Breast Ironing: A Harmful Practice That Spans Generations

The cocks crowed, signifying morning was nigh.
Hope shuddered as she thought of what awaited her.
Her developing breasts throbbed with excruciating pain, worsened hours ago when her mama had pounded them with hot stones.
She’d cried and pled as mama pounded and auntie held her, but it was useless.
They said they were doing it for her, they didn’t want the men to desire her, but Hope felt none of their love.
All she felt was the pain.
And she saw the scars she knew would never leave.
She heard mama’s footsteps. It was time.
This was her daily routine, one that began when she’d clocked nine and the breasts started to show.
She sobbed, wishing herself away from this hidden ritual.
No one could hear her, no one could save her.

Hope may not be real but what she suffered – breast ironing – is. This is the reality for many girls.

Breast ironing is an action perpetuated to stop the development of breasts. It is carried out by using hot objects like stones, paddles, spatulas, and brooms to massage, pound, and press the breasts flat. Sometimes, belts or bandages are used to bind the breasts. This act is usually carried out by mothers, female relatives, shamans and rarely, the victim.

I first came to know of this practice when I stumbled across a report by Aljazeera, detailing this cruel act that is ongoing within refugee communities in Ogoja, Nigeria – my country. The report explained that this act is carried out by refugee Cameroonian mothers because of the high levels of sexual harassment and assault to which female refugees are exposed. It is done in the hope that their daughters will become less desirable to men.

According to the United Nations, 3.8 million girls in the world today are affected by breast ironing.

Breast ironing culture, also known as breast flattening, is widespread in African countries like Cameroon, Guinea-Bissau, Chad, Benin, and Togo. It is most prevalent in Cameroon, with the number of girls who have been subjected to it estimated at around 1.3 million! However, it is not only prevalent in African countries. Came Women and Girls Development organization estimate that every year, 1000 girls aged 9-15 across the UK are victims of breast ironing!

The reasons behind the practice are meant to “protect” girls.

Mothers perform this act because they believe that no breasts will make their daughters less attractive to the opposite sex, thereby warding off sexual advances. These mothers ignore their daughters’ pain as they have the intention of “protecting” them from rape, sexual harassment, early marriage.

Nonetheless, it remains a misguided intention because breast ironing only exposes girls to extreme pain, psychological damage, infections, cancer, and inverted nipples.

What’s being done against breast ironing?

Breast ironing does not receive as much attention as it should. In Cameroon, where it is rampant, anti-breast ironing laws are non-existent. In the UK, it has been recognized as abuse within the Violence Against Women and Girls strategy. As of July 2019, The Crown Prosecution Service (CPS) has updated the So-Called Honour-Based Abuse and Forced Marriage guidance to recognize breast ironing as a criminal offense. Notwithstanding, to date there have been no prosecutions. This practice continues in secret and is difficult to detect.

While organizations exist that fight against this act, more still needs to be done.

We need to stop it now and save lives.

People need to understand that breast ironing is not capable of solving the larger problems. It is just a branch of a larger tree: gender inequality.

Girls should be seen as equals and taught to respect themselves. Women should understand that sexual abuse is not their fault but the perpetrator’s. This way we can wipe away the need for this practice. Sex education for mothers, children, families should also be integrated into the society.

Lacking restrictions against breast ironing is one of the reasons this practice festers.

The law has turned its face away and refuses to protect these girls. No more should we give the excuse of culture when millions are hurting. We have to start prosecuting perpetrators – this will serve as a deterrent and protect victims. Educators need to be alert for signs of breast ironing. Finding out early will be effective in saving girls.

Breast ironing is a global issue that we need to pay attention to. We should work towards affecting solutions and curing these inequalities that devalue women. Most importantly, we have to put an end to sexual violence, as this harmful practice was ignorantly borne as its solution. We have to stop hurting girls and go after perpetrators of this act and sexual abuse.

Gerri McHugh: Storytelling & Films for Change

Last November we wrote about a specific event: the Women Leaders in Global Health Conference. The event focused on the importance of female leadership in health and science and led us to create a series of blogs. In each post, we encounter a woman who has reached a position of leadership and can be a role model for many young women out there. 

We hope you will feel inspired, and maybe even decide to follow in their footsteps to become the leaders of tomorrow! 

Our second guest on the series is Gerri McHugh. Gerri is director and founder of Global Health Film, a nonprofit organization that promotes storytelling and film as tools of catalytic discussion and change. Her interesting lifepath shows that a career can be more like a series of interconnected roads, rather than a straight line. 

Gerri McHugh

Gerri has been working in positions of leadership for a long time. However, she hasn’t always been part of the nonprofit world. At the beginning of her career, she worked for profitable businesses. Something changed when, in her late 20s, Gerri lost her father. This triggered a series of life changes.

She came back to the UK, after years of living in the South of Europe, and started to work in the non-profit sector. She started in a junior role, but thanks to her commercial experience and the acquisition of an MBA degree (Master in Business Administration), she quickly advanced to a senior level.

After talking with Gerri, you realize how passionate she is about her work and it is not surprising to hear about her long-lived interest for social justice and fighting hidden inequities, such as female genial mutilation (FGM) and sexual violence as a weapon of war. She says she believes all people should live their life fully and be in a condition to utilize their potential and create their own opportunities.

“Luck is when an opportunity arises and you are ready to take it; you can create your own luck.”

Today, Gerri spreads knowledge through great movies from all over the world through Global Health Film. She is not a film-maker, but in 2011, a small group of people started a film club to organize a few movie events a year. They were all members of the Royal Society of Medicine and interested in storytelling. Then, in 2014, supported by a Bill & Melinda Gates Foundation grant, they started the adventure that led to Global Health Film as it is known today. 

“You need to understand what storytelling is, you don’t need to be a filmmaker; you just need to bring new ideas, which is very similar to scientific thinking.”

Volunteers at the Global Health Film Festival 2017

She continues by saying that storytelling is the perfect way to show the grey areas, because reality is never black and white. Movies have the capacity to show you different people’s perspectives, and can help you understand those perspectives. Understanding is fundamental to connection, especially when you talk about global health topics which are complex and involve multiple disciplines. A great movie can capture this complexity.  

When asked what leadership means to her, Gerri said leadership is risk-taking and being unafraid to fail. Adding to that, it is also a collective effort, so as a leader you need to make everybody part of the journey.

Gerri feels very hopeful about the future. She would like to tell every young woman to remember that she is unique, and needs to grab any opportunity to make the most out of her time on this earth.

Feeling inspired by Gerri’s story? Would you like to use movies to spark positive change? Look out for gathering places in your community for people who are passionate about journalism, photography and media. Spaces like Front Line Club in London host events and workshops are can be great opportunities to meet people and build networks.

There are also many study pathways to consider, such as an MBA in Communication. Admission criteria and fees vary around the world, but one example is the EU Business School with programs in different European cities and online. This could give you some ideas about where to start, but remember that everything always starts from within, from you.

Ola Abu Alghaib: an activist for women with disabilities

In November, we wrote about an amazing conference. It was born from the realization that women’s leadership needs to be a priority in the health ‘business’ landscape. Not only because women’s voices should be present at the ‘decision making table’, but also because a new narrative on leadership is needed for all the young women and girls out there.

Girls need female role models to look up to. They need role models who can inspire them to work towards their own goals and tell them that nothing is impossible. Role models who say: ‘you can, and should, fight like a girl in order to become whoever you want to be!’

Inspired by this feeling, Swedish Organization for Global Health wants to share the story of some of these role models. We hope you will feel inspired and relate to them. Maybe you’ll even decide that, yes, this is exactly what I would like to do too!

First up is Ola Abu Alghaib, the current Director of Global Influencing and Research at Leonard Cheshire – an organization supporting people with disability to achieve their goals and live life at their very best.

Photo credit: Ola Abu Alghaib

Ola embodies the real meaning of the word activist.

Her job is to fight for the rights of those who are generally underrepresented or even ignored by society – women and men who live with some form of disability. Her work tells you exactly what kind of person she is, but it doesn’t tell you for how long she has been an activist, or why she became one.

Her life is the expression of leadership. Ola was born north of Nablus, West Bank, in Palestine. Like every child, she had many dreams and goals for her life.

When she was just 14 years old she underwent surgery, but a mistake during the operation resulted in Ola losing the ability to walk or move her right hand. Ola says, “this was obviously very shocking, but it didn’t change who I was and what I wanted to achieve in life”.

However, she soon realized that people around her started to see her differently. Many thought she could not live a ‘normal’ life, that she was broken, and that the only option she had left was to survive. Ola proved those people wrong. She was, and continues to be, a very determined and ambitious woman.

She is not just writing her own story but is also influencing the lives of others on her way.

After completing her first degree, Ola came across the German Organization for the Disabled, who decided to invest in this smart woman. Through them, she started to work in a rehabilitation center that supported people with disabilities. In the following 8 years at the center, she was aware that she was the only woman working there.

She felt that women with disabilities were not being given the opportunities they deserve, and knew was time for NGOs to act and involve more people. However, the issue seemed to fall on deaf ears. Her response?

Ola founded Stars of Hope. Their mission is to abolish disability and gender discrimination, while empowering women with disabilities to achieve their goals.

From that first step into advocacy, Ola has done so much work to bring the voices of women with disabilities into decision making rooms, such as the UN disability committee.

“Access to services continues to be a challenge for women,” she says. Influencing policy is fundamental to changing that.”

Ola has often underlined her belief that women with disabilities are generally forgotten by the feminist movement. She says this happens because disability-related issues make things even more complicated for women’s rights advocacy, but also because women with disabilities don’t ask to sit at the table. She says:

(1) We need to understand what disability means for a woman
(2) We must make sure disability receives as much attention as any other issue
(3) Women with disabilities need to demand their seat at the table

When I asked what leadership means to her, Ola told me: “Leadership is the privilege that comes with it”. If you are a leader, you should use that position to make your own contribution to improve things for others.

If you are a girl or a woman who feels, “I can’t be a leader,” and if you are suffering because of the way society defines you, Ola has this piece of advice: “The world is changing so take the lead and be determined, starting in your household.”

Feeling inspired by Ola’s story? Are you a woman with disabilities and want to become a leader in global health? Check out the following links that could give you some ideas about where to start, but remember – everything always starts from within, from you.

Ashoka Fellowship
Google Europe Students with Disability Scholarship
Wellcome Trust fellowships/scholarships

Women Leaders in Global Health Conference 2018

The Women Leaders in Global Health Conference was born from frustration many women working in global health felt when seeing the lack of women and diverse leadership in their field.

Women make up 70% of global health force but hold just 30% of leadership positions, and many felt the urge to direct an international spotlight on the matter.

This urge became a reality in October 2017 with the 1st WLGH Conference, hosted at Stanford University.

This year, the 2nd Conference was hosted in the UK by the London School of Hygiene and Tropical Medicine. Longer and richer in content, there were 2 days of panel discussions and vibrant exchange among women – and men – who work in different areas of global health.

Credit: @drawingchange

One of the main figures of this year’s conference was the former Minister of Health of Peru, Dr Patty J. Garcia. Patty is a scientist and an expert in Public Health who decided to take a new leadership position when the Prime Minister of Peru, Pedro P. Kuczynski, called her to offer her one of the most important roles in the country.

She worked within the government of Peru from July 2016 to September 2017, achieving important public health goals such as access to contraceptives for adolescent girls, availability of emergency contraception and rise in vaccination coverage.

Credit: Giorgia Dalla Libera Marchiori

She said that she would have never imagined she would be involved in politics, and even less to become a minister, but that “we need to take opportunities as women”. She took the lead and decided she would use her position to make the changes Peru needed.

Sometimes you are invited to the table and you just have to sit down and get to work. Most of the time, however, you need to open your folding chair and make space for yourself at the table. If no one makes space for your folding chair – “you sit on the table”, suggests Dr Ayoade Olatunbosun-Alakija, Chief Humanitarian Coordinator in Nigeria.

Women have great expertise, but too often don’t believe in themselves, because the patriarchal society we live in has taught us to look down, apologize and not be a ‘bi**ch’. Women and men need to rethink gender roles and move towards an equal society, where gender, place of birth, sexual orientation or disability will not count anymore, only competence will. 

Around 100 speakers participated in this year’s conference, bringing different perspectives which animated the discussion in so many ways. Dr Ola Abu Alghaib, Director of Global Influencing and Research at Leonard Cheshire Disability, told the audience of her personal experience with disability and finding her leadership role as a person with disability.

Her life is a proof of resilience. She has achieved what she wanted, including doing a job she is passionate about and having her own family. Many told her that as a disabled woman she would not be able to reach those goals, but she decided early on to lead her life in the direction she wanted. Women with disabilities need to be part of the conversation, Ola says, because there is no equity if we, as women, are the first to exclude some of us from the running.

Every woman can be a leader.

This is the philosophy behind one of the best universities in the African continent, the Ahfad University in Sudan. Professor Nafisa M. Bedri explained how their university, founded originally as a girls school by her grandfather, Babiker Bedri, aims to form future women leaders in Sudan.

Investing in women’s education and shaping women’s roles in society is challenging, because of cultural and religious beliefs, but the benefits are tangible and impact our entire society. 

One concept shared loudly and proudly at the end of this gathering was well summarized by Ayoade: “my ceiling has to be your floor”. This means that whatever we do, it has to create better opportunities and a world free from inequities for the generations to come, for all the girls who are dreaming big and should never have their wings cut off.

See you all next year in Rwanda for WLGH 3.0!

In the meantime, find your opportunity to become a leader in your group, community, work place, country. Don’t wait, act. And while doing it, “ensure that your significant other (whether a woman or a man) is a feminist” – Professor Sarah Hawkes, Co-Director of Global Health 50/50.

U.S. Opposes Global Breastfeeding Resolution

If it seems like the world is crying over spilled milk right now, I promise it’s much more than that. In May this year, a global breastfeeding resolution was passed at the World Health Assembly in Geneva, but not without a fight.

What Happened?

As recently reported by the New York Times, the proposed World Health Organization (WHO) resolution aimed to limit the marketing of breastmilk alternatives, and to “protect, promote and support breastfeeding”. An American delegation attempted to block the resolution, and made threats of trade measures and cuts to military aid to countries planning to introduce the measure. This, naturally, made other nations hesitant to support the resolution.

Ultimately, Russia proposed the final resolution, though U.S. delegates successfully had language removed stating the WHO would support nations discouraging misleading promotion by formula companies.

Why It Matters

The American Academy of Pediatrics recommends breastfeeding as the optimal source of nutrition through a baby’s first year of life. Breastfeeding provides benefits for both baby and mother. In fact, breastmilk could lead to lowered risk of asthma, type 2 diabetes, and obesity in babies and lowered risk of breast and ovarian cancers in moms.

A joint investigation by the Guardian and Save the Children in poorer regions of the Philippines found four large formula companies (Nestlé, Abbott, Mead Johnson and Wyeth) to be enticing health workers to promote formula in addition to distributing pamphlets disguised as medical advice to mothers. Although this is an explicit violation of the WHO’s international code, formula promotion persists in poorer countries where mothers are less informed about breastfeeding benefits.

Soon after transitioning in 2017, the new American administration re-enacted the global gag rule, prohibiting international non-profits receiving U.S. government funding from sharing abortion service information. Now the U.S. is supporting pro-formula companies over policies promoting global childhood nutrition.

This is not just another example of prioritizing private profit over public health, but rather, yet another infringement upon women’s rights.

While there are, of course, circumstances where choosing formula over breastmilk may be the best option for mother and child, every mother deserves to make her own informed decision, and country delegations should support that globally.

Global Healthcare: is there a Perfect System?

“It is easier to complain about a problem than it is to create a solution.”

This statement goes against everything I believe in. Yet, the truth is, I am often guilty of shouting into the ether or holding up a sign with words of disdain rather than slogans of hope. Sometimes we need a reminder that advocacy and development are based in the belief that things can, and should, be better. Take the global healthcare system, for example.

Healthcare is a topic capable of evoking a range of emotions. Things can get messy when there are so many categories to address and systems to choose from. April 7 2018 was World Health Day, on which the World Health Organization (WHO) marked its 70th anniversary and reminded us of its work over the past 7 decades – for example, “to rid the world of killer diseases like smallpox and to fight against deadly habits like tobacco use” (WHO). Addressing health needs is important, but so is addressing healthcare systems.

What is a healthcare system, you might ask? Well, the basic goals are to keep people healthy, to treat sickness and to exchange payment for service in some way. To meet those goals, steps are identified in each country and those steps make up a healthcare system.

We asked our network here at Swedish Organization for Global Health to weigh in on what a perfect healthcare system would look like for them. Is it universal health coverage? Single-payer? Everyone receiving healthcare clinician training?

Our main question: what components make up a good healthcare system?

According to the WHO, these 6 components create a well-functioning healthcare system:

  • Healthcare Workforce
  • Health Financing
  • Health Governance
  • Research and Innovation
  • Service Delivery
  • Medical Products

And according to SOGH, these additional components are needed:

  • Affordability, accessibility and quality care
  • Insurance that is affordable, humanized and effective
  • Inclusivity for all people, of all types, for all services (no discrimination)
  • Collaboration between all health care sectors and workers
  • Communication between patient and health care workers
  • Support and access to continuing education for health providers

The above are ingredients of a good healthcare system. After these components are implemented, what’s next? What is needed to ensure quality, strength, and sustainability of good healthcare systems? 

Is there a perfect healthcare system that will work for all countries, everywhere? I would argue, when stripped away of negativity, that yes – there is. Is that system the same for each country? I believe that while some aspects may be the same, there is not one perfect global system. The goal of healthcare for all countries should be the same, though the means to get there can and will differ.

I urge you to examine your own country’s healthcare system, and to think about how it affects or serves you and how you contribute to it. Try doing so from a gendered lens. This is not a hopeless or utopian task! Our lives and the lives of our children depend on how their health is prioritized.

Once you’ve read, considered and formed some of your own opinions, do something about it. Grab some friends, the phone, your computer, and remember that you have power to create solutions. Try reading up on this Health Data site, or click around on other global health platforms. We’d love to hear your thoughts and ideas in the comments section.

“Humankind has become so much one family that we cannot ensure our own prosperity except by ensuring that of everyone else.” – Bertrand Russell