Politics Affects our Health: the Case of Sudan

‘Social determinants of health’ are the circumstances and surroundings that influence an individual’s health outcomes.

Researchers have focused on social determinants of health for decades and there is now a general consensus that higher socioeconomic status predicts better odds of future health and well-being. While this notion is scientifically accepted, it prompts the question: what creates these social determinants of health? This has brought much needed attention to the ways in which politics affect health – both directly and indirectly.

‘Political determinants of health’ are the factors that shape the social determinants of health. This is a relatively new concept and is of particular significance for women. An example of the link between politics and health can be found in Sudan.

In Sudan, the political climate is shaped by religion and the constitution is based on teachings of Sharia Law. Currently, many communities face extreme financial strain as a result of failed past politics and/or war and insecurity. This has increased pre-existing and vast social inequities, including gaps in financial and educational opportunities.

The political situation in Sudan has had inevitable consequences for health.

Social disadvantage falls heavier on women. Until recently, girls have been denied the same education as their male counterparts. Lack of education leads to limited knowledge of health, which affects an individual’s ability to improve their own health outcomes. 

One example is the issue of sexual and reproductive health. Sexuality and sexual behaviour are sensitive topics rarely discussed in conservative, religious cultures like Sudan’s. Sexual and reproductive health and rights do not enjoy a high-priority status among political agendas, either, and there has been very little consideration of introducing sexual education into classrooms. However, many educators and health officials have started to support sex education in schools, resulting in increasing support by legislators.

Another example is the high prevalence of female genital mutilation (FGM) in Sudan, at a prevalence of approximately 89% countrywide. The harmful practice continues to affect many areas of the country, and although it is legally banned, it is well-known to continue with the open support of many religious leaders. This is a clear example of failed implementation of legislation that has allowed FGM to remain prevalent despite wide-spread efforts by campaigns and NGO peer-education programs.

Under Sudanese constitution, child marriage, forced marriage or marital rape are not against the law.

Much of the country’s legislation does not provide any protection for women’s rights. As a result, many Sudanese women fear persecution.

One case that struck the international community was that of Noura Hussein in 2018. The 19-year-old was sentenced to death for fatally stabbing her husband – who she had allegedly been forced to marry – after he attempted to rape her. In the eyes of the law, marital rape does not exist, and so Hussein had no claims to self-defence as she was viewed as a belonging of her husband. The ruling was thankfully overturned after increasing international pressure on the Sudanese government. Hussein received a reduced sentence of 5 years in prison. 

Historically, women in Sudan have been forced to be subordinate to men. Although this is changing and vast improvements have been made, drastic changes to the country’s politics and constitution are needed to ensure full protection of women’s rights – especially their rights to health and wellbeing. 

 

Will Education Alone Suffice?

In a not-so-small village in India, where people earn their livelihood by farming, education is booming. In the last decade, this village has seen the birth and development of a government school and several private schools. A couple of these are even elite ‘English medium’ schools.

The village has also seen the opening of a pre-university college. But to pursue any vocational or professional course afterwards, an individual must travel to the next town. With no frequent bus connectivity, this higher education remains a distant dream for many. But the people of the village are still ecstatic.

Their children can now say a few words in English. They can identify the English alphabet. They can – sometimes stutteringly – say a sentence in English too. Their children are educated – a word whose purpose and worth many of us fail to comprehend.

In a real-life scenario, each family enrolls their child/children in school dutifully. Fees are low, midday meals are provided and children are taken care of while the parents work in the fields as daily wage labourers. By the time the children are back, parents are back at home too.

When boys reach 5th or 6th standard, they drop out of school to work alongside their parents. Another breadwinner for the family is more important than learning English – which ‘they will never use anyway’.

The girl child, however, is sent to school to complete her education up to the 10th standard. Some progressive families will even allow their daughters to study up to the 12th. All because it increases their demand in marriage.

A boy educated up to 4th standard will work from the age of 9 till 24, manage to buy an acre of farm land with the joint earnings of his family, and then approach the family of a well-educated girl with a marriage proposal.

If all goes well, the proposal is accepted and a marriage is celebrated by the families. The daughter-in-law dutifully takes up her responsibility of cleaning the house, cooking three meals, tending to the cattle and bearing children – often before she herself is even 20 years old.

This is the story of young adults in most villages here.

Is there any need for change? Who is to blame? Does something have to be done, or is this something to be left alone?

Schools and colleges were, at some point, new to many living in villages across India. Yet most people accepted them with open arms. My question, though, is if this education does not translate into a good job and decent pay, is it of any use to poor farming communities?

Ensuring we don’t just stop with providing schools, but focus on creating livelihoods through relevant vocational training is a major need for our people.

Making opportunities for working and earning available to girls and boys equally is the responsibility of every government.

What use is a 12th standard education if a girl is unable to support herself financially? After all, financial independence is very closely linked to security and safety.

I believe that societies change and adapt to the opportunities presented to them. Law makers, influencers and policy makers must understand the needs of a population with a view to future growth, rather than simply providing dead-end educations!

Raising the Girl Agenda in Myanmar

We are still coming off the buzz of a really energetic and earnest Girls’ National Conference in Myanmar. Bringing together adolescent girls from across 70 diverse communities, the conference supported girls to work together and articulate an agenda to submit to regional and national lawmakers.

This agenda will be in the form of a letter. It will describe the barriers faced by girls in communities across Myanmar and the ways that law-makers can help to knock down these barriers so that all girls can achieve their full potential.

Last year, we made a big deal of International Day of the Girl – dedicating almost an entire season to it! We created opportunities for girls from all of our project communities to contribute directly to the development of an agenda for national and regional change – an agenda that would support girls’ development, education, access to safe work, freedom of movement, expression and beyond.

There were two key steps to making this work. Firstly, we held Regional Forums in 15 geographic hubs. Then, based on the outcomes from those events, we built the content and activities needed to make the National Conference both productive and deeply connected to the views and attitudes of adolescent girls.

In the lead up to those Regional Forums, our staff moved around the country with a mission to ensure every girl currently enrolled in our weekly leadership circles — over 3,000 girls — could attend a forum in her region. This would mean every girl could meet with others from nearby areas to discuss the specific, and sometimes invisible, barriers they share which can diminish self-perception and limit  choice.

Girls’ Regional Forums

The forums were focused on consensus-building activities. The day’s discussions were based on what we already knew about the situations of girls in different areas and the concerns girls have expressed to us in the past. In small groups, girls worked through various possible barriers to identify which applied most directly to their lives. They also discussed specific examples of times when, as a girl, they have encountered a barrier, been discriminated against, or felt unheard.

Girls’ National Conference

Immediately following the regional forums, we held our inaugural Girls’ National Conference in the City Hall of the ancient capital of Mandalay. The theme was “Girls, do you know you can fly?”  Attending the conference were 140 adolescent girls – peer-selected delegates representing nearly all of Girl Determined’s project communities.  Each spokesgirl shared on behalf of girls in her unique community, speaking out in a broader discussion with other girls facing sometimes similar and sometimes different issues.

Over two full days, the conference brought girls’ voices and experiences to the fore, while encouraging girls to act as change-makers in their communities and consider a different future for girls and women. Girls heard from one another and were introduced to basic concepts of civic action. Through consensus-building activities, they drafted a joint-letter expressing the concise needs of adolescent girls nation-wide.

Four main issues came out as the most detrimental to girls’ success in Myanmar:

    • inadequate or limited access to education
    • inadequate or limited access to health, nutrition, and sanitation needs
    • feeling unsafe and not knowing how to respond in dangerous situations
    • feeling unable to make decisions and express opinions about their own lives

We expect to see more girls taking issues into their own hands by expressing their needs in a structured way and demanding accountability by those in positions to make decisions.

Building On The Outcomes

Now that the conference has ended, two tasks remain.

Firstly, we will refine and revise the letter before the girls present it to members of parliament. A delegation of six girls from the conference will present the letter and express their concerns and hopes directly to parliamentarians.

Secondly, we will report back to ALL the girls who contributed their experience and insight on what their inputs have gone towards – both at the National Conference and during the direct appeal to lawmakers.

We will report back to all these girls through an article in our Wut Hmon magazine, and through a summary video of the National Conference.  This way, girls who weren’t at the national level gathering can see how their concerns were carried forth by their peers, and can experience the full process from regional forums to visits with parliaments.

We are excited to see how this plays out in the coming months, as girls’ voices resonate through Myanmar to create awareness of the hardships girls face, and of how they can rise up together.

“A world of hope for adolescent girls” – Olive’s story

This is the fourth and final blog in a series sharing personal family planning stories from around the world – presented by CARE and Girls’ Globe in the lead up to the 2018 International Conference on Family Planning. Catch up on the whole series with stories from HawaParmila, and Oun Srey Leak.

Rwanda has made significant strides in empowering women and girls and ensuring they have access to affordable healthcare, including access to family planning.

Access to contraception has steadily increased from 17% in 2005 to 53% in 2015.

The government has decentralized and subsidized healthcare to ensure the most remote areas are reached and the most vulnerable communities can access services. However, the biggest unmet need for family planning is predominantly among young and unmarried women. In 2016 alone, 17,000 girls reportedly became pregnant before turning 18!

In 2016, the Government of Rwanda began providing comprehensive sexuality education in schools, however there is still a long way to go to ensure teachers are equipped with the skills and information needed to engage in age-appropriate, open and honest conversations with students.

I work for CARE in Rwanda, where I advocate for increased access to age-appropriate, integrated sexual and reproductive health services, rights, and education for in-school and out-of-school adolescent girls. Although the country has made notable progress in promoting women’s and girls’ rights in recent years, teenage pregnancies have continued to rise, leading to dire socio-economic and health consequences for Rwandan girls.

A few weeks ago, I attended an information session for young women in Kigali where a medical doctor explained available methods of contraception. I realised then that there is a lot young people do not know. But it made me wonder…

If the youth of Kigali don’t know how to prevent pregnancy or to take care of their sexual and reproductive health, what about women and girls who reside in rural areas where access to information and services is still a challenge – even a luxury?

In my time at CARE, I have seen the tremendous work the organisation is doing around the world to increase demand for sexual and reproductive health information and services, including contraception. Much of our work focuses on addressing underlying causes of poverty and vulnerability and helping communities to challenge harmful and negative socio-cultural norms that hinder women and girls from enjoying their rights and reaching their development potential.

Two weeks ago, I met a group of adolescent girls in Karongi District, Western Rwanda, where CARE is implementing the Better Environment for Education (BEE) project to increase chances of girls staying in school. During my visit, the girls talked to me about the various problems that they faced, including unwanted and early pregnancy. As I listened to their stories, I wondered whether we are doing enough to address these issues.

One particular 17-year-old stood out to me. As she narrated her story with teary eyes, she recalled the difficult time she went through when she found out she was pregnant, and described how she was abandoned by her family. She felt she had failed them and failed herself. At some point she was forced to quit school to raise her infant. But when the BEE project began, she decided to join one of the clubs and suddenly found hope. According to her, the clubs have provided a space and a voice for girls to talk and to get accurate and comprehensive sexuality education.

Although the local health centre is just a few metres away from the school and provides condoms and other contraceptive methods, young people in Karongi told me they feel judged and shamed when they go there to seek services that they are entitled to. The BEE project aims to address this as well by giving adolescent girls a platform to dialogue with the school administration and local leaders to express their needs.

Studies have shown adolescents are increasingly becoming sexually active before they turn 18 and this is a reality we should not ignore. Too often, in countries like Rwanda, adolescent girls do not have information regarding their changing bodies or sexuality in general.

Adolescent pregnancy undermines a girl’s ability to exercise her rights to education, health, and autonomy. It’s not only a health issue, but a human rights and development one too. 

I believe that CARE’s integrated approach to empowering adolescent girls, including economic empowerment through savings clubs, sexuality education, addressing gender-based violence and engaging power holders such as parents, boys, school administration officers, and local leaders is powerful in ensuring the problem is addressed from all sides. I have no doubt that this will bring about transformation in the lives of girls and their communities.

We have no more time to lose.