Health Heroes on the Front Lines

The ability to see a doctor, nurse, or other trained health provider when we need to is hugely important. We may not think about it much when we are healthy, but sometimes, a visit with a health provider could mean the difference between life or death.

Unfortunately, millions of people in rural areas and low-income communities live far away from their nearest hospital, clinic, or health center, and don’t have adequate transportation or resources to reach them during an emergency. In fact, about half of the world’s population cannot access health care when they need it.

Consider those living in areas affected by natural disasters, emergencies, or armed conflict. Frontline health workers typically live in or near the communities they serve. If a community is affected by drought, the health workers are affected too. If ongoing conflict causes people to flee their homes and communities, doctors and nurses will likely flee with their families as well (if they can). Those left behind may have no one to provide them medical care or to help them stay healthy.

CARE trains, works with and relies on frontline health workers (FHWs) to deliver health services every day in a variety of low-resource settings. These include doctors, nurses and other health workers with varying degrees of formal and informal training. We know that their jobs are difficult, even in the best circumstances. Now imagine what life is like as a FHW in an area affected by crisis or armed conflict.

Let us introduce you to some of the people doing this work:

Mary is a midwife working in the Imvepi refugee settlement in Uganda. She has a three-year-old son.

Photo credit: Jennifer Bose/CARE

Uganda has become one of the largest refugee hosting countries in the world. At the height of the crisis, more than 3,000-7,000 people from South Sudan would arrive every day in the search of refuge. Of the 1.2 million refugees in Uganda, 900,000 are South Sudanese and 86% are women and children in real danger of sexual and physical violence, with many reporting incidents of violence on their journey. Imvepi refugee settlement hosts more than 110,000 refugees.

CARE has established five centers in Imvepi where refugee women and girls can seek assistance and sexual violence survivors can be provided with psychosocial support and health services. Mary works in one of these centers.

She has a busy schedule. At the women’s center, she identifies pregnant refugees who need maternal health services, screens for possible complications, and advises them on antenatal care. She refers any serious medical cases to nearby health clinics and balances a large case load. “Usually in a day I see around 80-100 people, many of them are pregnant mothers,” she explained. “I make sure to highlight the importance of hospital deliveries, as most of them have never seen a doctor before. But it is challenging.”

Because of the scale of Imvepi (about 150 square kilometers), Mary also makes home visits. She provides education on different topics – from family planning to gender-based violence to malnutrition and HIV.

“[Intimate partner violence] is a reoccurring problem in many families. I mostly hear of cases where food shortages lead to physical violence. Many families decide to sell the food rations they receive, ending up with little to no food left for themselves and extreme tensions at home.” Mary said. “I screen such women to see if they are in need of immediate help or referrals.”

Khawla is also a midwife, providing family planning services in Aleppo, Syria. She lives with her husband and children.

Photo Credit: CARE/SRD

Conflict has been ongoing in Syria for over seven years, and civilians are bearing the brunt of the suffering, destruction, and disregard for human life. An estimated 13.5 million people require humanitarian assistance, including 4.9 million trapped in besieged and hard-to-reach areas, where they are exposed to grave protection threats.

Working through partners, CARE supports 10 primary healthcare centers and 10 mobile clinics in northern Syria to provide vulnerable Syrian households with access to sexual and reproductive health and primary health education and services.

Khawla’s home and the health center often do not have electricity. She spends most of her time talking to women about their reproductive health and contraception. While most of Khawla’s work happens during daylight hours at the health center, sometimes she gets emergency calls from women late at night. “This is what scares me – having to go out during evening or night hours due to the security and conflict conditions in Syria,” Khalwa explains. The nearest hospital is 15 kilometers away.

Mary, Khawla, and other frontline health workers make personal sacrifices every day to deliver life-saving health care and emergency assistance to those in need under difficult circumstances. They experience and witness incredible suffering and choose to run towards the need when many would run away.

At CARE, we want to say thank you to all health heroes, wherever you are. We appreciate you, and your commitment to helping others.

Meet more of CARE’s frontline health heroes in our World Humanitarian Day publication: A Day in the Life of Seven Aid Workers.

Barriers to Education Equality in Latin America

Here’s something I didn’t know a month ago: Latin America has the second highest rate of teenage pregnancies in the world.

An estimated 15% of all pregnancies per year in Latin America occur in girls younger than 20 years old, and 2 million children in the region are born to mothers between the ages of 15 and 19.

According to a recent report – Accelerating Progress toward the Reduction of Adolescent Pregnancy in Latin America and the Caribbean’, overall teenage pregnancy rates have “dropped slightly” over the past three decades. However, this is the only region where a rising trend has been observed in pregnancies among adolescents younger than 15 years old.

The report, written by the Pan American Health Organization (PAHO), UNICEF and the United Nations Population Fund (UNFPA), states that teenage girls with only primary education or less are up to four times more likely than girls with secondary or higher education to have children. Similarly, girls from poor households are between 3 and 4 times more likely to become pregnant than girls from upper class households.  

Why is this so important? Because maternal mortality is one of the main causes of death among young girls between 15 and 24 years old in the region. In 2014, approximately 1,900 adolescents died as a result of complications during or after pregnancy and childbirth.

Earlier this year, a 14-year-old girl in Paraguay died during childbirth while her doctors performed an emergency cesarean section. The pregnancy had been a result of rape. Her case made international headlines only three years after a 10-year-old in the same country became pregnant, also as a result of sexual violence.

Explanations for high rates of teenage pregnancy provided in the report are poor quality sex education and the prevalence of child marriage. The report also highlights the fact that girls who get pregnant are more likely to drop out of school, which has a lasting impact on their future economic opportunities and their ability to support themselves and their children. This, combined with strong Catholicism that frowns upon having children out of wedlock, leads to social pressures for these girls to marry the father of their babies, regardless of circumstance. 

Limited access to information about reproductive health means that young girls often don’t have the information they need to prevent pregnancy or protect themselves from contracting diseases. However, this report also emphasises that young girls in the region need to be better protected from sexual violence, which not only has long-lasting negative effects on their mental health, but also forces unwanted pregnancies upon them. 

Another major barrier to education equality in Latin America is poor menstrual hygiene management. It is every girl’s nightmare to be surprised by her period at school, unprepared and without supplies, having to spend the day with a stain on her clothes until she gets home.

Lack of access to sanitary products and private toilets prevents girls from going to school during their periods and, in some cases, leads to them dropping out altogether. Thankfully, organizations like Be Girl are working towards removing periods as a barrier to opportunities by providing affordable, reusable sanitary products to girls in developing countries, including across Latin America. Their work is crucial to achieving gender parity in higher education throughout the world.

Reducing adolescent pregnancy rates in Latin America, as well as ensuring all girls have access to sanitary products, is crucial to closing the gender gap in education in the region and increasing women’s ability to support themselves economically in the future.  

Midwives of the World: Part 3

In order to reach a completely equal society, all basic human rights need to be secured. One of these is maternal health. The success of a country can often be traced back to successful maternal health programming. Therefore, my project partner Anna and I decided to create a documentary series about midwives around the world.

This is the final part of the documentary series, which also marks the end of Project Let’s Talk Equality. (You can still catch up with Part 1 and Part 2 if you missed them!)

To create this documentary and to get a fair picture of the situation for mothers and midwives around the world, we have collaborated with the White Ribbon Alliance (WRA). The WRA is an incredible organization for maternal health, and a network for volunteers from all over the world. We decided to focus on White Ribbon Alliance Indonesia, or Aliansi Pita Putih Indonesia  (APPI), and visited their team in Jakarta earlier this year.

With the three parts of our documentary, we hope to do two things. One is to present a fair picture and comparison of the maternal health situation in Sweden and Indonesia. The other is to inspire people to make a change in their local communities, just like the volunteers of the White Ribbon Alliance do, or like midwives do in their daily work.

It has been an inspiring adventure, and we hope that our documentary series has captured some of the remarkable energy volunteers and midwives from both Indonesia and Sweden put into their work every day to help others. From when we first brainstormed our ideas for the project in September 2016, throughout our site visit half a year later, to completing our documentary series, we have been continuously overwhelmed by the wonderful people we’ve encountered and the great response we’ve received from sponsors, mentors and our audience.

Although the project has come to a close, we hope that it has sparked discussion that will continue for years ahead, and that it will encourage more people to contribute to work for women’s rights in their communities.

Feel free to share, comment and spread the word. Thank you for watching, and remember – let’s get together for moms, and let’s talk equality!

Do you want Girls’ Globe to be able to support young women to create inspiring material like this in the future? We are crowdfunding for 2018!

How Venezuela’s Crisis Has Affected Women’s Lives

This past July, The New York Times’ front page featured an image of Venezuela’s street protests, showcasing the deep political, economic, and human rights crisis in the country. The violence that has ensued is a serious problem, but other, less visible effects are also problematic – and some affect the country’s women more than its men.

Situations of conflict and crisis are not gender neutral. Luz Patricia Mejía, a Venezuelan expert in women’s rights working at the Organization of American States, made this point in an interview when saying that in any kind of crisis, women’s rights are disproportionately affected. Three areas in which women have been suffering the greatest in the Venezuela crisis: menstrual and sexual health, maternal and infant health, and gender-based violence.  

Menstrual and sexual health:

Food isn’t the only things missing in Venezuela’s supermarkets and pharmacies: so are condoms, birth control pills and menstrual hygiene products.

Earlier this year, factories from different companies had to stop production of sanitary pads, affecting not only the women who desperately need them, but also the women and men employed by those factories. Venezuelans have had to turn to social media to find basic necessities, and many women have resorted to this to get tampons and pads – by exchanging them for flour, for example.

Venezuela is the country with the highest rate of teen pregnancy and earliest start of sexual activity in South America. A lack of contraception is especially problematic. Because of this, couples have had to make drastic changes to their sex lives to avoid pregnancy, such as using calendar-based methods and buying birth control pills off the black market.

Some Venezuelan women have chosen an extreme method of avoiding pregnancy during the crisis: sterilization. Speaking about her decision to go through the procedure, a young mother of two, aged only 25, said in an interview: “I will not bring a child to suffer. 

Some women who do find themselves pregnant amid the crisis have resorted to a dangerousand illegalalternative: unsafe abortions through homemade herbal medicine and introducing acids through the vaginal canal, procedures that can cause severe and life-threatening bleeding.

Maternal and infant health:

Lack of medicine and basic hospital supplies, as well as a reduction of the number of doctors in the country (in recent years, around 20% of doctors have left Venezuela because of working conditions) adversely affect maternal and infant health in the country. Hospitals have been lacking incubators and other essentials to care for pregnant women and newborn babies. Lack of food also means many mothers are unable to breastfeed.

More worrisome, infant mortality increased by 30% and maternal mortality by a staggering 65% in 2016—and back then, the crisis was not yet at its worst. 

Gender-based violence:  

Domestic and gender based violence don’t stop just because the rest of the country is in a crisis. In 2016, for example, the number of femicides increased compared to the year before. The dire situations in hospitals also affect the victims of domestic violence who need medical attention. Impunity of gender-based crimes is also a major issue, especially given that it’s currently estimated that impunity of human rights related crime in the country hovers around 98%.

As the crisis in Venezuela persists, so do the daily struggles of women to access their basic needs and rights. The ways in which this crisis has affected women’s lives highlights how gender issues are extremely important in the context of crisis and conflict, and should be taken into consideration as these situations are studied, researched, reported, and addressed.