s ability to take advantage of a demographic dividend. A demographic dividend is a window of opportunity to hasten economic growth when a population’s age structure shifts from one with fewer people of working age (15 to 65) to one with fewer dependent people (under 14 and over 65).

In response to this situation, the Ivorian Council of Ministers formally adopted the accelerated pregnancies reduction plan on April 2, 2014. The plan is a comprehensive program that integrates sexuality education in Côte d’Ivoire, teaching over several years starting in 4th grade to provide age-appropriate information at each stage.

Based on human rights principles, sexuality education encompasses more than sex education. The fundamental components of the curriculum feature the information about the human body, contraception and sexual and reproductive health. This includes knowledge about sexually-transmitted diseases and the effects of early pregnancy. The curriculum also addresses the issues of child marriage and gender-based violence so that human rights, gender equality and the empowerment of young people is advanced.

The comprehensive program offers other school activities beyond the classroom. Nationally, student clubs are being formed to raise awareness, and an arts and culture festival is planned where students can display their creative endeavors, such as plays, poems, stories and drawings about pregnancy in school. UNFPA has helped the government open a call center that provides free, confidential information. To disseminate information about health and services, various media, such as leaflets, videos, radio announcements and SMS messages will be disseminated.

Much of the needed education involves demystifying contraception and pregnancy. Amina, a pregnant student, revealed: “I did not take contraceptives because my mom told me that it might make me sterile.” Some girls are also told that not getting pregnant by age 15 or 16, “is a problem,” remarked Clarissa, 22.

The Zero Pregnancies in School Campaign was launched in Bondoukou, the most affected area in Côte d’Ivoire. Students in the region brought banners to the event with such messages as “Zero pregnancy in school, I endorse it,” “You don’t get a child pregnant” and “I am a child. A child doesn’t bear a child. A child goes to school to succeed.”

The government is making even further changes. Laws have been introduced that increase penalties for the sexual abuse of minors. Most significantly, this includes sanctions against teachers who abuse their students. Girls are often pressured into sex with teachers in order to get good grades.

Additionally, the government is planning to build better housing for the 10,000 to 15,000 students in cities that must board. This will enable the young students to have proper housing where boys and girls do not have to share a room.

The government also no longer expels girls when they are pregnant, and girls are returning to school after giving birth. Amina told UNFPA, “My mom takes care of my baby when I come to school.” Clarissa’s mom also takes care of her son. Clarissa explained to UNFPA that she still has her dreams: “I lost a school year,” but “I want to become a teacher.”

– Janet Quinn

Sources: UNFPA, UNFPA, Demographic Dividend, UNFPA
Photo: Flickr

Mobile Family Planning in India

mobile family planningJanani, an affiliate of DKT International, has started a mobile family planning project. Twenty outreach teams in vans provide family planning services to rural and hard-to-reach areas in India. This helps expand access to family planning options.

The vans specifically visit regions where family planning is unavailable and where birth rates are exceptionally high, like Bihar and Uttar Pradesh. According to the last India National Family Health Survey in 2005-2006, the average birth rate in Bihar was 4.0 children and the average birth rate in Uttar Pradesh was 3.82 children. Bihar and Uttar Pradesh have the highest and second highest birth rates in all of India. Even so, the mobile family planning project can help women postpone or eliminate the option of pregnancy.

Janani offers IUDs, tubal litigation, condoms, oral contraceptives, injectables and emergency contraceptives for women. Additionally, the project offers non-scalpel vasectomies for men. This project helps promote long-term contraceptives, like the IUD, and permanent methods, like tubal litigation and vasectomies.

Doctors, nurses/midwives, van coordinators, attendants and drivers all make up each team. About four to nine people are in each van to serve Indian communities. The vans have a counseling chamber, audio-visual equipment and medicines and equipment needed for IUD insertion. The nurse/midwives are trained for counseling and IUD insertion in Patna at the Surya Clinic and Training Centre, which is owned by Janani.

The teams in each van serve around 10 to 15 new clients and about five to eight follow-up clients per day. Each team also makes up to 15 days of visits per month. Janani serves between 2,000 and 3,000 new clients and 1,000 and 1,500 follow-up clients each month. While it is important to care for new clients, it is also beneficial to conduct follow-up appointments with previous clients.

Janani aims to help women and men in rural and low-income areas. Improved access to family planning can help individuals who do not want to have children. Additionally, this could help keep more children out of poverty, considering that women may not want to have children if they are in a low-income household. Furthermore, this could help address the issue of overpopulation in India. Solutions such as mobile family planning are innovative and reach individuals who previously may not have access to family planning options.

– Ella Cady

Sources: DKT International, Impatient Optimists
Photo: Needpix.com

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Sexual Health of Adolescents in the Developing World

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There are more than 1 billion teenagers worldwide. Seventy percent of them live in developing countries. According to the Demographic and Health Surveys and the AIDS Indicators Survey, the average age that young people in impoverished countries have their first sexual encounter is, at the lowest, age 16 or younger, and, at the highest, 19.6.

Just like in developed nations, with sexual activity comes the risk of sexually transmitted diseases and unwanted pregnancies. Unlike wealthier nations, these impoverished countries lack adequate healthcare. In places such as Sub-Saharan Africa, AIDs is an epidemic. Two-thirds of those infected are adolescents.

Adolescent girls run the greatest risk for sexual and reproductive health threats. A young girl that becomes pregnant who lacks access to healthcare faces many serious health risks. Pregnancies, child-birth and abortions are all perilous. The likelihood that a 15-year-old girl in a developed nation could ultimately die of maternal complications is 1/3800. Compare this to just 1/150 in the developed world.

Meet Reem: she is a 15-year-old girl living as a refugee in a camp. Her two-month-old baby is underweight because it was born prematurely and because Reem was never taught how to breastfeed. She has no one to help her, her husband was killed before the baby was born, and her mother was separated from her in the national conflict.

In other instances, girls marry older men. Hibo is a 13-year-old girl living in a Somalian refugee camp. The oldest of five children, she is responsible for helping her mother care for the family. Her parents are planning to marry Hibo to a wealthy landowner that will bring the family much-needed money and honor. She has been told that it is her duty to marry, serve her husband, and bear him children.

Married women like Hibo are encouraged to have children as soon as possible. Their social status and identity are associated with raising children. Being childless is frowned upon. Unfortunately, wedding older men who have had previous partners bring the potential for STDs.

Young people also face the danger of sexual violence. A national survey in Swaziland revealed that one-third of girls aged 13-24 suffered sexual abuse before the age of 18. Boys face abuse as well but are reported as being less likely to reach out for help from healthcare providers.

Although young people are getting married at an older age, the amount of premarital intercourse is increasing. At the same time, contraceptive use for all teens is low. In Sub-Saharan Africa, contraceptives are used by a low of 3% of sexually active adolescents in Rwanda and a high 46% in Burkina Faso.

Due to the U.N.’s Millennium Development Goals, more youth have greater access to formal education. Health officials decided that school-based sexual/reproductive health programs were the perfect way to educate adolescents. Yet, a survey of these programs and their effects have produced varied results. Not all adolescents attend school, and the funding for these programs is not always there.

The Save the Children organization understands that if there are no programs that specifically reach young people with sexual health programs and education, they will never access the care and knowledge they need. The organization has set up teen-accessible places to teach them about safe sex and offer health services.

Their methods and the continuation of school-based programs have been yielding promising results in places like Mexico, Nigeria and the Dominican Republic. Young people are taking more measures to prevent STDs and unwanted pregnancies.

– Lillian Sickler

Sources: Guttmacher Institute, Women and Children First (UK), Alliance for International Youth Development
Photo: The Times

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Family Planning and Poverty

Family-Planning-Reduces-Poverty

Latin America and the Caribbean provide valuable examples of how family planning can reduce poverty.

Family planning involves strategies to delay childbirth, space births over time and avoid unintended pregnancies. When women and men can control the size of their families, they are more likely to have the resources to support their children.

A recent report, “Family Planning in Latin America and the Caribbean: The Achievements of 50 Years,” shares many success stories of family planning research and programs in this region.

The current contraceptive prevalence rate in this region is 74%. This is one of the highest rates within the developing world. The rest of the world can learn from success in Latin America.

With the rise in contraception use, Latin America has seen an increase in educational participation, a decrease in the infant mortality rate and a more stable economic climate.

A few of the most effective strategies include the work of dynamic NGOs with new methods of family planning, financial and technical assistance from USAID, the development of local expertise, and availability and access to research data.

The family planning strategies developed from clinic-based efforts include direct delivery of contraceptives to community-based awareness efforts involving mass media.

The use of mass media to change cultural norms and attitudes proved to be an effective strategy. The use of radio and television helped increase awareness about family planning and strengthen support. Traditionally, families in the region had many children and did not use contraception. This put a strain on limited resources. For families to accept family planning methods, this required a change in belief about how families should be created and maintained.

In Mexico, popular singers, Tatiana and Johnny, recorded songs and produced music videos that supported responsible sex. For example, the song titled “Detente” or “Wait” in English, suggesting ideas to delay childbirths or wait to have sex.

While this region of the world has achieved great success and can serve as a model for areas such as Sub-Saharan Africa, there is still work to be done. Adolescent fertility rates remain high, and young, rural women of lower socioeconomic status are less likely to have access to family planning resources. There is a need for continued research and commitment to reach all people.

– Iliana Lang

Sources: Carolina Population Center, Carolina Population Center 2
Photo: YouTube

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Pathfinder International Addresses Overpopulation

pathfinder_international
Clarence Gamble was born in 1894 in Cincinnati, Ohio and proceeded to attend a slew of universities including the likes of Princeton and Harvard University, where at the latter he received his M.D. degree. Following, he became heavily involved in birth control organizations and research. He worked alongside Planned Parenthood and initiated projects to study population growth in countries such as India and Japan.

In 1957, Gamble founded the Pathfinder Fund, an organization dedicated to providing a wider audience of people with access to safe, efficient and helpful reproductive health services. The fund is donation-based, which came into play as early as the 1960s. In fact in the 1960s the USAID and Office of Population donated $10 million to the organization, thus proving the government’s support of the discussed issues.

Pathfinder was already operating globally in the 60’s and 70’s opening offices in Latin America, Indonesia, Egypt, Chile, the Philippines and actively participating in population schemes in various African countries. Over the decades, the Pathfinder Fund continued to grow and, by the 90’s, it was the Pathfinder International.

In 1996, Pathfinder won the UN Population Award, an award given to someone who has raised awareness of population issues and solutions. And more recently in the 2000’s Pathfinder began the African Youth Alliance program aimed toward people 10-24 years of age in African countries like Botswana and Ghana. It was formed in order to assist with reproductive health.

Nowadays, Pathfinder International continues their hunt for better sexual and reproductive health care for all. They have six main focus areas: Adolescents, HIV/AIDS, Contraception and Family Planning, Advocacy, Abortion and Maternal and Newborn Health.

For example of their comprehensive care, as part of their abortion focus, Pathfinder not only supports a woman’s right to an abortion, but also advocates for safe abortions and rigorous post-abortion care. The organization accomplishes this in a number of ways one being through legislation, and another by funding an expanded number of professionals who can provide the medical and psychological services needed.

Another focus area, the Contraception and Family Planning focus, is also a worldwide project for Pathfinder. Over the years, Pathfinder has involved itself in over 100 countries attempting to integrate family planning concepts and to provide contraception to those in need of it. Above all people need to be educated, and Pathfinder does their best to also take on that responsibility.

Pathfinder International encourages the public to do its part as well. People can host fundraisers and events of that nature to provide contraceptives to people. One of the easiest ways to support the cause is for people to use their voices. People can become a part of their advocacy network or even start a conversation about reproductive health on a public forum. And lastly, Americans can vote for legislation to continue this type of focus. In an ever-growing population, it is important to be as conscious as possible of the world’s sexual and reproductive health.

– Kathleen Lee

Sources: Pathfinder International, Harvard Library

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Global Health Investment is a Win-Win Situation

Economists, public officials and humanitarian leaders across the globe are all echoing a new stance on foreign aid: treat it like an investment.

Sure, many areas of the world still require immediate relief in the form of solid goods, but what these communities absolutely require is the stability and means to sustain themselves long-term. In order to break the cycle of poverty, impoverished people need a new cycle altogether characterized by improved economic infrastructure and stability.

The best aspect of the investment approach is that it promises profit. Business executives are now realizing the untapped workforce potential of the world’s destitute. By developing interest in these areas from an economic standpoint, companies are not only opening up access to the world market, but they are seeing positive returns as well.

Companies like Samasource, a Silicon Valley-based startup, have illustrated success in the private sector. Samasource’s model involves big data projects that they break down into manageable tasks for their overseas workers. American tech giants such as Google and LinkedIn benefit from the work and finance of the paychecks of their outsourced employees. As a result, Samasource is profitable and growing while people in rural areas have new access to the technological world market.

Now, imagine taking the approach a step further and funding industries that directly address the critical issues impoverished people face, such as global health investments. Could financing ventures that treat HIV, malaria and infant mortality help those in need and actually boost the economy? More and more people are answering this question with a solid “yes.”

The solution won’t be so simple, however. Devex editor Rolf Rozenkranz recently sat down with Annie Baston who is the chief strategy officer at PATH, an international nonprofit that specializes in long-term solutions to break cycles of poverty. Baston explained the common challenges faced when determining a “best buy” for global health investment. Multiple factors come into play involving technological solutions and systemic reform. These elements need to be carefully orchestrated and illustrated to investors to generate interest and maintain longevity.

In fact, organizations such as The Lancet and their team of researchers have laid out a complex global health investment plan, titled “Global Investment Framework for Women and Children’s Health,” that will secure high health, social and economic returns. Through simulation modeling, The Lancet has found that “increasing health expenditure by just $5 per person per year up to 2035 in 74 high-burden countries could yield up to nine times that value in economic and social benefits.” Their models, published late last year, approach maternal and newborn health, children’s health, malaria, HIV/AIDS, family planning and immunization.

– Edward Heinrich

Sources: DEVEX(1), DEVEX(2), The Lancet, Samasource
Photo: University of Delaware

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Iranian Population Increases and Contraception Decreases

As the rest of the world begins to tackle the growing population problem and the threat humans have to the environment, Iran pushes forward with a goal in mind to increase the country’s population.

Hovering around 77 million citizens, Iran is no small country. Supreme Leader Ayatollah Ali Khamenei recently announced on his website that he wishes to “strengthen national identity” with this proposed Iranian population increase.

He also blamed Western culture for the rise in contraception usage and stated that the country should avoid these “undesirable aspects.”

The inherent expectation to come of this campaign is the reduction in access to contraceptive health, damaging the future of women’s rights as well as public health in Iran. Contraception was only introduced to Iran in the 1980s, and its likely disappearance will surely not be taken lightly. Not only will the population increase with no access to contraceptives, but so will the rates of sexually transmitted diseases. Contraceptives have long held more function than simply birth control.

Groups such as the AIDS Research Center at Tehran University have recognized the dangerous path this campaign is heading toward. Without complete access to contraception, educators will not be able to teach community members ways to practice safe sex and prevent the spread of AIDS.

This population policy does not address the needs of the modern Iranian citizen as represented in the reformist group. Those in poverty who struggle to support a small family will face great hardships if they have restricted control over the size of their family.

Iranian reformists are concerned with the future of the country under this new ruling due to its potential impact on women’s equality.

Many believe Iran is taking steps backward with this course of action, shying away from progressive women’s rights. Women’s rights in Iran have seen dismal support and this does little to eradicate that.

Since 1986, the population of Iran has fallen about 2 percent, which may play a part in the government’s decision to incite this new ruling for Iranian population increase. However, according to the World Population Review, Iran’s population is already on the road to rapid increase, with a majority of the population being held in the younger generations and immigrants from surrounding countries. It’s possible that with this new decree, the population will shoot up at alarming rates and threaten the stability of the country.

-Elena Lopez

Sources: Reuters, NY Times World Population Review, Khamenei
Photo: LA Times

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China Eases One-Child Policy

China_One_Child_Policy_Baby
In late December 2013, China’s Standing Committee of the National People’s Congress formally introduced measures to ease its notorious one-child policy.

The major tweak of the one-child policy now allows parents to conceive a second child if just one of the parents is an only child.

Previously, parents were allowed a second child only if each parent was an only child. Rural couples on the other hand, were allowed a second child only if the first born was female.

The new measures will be implemented in a phased process at the local level. Furthermore, provincial leaders now have the authority to introduce the changes in accordance with local demographic needs.

While modest, the change will hopefully reduce the number of human rights abuses perpetrated against Chinese women since the policy’s inception in 1979. In the New York Times, OP-ED contributor Ma Jian details some of the horrific experiences Chinese women endure when authorities become aware of a second conception.

She describes the staggering amount of personal invasion local officials engage in to enforce the one-child policy. Family planning officers vigorously chart data regarding menstrual cycles and pelvic exams of every female of child bearing age within every village.

Many of these women are subjected to forced abortions and sterilizations if they are found within violation of the policy.

Probably one of the most egregious injustices of the policy is its disproportionate enforcement. The policy frequently targets poor citizens while bypassing wealthy individuals.

In fact, all violators can avoid the consequences of having a second child if they pay a fine that falls within the range of three times to 10 times the annual household income. It goes without saying that poor citizens, unable to pay the steep fine, either flee their home to avoid the authorities or become victims of forced abortions.

Many see the easing of the policy as a response to the looming demographic crisis that China now faces after 30 years of steadily implementing the one-child policy.  Some say the change is too little, too late.

Nicholas Eberstadt reports in the Wall Street Journal, that even with the policy change, the Chinese government only expects one million extra births per year, resulting in only a six percent increase in the fertility rate.

He also discusses the lasting effect the one-child policy will have long after its easing. For instance, individuals born under the previous policy will be entering the workforce in 2030 and deciding to get married in 2035.

Demographers predict that at the end of the decade there will be over 24 million men incapable of finding a woman to marry. One can expect this number to increase by 2035.

The inability for many to reproduce will leave China with an aging population that will increasingly reduce the number of individuals who are able to work as well as government resources. By 2050, over one quarter of the Chinese population will be over the age of 65.

– Zachary Lindberg

Sources: BBC, The Wall Street Journal, The New Yorker
Photo:  Dailystormers

 

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Big Impact of Baby Footprints

baby elephant
In one of the largest countries in Africa, a new program is working to change the outcome of premature births with a simple footprint.  Tanzania is home to an estimated 46,218,000 people who earn an average of $570 per year.  With about one third of its people living below the national poverty line, Tanzania is regarded as a ‘developing country.’  The term ‘developing country’ is described by Princeton as “a nation with a low level of material well-being.”  A common reality in developing countries is the limited or complete lack of access to medical assistance, whether a hospital, pharmaceuticals or a birth attendant.

The latter is an issue that can have devastating consequences.  In low-income countries, about 40% of births are unattended by a trained, medical professional.  Whether or not they are equipped with modern tools and resources, a trained professional is better able to determine the dangers and necessary steps to take before, during, and after birth, especially regarding premature babies.  Of the approximately 10% of infants worldwide born prematurely each year, about one million die, with over 80% of those deaths occurring in South Asia and Sub-Saharan Africa.

At present, Dr. Joanna Schellenberg and a team at Ifakara Health Institute (IHI) in Tanzania are researching a strategy with the potential to have a global impact.  The research began by attempting to solve how to reduce premature infant deaths without requiring entire health systems to be constructed (and funded) first. This is especially important since one of the greatest obstacles facing health care in rural areas is the absence of equipment.  However, the World Health Organization (WHO) estimates that 75% of preterm infant deaths could be prevented without the use of intensive care and modern resources.  Premature infant weights are under 5lb 5oz, yet since scales cannot be assumed to be available, the IHI team came up with another measurement: the size of a baby’s footprint.

Volunteer health workers visit villages with a laminated card picturing two footprints.  The health workers measure infants’ feet against the pictures and determine how to proceed based on their size.  If the infant’s footprint is the same size or larger than the bigger footprint, then the child is not premature.  If the footprint is between the two sizes, it may be premature but not necessarily in danger.

Health workers then proceed with suggestions on how to promote infant health such as holding the child skin-to-skin for warmth, or how to breastfeed effectively.  Finally, if the footprint is smaller than both samples, about 67mm or less, the mother is directed to the nearest health center where the infant can receive potentially life-saving care.

The strategy just described is called “Mtunze Mtoto Mchanga” which translates to “Protect the newborn baby,” a concept that local women have been quick to support.  With the persistent visits and encouragement by the project’s health workers, support has grown into a greater compliance by the public. Though the project will continue for another six months before clear results are available, the team is already poised to implement it throughout Tanzania.

The laminated-card system is not only relatively simple to duplicate, it also demonstrates potential self-sufficiency amongst rural women.  Moreover, once the procedure and subsequent actions are ingrained, the individuals could monitor their babies themselves without the need for health workers help with premature birth testing.

The versatility of the project only heightens anticipation for the results of the study.  If successful, the IHI project could mean saving up to three-quarters of a million infants each year with just a footprint.

– Katey Baker-Smith

Sources: World Health Organization, Princeton University, United Nations Data, The World Bank, BBC
Photo: Giphy.com

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Bangladesh Healthcare Improves Despite Poverty

bangladesh_healthcare_improves
Despite widespread poverty and low governmental spending on health, Bangladesh – particularly, its healthcare system – has made significant improvements in life expectancy, vaccination rates and decreased infant mortality rates. In a special report by The Lancet, it has been shown that the remarkable strides made by the country are due to programs that focus on gender equality, family planning and immunizations.

Professor Mushtaque Chowdhury from BRAC, a Bangladeshi NGO, has said, “Over the past 40 years, Bangladesh has outperformed its Asian neighbors, convincingly defying the expert view that reducing poverty and increasing health resources are the key drivers of better population health. Since 1980 maternal mortality has dropped by 75%, infant mortality has more than halved since 1990, and life expectancy has increased to 68.3 years—surpassing neighboring India and Pakistan.”

Women have played a large role in these advancements. Door-to-door female health workers delivered family planning services over the last 40 years, resulting in a drop from 7 births per woman in 1971 to 2.3 in 2010. During that time, contraceptive use has increased from 10% to 62%. Education for girls was also noted as a key factor in these improvements.

The success achieved has been attributed to the involvement of NGOs, such as BRAC, in poor rural areas. “NGOs as a group have innovated to address issues of poverty, unemployment, health, education and the environment, and in many cases the government and NGOs have worked together to achieve a common goal,” The Lacent report continues to reveal.

While Bangladesh is succeeding in many areas, there are still many more that are not so positive such as child malnutrition. In the poorest families, 50% of children are still underweight. Even in the wealthiest quintile, 21% of children do not receive enough food.

“The Bangladesh health system has been shaped to address the first generation of poverty-linked infections, and nutritional and maternity-related diseases,” the Lancet goes on to say. “But given the epidemiological transition, the health system will have to be adjusted to grapple with chronic non-communicable diseases. For the fragile and evolving Bangladesh health system, the global attention on universal health coverage has not been translated into substantive action.”

– David Smith

Sources: TheLancet, TheGuardian, The Conversation