10 December 2015
Sally Theobald, in conversation with Alexander Dimiti, Director General Reproductive Health in Ministry of Health, South Sudan; Lucy Bahr, Associate President of Liberia Midwife Association and Jesse Rattan director of CARE’s global programme of SRH in emergencies with experiences in Eastern DRC, S. Chad, Djibouti, Mali and S. Pakistan.
December 10th is human rights day and the culmination of 16 days of action of the UNiTE End Violence against Women Campaign. The 2015 theme for action to end violence against women is prevention; whereas this year’s Human Rights Day is devoted to the launch of a year-long campaign for the 50th anniversary of the two International Covenants on Human Rights: the International Covenant on Economic, Social and Cultural Rights and the International Covenant on Civil and Political Rights, which were adopted by the United Nations General Assembly on 16 December 1966.
There are events happening all over the world today to mark action, for example in DRC the Palais de Justice (Democratic Republic of the Congo) will turn orange to highlight the importance of ending violence against women; there has also been the ‘oranging’ of bus stops in Timor-Leste and spontaneous orange flash mobs in Indonesia. In Amsterdam, KIT (Royal Tropical Institute), and partners are organizing a symposium on sexual and reproductive health and rights in fragile environments: Turning Challenges into opportunities. And it is here in Amsterdam in preparation for the panel that will be held in the symposium that we panelists had the opportunity to discuss the opportunities to realize sexual and reproductive rights and address violence in fragile settings. Here’s what we discussed.
We need to promote family planning as a right
There has been resistance to promote family planning amongst some in contexts like South Sudan where an estimated 2.5 million people have been ‘lost’ to war; leaving some to feel discussion about contraception should not be entertained. Here exposing high profile policy players to debates and discussions at the 2013 international conference on family planning in Addis Ababa, helped transform senior delegates views on family planning as a right and as a strategy to save lives and build healthy communities.
Promoting sexual and reproductive rights requires action on child marriage. Lucy Bhar explained that in Liberia after 40 years of conflict forced early marriage is a reality for many girls. Similarly in many communities in South Sudan a girl is considered ready for marriage when she gets her first menstrual period; and child pregnancy is one of key reasons why girls drop out of school.
In South Sudan women and girls have very little autonomy, rights or ability to negotiate sex in marriage or the use of family planning. However, even within very challenging circumstances and constrained room for manoeuvre some women manage to exert agency to reduce pregnancy. Dr. Dimiti narrated the stories of 2 women from his district, one had 5 children in 8 years; she became adept at tracking her menstrual period and make the proactive decision to sleep in the bush – and hence avoid sex – during her fertile period. Another with 11 children, nearly died during child birth, but her husband still would not consider family planning. Here she offered her own cows as a form of dowry so that her husband could ‘access’ a second wife and continue procreating.
We need to build spaces for reflection and dialogue and change at policy level and at community level to support women’s rights and make family planning a reality. Exposure to debates in Addis brought change to the views of policy players and opportunities for facilitated discussion can bring change at the community level: The SHARP programme in South Sudan has been hosting community dialogues – facilitated discussions between genders and generations – statements for change were negotiated and agreed. Here are some examples:
• “If a man with more than one wife is not looking after one of his wives and their children, the wife has the possibility to refuse to produce any more children without having to pay back the cows/bride price and also has the right to not be beaten.”
• “We don’t want daughters to marry or be pregnant before 18 years old and we in our family will do all we can – we want to pledge this to our family and community.”
• “Married women should be allowed to use contraception and have three year birth spacing.”
Unsafe abortions are too often the last chance for some women and girls wishing to avoid pregnancy:
Many girls and women seek abortions but in South Sudan and Liberia this is only legal when the pregnancy poses a threat to women’s lives. Lucy Bahr said that women, and especially poorer women with limited options, resort to using stick to try to self-abort. Whereas Dr. Dimiti explained that 2/3rds of maternity wings in South Sudan are due to cases of bleeding and it is not known how many of these follow unsafe or partial abortions.
Yet again change is possible
Jesse Rattan narrated an inspiring example from Eastern DRC where stakeholders at different levels – including policy makers, the police, health providers and community leaders took action to address the negative and effects of unsafe abortion that was literally killing women and girls. They joined together to create action and change to support girls and women to access safe abortion within the law, and where needed post abortion care and doing so without fear of harassment, blame or stigma. This is an example of partnerships for change and embedded community action for change.
We also need to stop the silence on sexual and gender based violence:
There is too often silence when girls and women suffer sexual and gender based violence. In some contexts, this silence is seen as protecting, as the stigma associated with being raped is immense, and hence not speaking about it will ‘protect’ a girls chances in life. There is also arguably an even bigger silence around cases of rape of boys and men which is also sadly a reality in context such as Eastern DRC. Action here requires service provision – post rape care, emergency contraception, post exposure prophylaxis and counselling and ensuring that services to address sexual and gender based violence also link with and strengthen the broader health system, as disused in a set of resource on building back better gender, equity and health systems in post conflict contexts. And as per this year’s theme we also need to go beyond the sticking plaster treatment approach and simultaneously focus on prevention. This too requires action and changes on multiple levels and new partnerships within and beyond the community to promote change.
We have seen that change is possible – with challenges come opportunities – we need to work together to be part of the solution, and work in partnership at the community level to promote resilience and gender and societal norms that address violence and promote rights. Today’s symposium is focusing on experience sharing for action to meet sexual and reproductive rights in fragile contexts – learn more #srhrsymposium / @100KIT