http://www.irinnews.org/irin-fp.aspxUpdated everydayen-gbFri, 13 Nov 2009 13:14:02 GMTBANGKOK Friday, November 13, 2009 (IRIN) - A recent spate of natural disasters in Asia has further underscored the importance of breastfeeding during emergencies, with a need for additional policies to support this.BANGKOK Friday, November 13, 2009 (IRIN) -  A recent spate of natural disasters in Asia has further underscored the importance of breastfeeding during emergencies, with a need for additional policies to support this.
 
Hundreds of thousands were displaced and forced into evacuation shelters following a series of deadly typhoons in the Philippines, Cambodia, Vietnam and Laos, and an earthquake in Indonesia in the past two months.
 
But according to experts, during such disasters, support for mothers to breastfeed is often overlooked and not given the priority it needs, despite its life-saving function.
 
Besides raising awareness of the importance of breastfeeding, aid organizations need to have policies on infant feeding, they say.

“You have to have a strong policy in place, and make sure all the actors and all the staff in that organization know about this policy,” Anna Winoto, a nutrition specialist with the UN Children’s Fund (UNICEF) in Indonesia, told IRIN.
 
In emergency situations, poor water and sanitation and security situations contribute to a heightened risk of disease among children, who are vulnerable to diarrhoea, malnutrition and pneumonia.
 
Practices such as using infant formula milk, when water may be contaminated and feeding bottles cannot be sterilized, contributes to the risk and has been shown to lead to an increase in diarrhoeal disease in infants.
 
“Breastfeeding is actually even more crucial under emergency conditions because children under five, and infants in particular, are at an increased risk of infection, disease and malnutrition,” Winoto said.
 
“Breastfeeding should be seen as a life-saving intervention,” she said.
 
In an emergency situation, establishing private spaces for mothers and infants, one-to-one counselling and mother-to-mother support is needed to encourage breastfeeding, say UNICEF and the World Health Organization (WHO).
 
“As part of emergency preparedness, hospitals and other healthcare services should have trained health workers who can help mothers establish breastfeeding and overcome difficulties,” said WHO Director-General Margaret Chan in a statement to mark World Breastfeeding Week in August.
 
Both UNICEF and WHO advocate exclusive breastfeeding for children up to six months of age, and continued breastfeeding and complementary feeding until age two.
 
Dangerous donations
 
But one obstacle to breastfeeding during emergencies is unsolicited or uncontrolled donations of breast-milk substitutes, which undermine breastfeeding, according to UNICEF and WHO.

Following a 7.9 magnitude earthquake in West Sumatra on 30 September, UNICEF Indonesia, worked with the country’s Health Ministry, and contacted local and national radio stations to broadcast requests to stop milk-substitute donations.
 
“It’s a huge problem, and the problem lies in the lack of knowledge among the donors on the potential harm,” said Winoto.
 
Meanwhile, coordination in emergencies also remains a challenge, with little capacity to locate only those children who truly need infant formula and not disrupt breastfeeding practices, she said.
 
“In our experience, it’s gotten better but it’s still a huge challenge because there are so many actors when an emergency comes, and so many donations,” she said.
 
Helping with trauma
 
Besides the health benefits, breastfeeding advocates underline the psycho-social benefit of maintaining the activity during an emergency, which is traumatic for babies and young children, experts say.
 
“In an emergency, keeping the baby on the breast is not only about nutrition, it is giving the child that security and closeness when it is scared,” Elvira Henares-Esguerra, director of the Philippine NGO Children for Breastfeeding, [http://breastfeedingphilippines.com/cfb.html] told IRIN.
 
In the aftermath of Typhoon Ketsana, which caused massive flooding in the Philippines in September, Henares-Esguerra and a handful of breastfeeding mothers with their children visited an evacuation centre.
 
They demonstrated breastfeeding practices, and encouraged displaced mothers to do the same.
 
“We discovered that infant formula was being given out by the government at evacuation centres,” said Henares-Esguerra.
 
“We wanted to encourage the mothers to breastfeed,” she said.

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http://www.irinnews.org/report.aspx?ReportId=87020BUGARAMA Friday, November 13, 2009 (IRIN) - A CARE empowerment project in Burundi is training women in dispute resolution, savings and credit schemes, and putting a stop to sexual violence.BUGARAMA Friday, November 13, 2009 (IRIN) - A CARE empowerment project in Burundi is training women in dispute resolution, savings and credit schemes, and putting a stop to sexual violence.

Odette Nzokirantevye, 37, a mother of six from Bugarama Commune in Bujumbura Rural Province, told IRIN on 6 November that joining the project had changed her life:

"I joined Gezaho! [The name of the CARE project, meaning “Stop!” in Kirundi - i.e. “stop violence against women”] in 2007 when I realized that women were not being treated as human beings when it came to gender-based violence. I had my own knowledge on many matters affecting us here at the village, but it was not enough; Gezaho! has given me power and knowledge.

"Before the programme, women who were victims of violence had nowhere to go for help and no one to help them. Since the project started in our village, whenever a woman is abused, she now knows what to do and where to go to seek assistance.

"My husband used to beat me and he would say that there is no way a woman can stand up and say anything in a meeting; when you stood up, you were given names. They would say 'that woman is above her husband'; some even told my husband to get another woman `because one who can stand up and speak out in meetings is not a woman to keep as a wife’.

"I had children and I didn't have anywhere to go should he throw me out. Initially, my husband did not want me to join Gezaho! thinking it would provide an opportunity for me to look for other men; he changed when he saw the benefits of the programme. Now he says it is alright for me to be a member. Men are also invited to Gezaho! and they do training, and because many of them have benefited, they are happy to be members. Of course, there are those who have not changed and continue to engage in violence against women but these are few.

"Since joining Gezaho! I now know my rights better and I have other members acting as my support group. Previously, I didn't have an opportunity to make any money of my own; now I don't wait for my husband to give me money for soap or lotion; I know how to conduct business; I can count money and I am now able to save. When there is a new type of `kitenge’ [cloth wrap] in the market, I can buy it for myself from the proceeds I make from selling charcoal, cassava flour and cooking oil.

"Gezaho! has sensitized us to fight for our rights; it has opened our minds and given us knowledge to know what we are entitled to as women. However, the project should give more support to women, especially those in the hills [in Bujumbura Rural] who are still lagging behind as most of them do not know their rights."

js/cbhttp://www.irinnews.org/report.aspx?ReportId=87024LAHORE Thursday, November 12, 2009 (IRIN) - People living along the busy Temple Road in Lahore, the capital of the eastern Punjab Province, are accustomed to some unusual sights.LAHORE Thursday, November 12, 2009 (IRIN) - People living along the busy Temple Road in Lahore, the capital of the eastern Punjab Province, are accustomed to some unusual sights.

“Every now and then we see blood or parts of an aborted foetus floating in the drain that runs past the houses and shops,” said Rubina Bibi, a housewife.

The street in Lahore is home to a dozen or more illegal “abortion clinics”, known as ‘Safia clinics’. Run in most cases by midwives, the clinics are visited by a large number of women seeking an abortion but having difficulty getting one in a society where the practice is highly stigmatized - and legal only under extremely limited circumstances.

“The [abortion] rate is rising because in these times of high inflation fewer families can afford many children,” Uzma Parveen (not her real name), who runs one of the clinics, told IRIN. She said that until two or three years ago around 10 women visited her clinic each month seeking an abortion, whereas “there are now 15 or 20.”

According to a May 2009 report [http://www.guttmacher.org/pubs/IB_Abortion-in-Pakistan.pdf] by the government’s National Committee for Maternal and Neonatal Health (NCMNH) and the New York-based Guttmacher Institute, which works worldwide to advance sexual and reproductive health, “a nationwide study estimated that 890,000 abortions took place in 2002. This amounts to 29 abortions per 1,000 women.”

About 30 percent of married women use contraception, although a quarter of them, an estimated 6.6 million women in 2007, have an unmet need for contraception, the NCMNH-Guttmacher study found. Opposition from husbands, a belief that God alone should decide if a child is to be conceived or not, and a lack of awareness are all factors in the low levels of contraception use.

The report noted that abortion rates were substantially higher in the North West Frontier Province (NWFP) and Balochistan, the most rural of Pakistan’s four provinces. In NWFP an estimated 37 abortions take place per 1,000 women aged 15-49 and in Balochistan the rate was 38 per 1,000. The lower rates of 25 per 1,000 women in the Punjab and 31 in Sindh were linked to higher contraception use in urban areas.

Research by the US-based Population Council [http://www.popcouncil.org/projects/RH_PakPilotStudyContrAbort.html] in rural Punjab found women resorted to abortion when contraception was unavailable. It stated: “Women attempt to abort pregnancies that are unwanted by all means even if their husbands are not supportive.”

Most women seek abortions to avoid surpassing a desired family size, on average around three children: poverty is another factor.

Poverty link

“I am coming here for the second time, to have an abortion. I know it’s a bad thing, but what can I do? I already have four children and we simply cannot manage to care for more,” said Amna Bibi (not her real name), outside a clandestine abortion clinic. The clinic is based in a dingy room; the equipment used by the `dai’ (traditional midwife) looks primitive; there are no facilities for sterilization and the sheet on the bed is badly stained.

“What choice do I have but to come here? No one else will help me though I am terrified about going through this, and all the pain it will cause,” said Amna, who estimated that she was about three months pregnant. She said she expected to pay around Rs 2,500 (about US$30) for the abortion. Prices for abortions run from around Rs 1,700 (US$21) to Rs 4,150 (US$50)

Amna’s sister Naseem Bibi (not her real name), who accompanied her, said: “I use birth control pills given to me by a nurse secretly, because my husband would be angry if he knew. Men think pills could encourage us to have intercourse with other men, as there would be no fear of pregnancy.” Naseem has two young sons, and does not want more children for now.

“Many practitioners know abortions are illegal, and refuse to perform them. Therefore women turn to quacks who perform abortions in unsafe conditions. This can lead to complications and many women end up in hospitals. Some of them even die due to these complications,” Marium Waqas of NCMNH told IRIN. “Abortions in unsafe circumstances do affect the health of women.”

Post-abortion care

According to the NCMNH-Guttmacher report, the 2002 national study estimated that 197,000 Pakistani women were hospitalized for complications after unsafe abortions. Only about 50 percent of poor women who need treatment for severe abortion complications receive hospital-based care. A study in a large Karachi hospital over a 21-month period reported that 10 percent of women admitted for post-abortion care died of serious complications.

“We see women regularly who have suffered acute post-abortion complications. Many are brought in very late because their families are scared. Few admit they have had an abortion. Infection and heavy bleeding are the most common problems,” Rubina Ahmed, a gynaecologist at a community clinic, told IRIN.

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http://www.irinnews.org/report.aspx?ReportId=86999DAKAR Thursday, November 12, 2009 (IRIN) - Six weeks after the deadly military crackdown on civilians in Guinea, families are still searching for loved ones, the wounded continue to need medical care and aid agencies are assisting state health workers cope with the aftermath, according to the UN Office for the Coordination of Humanitarian Affairs in Guinea.DAKAR Thursday, November 12, 2009 (IRIN) - Six weeks after the deadly military crackdown on civilians in Guinea, families are still searching for loved ones, the wounded continue to need medical care and aid agencies are assisting state health workers cope with the aftermath, according to the UN Office for the Coordination of Humanitarian Affairs in Guinea.

The UN on 9 November approved $416,056 from its Central Emergency Response Fund for a UN Children’s Fund (UNICEF) project to restore medical supplies, stock public hospitals, help treat people wounded in the 28 September violence and address nutritional and water and sanitation needs.

Following the December coup d'état many donors reduced or suspended development assistance, including some for the health sector. Philippe Verstraeten, head of OCHA-Guinea, told IRIN: “It is critical that the UN and aid agencies continue to help Guinea deal with the fallout of 28 September as well as stave off further humanitarian crises, as the situation remains volatile.”

The latest (2-9 November) OCHA bulletin says:

-The Red Cross continues to receive calls from families seeking relatives. “For the moment, access to Camp Alpha Yaya [Diallo / the main military camp and the junta’s headquarters] and to the detention centre at Kassa Island has not been permitted.”

-Hospitals have reported cases of secondary infections in some victims who had hesitated to seek medical care after 28 September for fear of reprisals by the army

-Protection experts say at least 225 victims of the 28 September violence remain seriously traumatized, 45 of whom victims of sexual violence

-Among the remaining protection needs are identification of rape victims, referrals and medical and psycho-social care

-The UN Population Fund (UNFPA), in collaboration with the Health Ministry, on 2-6 November held seminars to reinforce local capacity for treating sexual violence victims; the workshops included training in using rape kits

np/oahttp://www.irinnews.org/report.aspx?ReportId=87017NAIROBI Wednesday, November 11, 2009 (IRIN) - When the working members of a household die from HIV-related illnesses in northern Tanzania, older dependants have to work longer hours to cope financially, according to recently published World Bank study.NAIROBI Wednesday, November 11, 2009 (IRIN) - When the working members of a household die from HIV-related illnesses in northern Tanzania, older dependants have to work longer hours to cope financially, according to recently published World Bank study.

"Adult death is associated with increased farm hours ... Older women who suffer the loss of a co-resident member among their baseline household are working five hours more each week," the study found.

More than 1,000 men and women older than 50 were surveyed over a 13-year period between 1991 and 2004 in the Kagera region. http://www-wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2009/09/02/000158349_20090902155306/Rendered/PDF/WPS5037.pdf.

Older adults who had relied on remittances and other in-kind support from their adult children were left with the burden of caring not only for themselves but also their orphaned grandchildren.

"Grandparents who should be in retirement are forced to start working and parenting again, often when they are not in the best physical condition," said Wamuyu Manyara, portfolio manager at the Africa Regional Development Centre of HelpAge International http://www.helpage.org. "An older woman with thinning bones should really not be forced to return to the field and farm."

The study noted that the shocks caused by the death of adult children were primarily felt by older people living with the children when they died. Women had less secure access to land and assets than men, but shouldered most of the labour after their children died, and also felt the shocks more than men. Owning more assets, such as land and animals, could act as a buffer.

"Policies which help ensure complete markets for livestock and other forms of assets, provide asset accumulation, and preserve women's rights to property may help mitigate the long-run negative impact of prime-age [15-50 years] deaths," the report said.

Little support

The elderly were often marginalised by state welfare programmes. "Older people are not organised enough to advocate for their needs, and they wind up being grouped in government departments with either children or people with disabilities - both these groups have powerful lobbies that drown out the needs of older people," said HelpAge's Manyara.

"In Kenya we are currently in the process of identifying community spokespeople to give them a public voice, but because many of them can't speak English or are illiterate, they are not always willing to take on the challenge."

Several African governments were doing more to include older people in social welfare programmes, particularly older carers. "There is now an appreciation of the magnitude of the problem, and there are some programmes catering for older people's economic needs," Manyara noted.

"Old-age pensions and child-care grants provided to older South Africans, and cash transfer programmes for older Kenyans, are practical examples of the types of programmes that need to be rolled out across the region ... [but the need] is still much higher than the numbers being catered for."

Research by the UN Children's Fund, UNICEF, in five African countries found that between 40 percent and 60 percent of all orphans in Kenya, Namibia, Tanzania, Uganda and Zimbabwe were being cared for by grandparents, particularly grandmothers.

Need for targeted programming

"Some of these older people can still work - they have energy and should be supported in their work with income-generating projects," Manyara suggested. "The conditions for accessing microfinance are usually so rigid that older people do not qualify; something should be done to encourage older people still able to work to access these funds."

Kavutha Mutuvi, HelpAge International's regional advocacy coordinator, said older people needed secure incomes. "There should be social pensions ... especially for those who are caring for households in their old age," she said.

Yet the bureaucratic hurdles in accessing support were considerable. "When a grandmother wants to claim a foster care grant, she may be asked for death certificates for her children or birth certificates of the grandchildren," Mutuvi pointed out.

"She may not have or have access to this documentation, but the fact that she is their grandmother can easily be verified by consulting community leaders - there should be a way to do away with much of the red tape they go through to claim support."

Older people also needed psychosocial assistance when their children died and they were left to raise the grandchildren. "We have tried to form support groups, which are more successful among women than men, but when it comes to helping grandparents with parenting skills, there is a definite need ... because they do come to us with questions when kids, for instance, want to know about sexuality," Mutuvi said.

The role of older people should be acknowledged when drawing up national home-based care policies and programmes, she said, by providing meaningful support such as physical help from community workers.

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http://www.irinnews.org/report.aspx?ReportId=86984BALAKA Wednesday, November 11, 2009 (IRIN) - Obstetric fistula is preventable and treatable, but many women in Malawi are unaware of this. The condition is caused by prolonged obstructed labour and is not only one of the most serious complications of childbirth, but also one of the biggest and most disabling health afflictions.BALAKA Wednesday, November 11, 2009 (IRIN) - Obstetric fistula is preventable and treatable, but many women in Malawi are unaware of this. The condition is caused by prolonged obstructed labour and is not only one of the most serious complications of childbirth, but also one of the biggest and most disabling health afflictions.

Lucy Chikoti, 19, who lives in Balaka, a town in southern Malawi, suffers from obstetric fistula. This is her story.
 
"I got married last year, when I was 18. My parents were not happy that I was getting married at such a tender age - they wanted me to continue with my education. I was so much in love with my boyfriend and I was getting none of their advice.
 
"I moved in with my boyfriend when I realized that I was pregnant. My village is about 20 kilometres from the main town of Balaka, where the main district hospital is. Most expectant mothers do not go for antenatal check-ups because of the distance.
 
"Sometimes women deliver on the way to the hospital. Vehicles pass through our village once in a while. The bicycle taxis that we use here are not as reliable as vehicles. In my case I delivered at the hospital, but I arrived there late.
 
"My mother-in-law took me to an Azamba [traditional birth attendant] to assist me, but it was a big mistake. I spent a night there but nothing happened. It was after my situation had worsened that they decided to take me to the hospital.
 
"Doctors said there was little they could do. It was a stillbirth. They told me my case was obstetric fistula. I was referred to another major hospital where a specialist assisted me, but they told me I would never conceive again.
 
"Today, I pass out urine and faeces uncontrollably. My husband has assisted me quite a lot. However, my mother-in-law says my husband has to marry another woman because there is nothing he can do with me in my condition.
 
"My mother-in-law says she wants grandchildren. It pains me because it was her who took me to the Azamba instead of the hospital. If I had gone to the hospital earlier, doctors could have assisted me.

"Today, she wants my husband to marry another woman, as if I deliberately planned to find myself in this condition. She is not being fair. I walk with difficulty and I need special care.
 
"This was my first marriage and my first pregnancy. I cry every day and ask, 'Why did it happen to me?' At the hospital I met women who are in a similar condition. They also told me terrible stories - they are discriminated against in their families and communities.
 
"Most people do not come near me because of the bad smell I produce. Sometimes you think that dying would save you a lot of trauma."

jk/go/he http://www.irinnews.org/report.aspx?ReportId=86990NAIROBI Tuesday, November 10, 2009 (IRIN) - Three years after the Kenyan government began to promote emergency contraception as part of its family planning strategy, the “morning-after pill” remains as controversial as ever: critics argue that unless the public is better educated about its purpose, it risks undermining the messages of abstinence and protected sex, putting impressionable young people at risk of HIV.NAIROBI Tuesday, November 10, 2009 (IRIN) - Three years after the Kenyan government began to promote emergency contraception [http://www.who.int/mediacentre/factsheets/fs244/en] as part of its family planning strategy, the “morning-after pill” remains as controversial as ever: critics argue that unless the public is better educated about its purpose, it risks undermining the messages of abstinence and protected sex, putting impressionable young people at risk of HIV.

"When you speak to young girls and the youth, they confide that unwanted pregnancy rings more in their minds than the possibility of contracting venereal diseases or HIV," said Anne Muisyo, coordinator of the Abstinence and Worth the Wait programme at Crisis Pregnancy Ministries. "It is the very reason I have qualms about a campaign telling people to relax because there is a pill they can run to after engaging in unprotected sex."

Muisyo's fears seemed borne out by students IRIN/PlusNews spoke to in the Kenyan capital, Nairobi. Jack*, a student at the Kenya Polytechnic University, says even though he fears HIV, he finds some reassurance in the existence of the pill.

"You know for us young people, we engage in quick and unplanned sex, for example at a party... You get a girl and you do not have a condom, what do you do? Let the opportunity pass by? No," he said. "Do it and give her some small money for a pill tomorrow."

Molly*, a student at the same university, said: "It's not that I do not use condoms at all with my partner, but the comfort you get when you realize there is a pill which is available cheaply is very tempting."

"You give yourself the belief that just once will not bring damage," she added.

The government is keen to stress that emergency contraception must not replace the condom.

Not a replacement for condoms

"I think it is important to note that we have been very consistent in our condom use promotion campaigns and we are not ready to change course because it prevents both pregnancies and HIV," said Shahnaaz Sharif, the director of public health at the Ministry of Public Health. "We have also been very consistent in saying that these pills do not in any way prevent one from contracting HIV."

Experts warn that unless the messages about emergency contraception are accompanied by further education on family planning and warnings about the dangers of unprotected sex, the government's campaign could backfire.

A study published in a recent edition of the East African Medical Journal found that just 15.8 percent of sexually active students said they used condoms every time they had sex, compared to 22.5 percent who reported never having used a condom.
Need for more education

"Various studies have shown that the sexual debut amongst the youth is happening very early," said Marsden Solomon, regional medical adviser for reproductive health NGO Family Health International. "Because a pregnancy has an immediate effect on them both psychosocially and economically, they would jump into anything that presents an opportunity to prevent it, and an emergency pill provides that opportunity for them."

"What they forget is that while they might have prevented an unwanted pregnancy, they have not done anything to protect themselves from HIV and any other sexually transmitted disease," he added. "I think the message to the youth should be abstinence, and for those who cannot, then dual protection methods like other long-term contraceptives together with a condom should be the most appropriate."

Solomon noted, however, that the emergency pill should not be dismissed altogether, noting that with proper education, it could form a useful tool in a much-needed national family planning push. According to the 2003 Kenya Demographic and Health Survey (KDHS), nearly 20 percent of births in Kenya are unwanted and a further 25 percent happen at an unwanted time.

A study by social marketing group Population Services International - the government's partner in the national emergency contraception campaign - reported that the average age of women who use emergency pills regularly is 24.

(* not their real names)

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http://www.irinnews.org/report.aspx?ReportId=86953LESIDAI Tuesday, November 10, 2009 (IRIN) - Many Kenyan children are in school, but enrolment in the north has been adversely affected by insecurity, food scarcity and traditional attitudes, residents and teachers said.LESIDAI Tuesday, November 10, 2009 (IRIN) - Many Kenyan children are in school, but enrolment in the north has been adversely affected by insecurity, food scarcity and traditional attitudes, residents and teachers said.

"I just joined a new school a few weeks ago [20 October]," 14-year-old Kelly Lanyasunya said at Lesidai primary school in Samburu Central District (central-northwestern Kenya). "I got a new uniform and I am making friends but if this area gets insecure, I will have to move to another school."

Like her classmate, Nabik Kekichorumongi, is forced to change schools whenever bandits attack the surrounding villages.

Stephen Leparachwo, head teacher at Lolkunono primary school in Samburu Central, said Lesidai primary school often receives parents bringing their children from Pura, a neighbouring area affected by banditry.

"When they come, some are even without food… The bandits follow the fleeing residents [and their cattle], not giving the children a chance to read," he said.

Cattle-rustling

Much of the insecurity is due to cattle-rustling between the Samburu, Pokot, Turkana and Borana communities, according to local residents. In September, for example, Pokot cattle raiders killed 32 people in Samburu Central.

Rustling has also affected food production, especially in fertile areas like Ngano on the Kirisia ranges, where bandits lurk in the beautiful landscape.

In 2008, insecurity worsened in Ngano, according to the headmaster of a local school, Simon Lenolkulal. "We could hear gunshots, so we were seeking cover on the ground with the children," he said, recalling a recent incident.

"There is a high rate of transition even of school teachers here… Teachers are reluctant to work here because of the insecurity. One week there is peace, the next week we are moving... Every week we enrol new children, then when there is tension they leave."

The school relies on food aid from agencies like the UN World Food Programme (WFP). According to Lenolkulal, however, people could farm the land and eliminate food aid, if there were more security.

At neighbouring Lgoss primary school, deputy head teacher Bernadeta Lesuruan told IRIN: "When there is conflict and the parents flee, we have more children coming to the classes."

Hunger

Food scarcity tends to drive up school attendance, local residents said.

When there is a general food distribution, enrolment in school goes down, while in more difficult times the number of children increases, Lesuruan said.

"During such times you see young children carrying toddlers to school for the food… During the drought, the children were entirely relying on food in school. Some were fainting after coming from home hungry. When there is no food [at all], school attendance is very low."

In August, WFP was feeding at least 900,000 children in schools to help drought-affected families in Kenya's arid and semi-arid regions.

"Food is an issue," said Peter Emanman, the school feeding programme officer in Samburu Central.

Recent rain has brought hope of an improved food situation. "People are starting to plant but the food crops will not be ready by December [the next school holiday month]. What will happen then?" Emanman asked.

Few girls at school

There are few school teachers and hardly any female teachers. At Lgoss, Lesuruan was the only female member of staff.

"Since I came here [in 2008] more girls are staying in school especially those who would run away for the period of their menstruation," said Lesuruan. "I bring pads to the school for the girls."

Apart from the location of the school, 12km from the nearest shopping centre, the high cost of sanitary pads also feeds absenteeism.

Early marriages also affect girls’ attendance at school: Most drop out in the middle primary school classes. In 2008, some Samburu schools had no girl candidate sitting the national primary school leaving exam.

"There is a mentality that if girls are educated and get jobs, the earnings will not return home but go to the husband," said another teacher.

Most of the boys in school are late entrants; some of the girls stay at home to work. "In this community people are not fond of keeping children in schools," the teacher added.

Night school

However, some communities are trying to educate residents about the value of education: Currently under way in Baragoi District, the pastoralist night school initiative targets cattle herder children who are unable to attend day school.

"The children leave the fields at 4pm and then attend class," said Emanman. "The students get `uji’ (maize meal porridge) in the evening and are taught until 10pm."

Some children from these schools have progressed to the formal education system, but the night school initiative is largely designed to teach basic literacy to herders and others, he added.

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http://www.irinnews.org/report.aspx?ReportId=86968NAIROBI Monday, November 09, 2009 (IRIN) - A planned national survey of men who have sex with men (MSM) will be the first step in the government's plan to incorporate this high-risk group into the country's HIV programme, a senior government official has said.NAIROBI Monday, November 09, 2009 (IRIN) - A planned national survey of men who have sex with men (MSM) will be the first step in the government's plan to incorporate this high-risk group into the country's HIV programme, a senior government official has said.

"We have continued to ignore this group of people yet they are responsible for a big chunk of new HIV infections; we have resolved as a government that we cannot sit back and wait for things to get out of hand," said Nicholas Muraguri, head of the National AIDS and Sexually transmitted infections Control Programme (NASCOP).

There have been few studies on HIV among MSM in Kenya; a survey of 285 men in Mombasa in 2007 found an HIV prevalence of 43 percent among men who had sex with men exclusively, compared with 12.3 percent among men who had sex with both men and women. Kenya's national HIV prevalence is 7.4 percent.

HIV programming for MSM is extremely limited despite the country's national strategic plan for HIV/AIDS classing them as a “most at-risk population”.

"We cannot do this [provide HIV programmes for MSM] without knowing roughly how many they are and what special needs they require; I hope the survey that we will embark on will help us answer some of these questions," Muraguri said.

He noted that the survey - due to start in December and last six months - will attempt to discover information such as the specific sexual health risks and needs of MSM, MSM “hot spots” around the country, and the number of MSM-friendly health facilities available.

It will use respondent-driven sampling, recruiting openly gay men to reach out to other MSM who may not be out of the closet, and using existing MSM-friendly facilities to help conduct the research.

High hopes for better services

Joshua* is a male commercial sex worker in Nairobi who recently received training from NASCOP on reaching out to his peers with HIV/AIDS messages.

"Today I talked to 75 male commercial sex workers - 40 of them are HIV-positive but they do not know what to do," he told IRIN/PlusNews. "Many are homeless after being kicked out of their homes due to stigma."

Joshua hopes the survey will enable the government and NGOs to provide more services to MSM.

"Currently at a clinic in Nairobi, we are given one bottle of [water-based] lubricant to last three months but you know as a commercial sex worker, you finish it in a week," he added. "So it means for the remaining time, you engage in sex without the lubricant, putting yourself at great risk."

He noted that there was also a lack of sufficient knowledge about the risks associated with HIV and anal sex in the general population. "Many women [clients] approach us for anal sex wrongly believing that it lowers their chances of getting infected," he said. "Everybody should be educated on the dangers of this kind of sex because it seems people have the wrong perception."

However, not all MSM are as enthusiastic about the prospect of being counted and questioned by a government that has thus far shown little support for the rights of MSM.

Not everyone on board

"People in this country are still very homophobic and we are stigmatized a lot; who will want to come out to agree that he is a homosexual? Let them address issues of stigma first," said Donald*, who has not come out of the closet. "How do you convince me to come out and say I am a homosexual yet the same government that is asking me to do this criminalizes what I am engaged in?"

"I would rather they offered the services without going into the business of knowing who we are and trying to count us," he added.

Proof that homosexuality remains taboo in Kenya was not hard to come by on the streets of Nairobi: "To say they want to offer services to people who are engaged in acts that do not conform to the law is taking this issue of human rights too far," said Lynette Moseti. "That money can be used to help children who are living with HIV."

Homosexuality remains illegal in Kenya, punishable by up to 14 years in prison. According to Muraguri, however, the urgency of the problem necessitated ignoring the law. "Rigidity will only make our situation worse," he said.

Muraguri stressed that the government's survey did not intend to stigmatize MSM.

"We appreciate the stigma these people face and that would be [the] last thing we would want to do; even in other mainstream HIV services that the government offers we use data to offer services, so I do not think there is anything unusual about the survey," he said.

Lorna Dias, MSM coordinator at Liverpool VCT (voluntary counselling and testing), Care and Treatment, one of the only organizations in the country that provides services to MSM, says the planned survey shows that the government is serious about tackling the epidemic among most at-risk populations.

"It is a positive step and a clear indication that the government is ready to open up to the reality that men who have sex with men pose a great risk to the war against HIV unless they are integrated within mainstream HIV and AIDS programmes," she said. "The next step should be to de-stigmatize them and see them as normal people who need services like everybody else."

*(not their real names)

ko/kr/cbhttp://www.irinnews.org/report.aspx?ReportId=86932NAIROBI Monday, November 09, 2009 (IRIN) - Some of the most widespread forms of malnutrition can best be reduced by delivering micronutrients and fortifying food in new, cost-effective ways, in combination with community outreach work, experts have said.NAIROBI Monday, November 09, 2009 (IRIN) - Some of the most widespread forms of malnutrition can best be reduced by delivering micronutrients and fortifying food in new, cost-effective ways, in combination with community outreach work, experts have said.

Approaches could range from the obvious - adding iron to flour – to the novel, such as vitamin-enriched chewing gum, a Nairobi conference heard.

Vitamin A, iron and iodine are the most important micronutrients in global public health terms, according to the World Health Organization (WHO), particularly for children and pregnant women in poor countries.

Vitamin A deficiency affects more than half of all countries, especially in Africa and Southeast Asia, and it is "especially important where under-five mortality is high," Sue Horton, a malnutrition economist, told the conference.

The conference on nutrition, held in Nairobi on 3 November, was organized by Danish think-tank The Copenhagen Consensus Center (CCC).

CCC has ranked micronutrient supplements as a top development priority following findings of a study it commissioned in 2008 to identify the best ways to spend aid and development money.

Provision of Vitamin A, it added, to children aged six months to five years every four to six months could reduce mortality by 23 percent.

Currently, Vitamin A deficiency is the leading cause of preventable blindness in children and increases disease risk and death from severe infections. In pregnant women it causes night blindness and may increase the risk of maternal mortality, according to WHO.

CCC says that up to 219 million children worldwide are susceptible to Vitamin A deficiency, and over one billion people to zinc deficiency.

Supplements not the only answer

Experts at the conference said current systems of providing the vitamin through supplements often missed out on some target groups.

"[Community] outreach is important in remote areas and among migratory groups, as relying on immunization days alone does not work," Horton said.

Kenya, for example, used to achieve coverage rates of over 80 percent for Vitamin A twice a year using mobile immunization campaigns. From 2007, supplements were only provided at health facilities. Coverage then declined to 20 percent for six to 59-month-old children, Horton said. A similar decline was observed in India.

The CCC also noted that global zinc supplementation to reduce the impact of diarrhoea was low, yet it could reduce diarrhoeal mortality for children under five by 50 percent.

"Outreach can be particularly cost-effective when Vitamin A supplementation is combined with the delivery of other services such as deworming, distribution of bednets, etc," it noted.

Shawn Baker, vice-president of Helen Keller International, said additional childhood interventions needed to be institutionalized yearly to avoid locking out some children on routine child health days.

"We need to be thinking not only of what we can do well but what we can do well at a large scale," Baker said.

Food fortification

Such interventions could include fortification and the addition of nutrients to widely-used foods. According to the CCC, salt iodization and flour fortification with iron are cheap.

In West Africa, a regional initiative is promoting folic acid fortification in wheat flour and Vitamin A in cooking oil.

"This has the potential to reach a large number of people with essential nutrients," said Kodjo Gbemou, director of the Grand Moulins du Togo, a flour milling company.

Wheat flour is industry-processed while the rest of locally grown cereals are processed at home, Gbemou said. West African countries, he added, were accelerating regulations to make fortification mandatory, as is the case in Cote d'Ivoire and Senegal.

Chewing gum

Globally, private companies are also developing innovative products to deliver micronutrients. Such products include Danish Gumlink's Vitamin A chewing gum.

The gum, prepared in a dry-cold process to protect the heat-sensitive Vitamin A, is sugar free and easily digested. It comes in two forms - for children aged 3-5, and for pregnant and lactating women.

"The gum promotes mouth hygiene, is easy to administer compared to other programmes that rely on co-immunization campaigns, and children find gum fun," Henrik Jespersen, Gumlink Group vice-president said.

"Our idea is to use our technology to provide one more way of delivering Vitamin A to those who need it."

Deworming

Other effective interventions include regular deworming. Deworming works well as the parasites stop nutrients from being fully digested.

"Mass treatment is safe and inexpensive... The cost of delivering one round of treatment is about 15 US cents per child when administered in school and 25 US cents for pre-school children when combined with another intervention in programmes such as Child Health Days or in primary health care facilities," the CCC said in a paper.

The Nairobi conference called for improved community nutrition, including the use of locally available nutritious foods and breast-feeding education.

Such practices, CCC director Bjorn Lomborg said, were crucial in a world with competing challenges and funding constraints. "Where do we get the most bang for the buck?" he asked.

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http://www.irinnews.org/report.aspx?ReportId=86945GOMA Wednesday, November 04, 2009 (IRIN) - While medical and psychological care are being provided to survivors of sexual violence in eastern Democratic Republic of Congo, where 7,000 women and girls have been raped this year alone, UN and aid workers on the ground say the funding response has been too narrow, leaving key issues inadequately addressed.GOMA Wednesday, November 04, 2009 (IRIN) - While medical and psychological care are being provided to survivors of sexual violence in eastern Democratic Republic of Congo, where 7,000 women and girls have been raped this year alone, UN and aid workers on the ground say the funding response has been too narrow, leaving key issues inadequately addressed.

"Increased international attention to sexual violence in DRC has led to a substantial increase of funding, accompanied by a disproportionate lack of evaluations of the real needs on the ground and lack of understanding of the complexity of the issues," notes the Comprehensive Strategy on Combating Sexual Violence in the DRC,
[http://www.stoprapenow.org/pdf/SVStratExecSummaryFinal18March09.pdf] released in 2009 by the Office of the Senior Adviser and Coordinator for Sexual Violence in the DRC.

"Efforts are unevenly distributed [...] The programmatic focus is essentially on two sectors: medical and judicial support to sexual violence survivors, while the remaining sectors show very few interventions," according to the strategy.

The sectors receiving proportionally less funding and attention include prevention and reintegration.

"Just treating the results of sexual violence is a catastrophe. No one is really treating the root or the entirety of the situation. If you just care for the raped women, you will be caring for them up until infinity," said Butros Kalere of Women for Women. [http://www.womenforwomen.org]

Among those feeling the funding pinch is Heal Africa [http://www.healafrica.org/cms/], a Goma-based NGO that provides medical and social care in the region.

"Sexual violence is not just a physical problem, but we often don't have enough funding and thus, we are limited to real work only for the immediate victims," the organization's community health coordinator, Jean Robert Likofata Esanga, told IRIN, adding that its programmes that focus on prevention, rehabilitation and re-integration continually suffer under-funding.

Effective prevention programming, according to Tasha Gill, child protection officer with the UN Children's Fund (UNICEF) in the DRC, "employs advocacy and awareness to mobilize the communities through community leaders, identifying the issues and working towards longer-term changes within local social norms, while alternately working towards protecting those who are most vulnerable".

Gill also noted that the UN planned over the next few years to better direct funding so that "funding for this sort of prevention programming no longer falls through the cracks".

Even organizations that specialize in protection are feeling the pinch. "We usually try to reduce vulnerability and protect 1,000 women in the communities on the outskirts of Goma by providing them with skills training, literacy and financing a portion of their activities," explained an employee of one such NGO. "Now that our donor wants us to work more in an 'emergency' setting and we are confined to working in the IDP camps, it is very difficult as the population is always in flux. It's hard to keep track of them and be consistent with the training."

Reintegration

The UN's goals for re-integration include "ensuring victims' satisfaction and guaranteeing non-recurrence of sexual violence" as well as ongoing psycho-social care. However, the services are fragmented due to minimal funding, complicated coordination and the distances to be covered for transportation and service provision. Even in Goma's Kibati I IDP camp in July, women were returning without access to further counselling, education or skills-building.

As Constance, a Heal Africa counsellor, said: "We would like to help each victim reintegrate smoothly and carry on with counselling sessions, but we are limited to having a clinic or a skill centre nearby. We do not have the funds to help every woman through her return."

The UN's ideal plan for re-integration also includes a "survivor-centred skill approach". While some NGOs have funding to provide women with the opportunity to learn skills during their hospital stays, their use of those skills upon their return can be restricted by location and availability of material. For example, women are restricted in practising their sewing skills by lack of access to a sewing machine, while literacy skills are restricted by the lack of schools.

"Medical, protection, and legal/justice services and psycho-social care are part of treating sexual violence, but these services also need to include enabling women to be able to provide for their families... for them to feel like they can move on and take care of their children," Mendy Marsh, an independent expert on sexual violence, told IRIN.

Until funding for programmes addressing sexual violence in the DRC makes this a priority, prevention and rehabilitation funding and programming will continue to have to make do with a small percentage of current funding.

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http://www.irinnews.org/report.aspx?ReportId=86865KARACHI Wednesday, November 04, 2009 (IRIN) - Anecdotal evidence suggests breast cancer is on the rise in Pakistan but budgetary constraints, bogus healers and a lack of awareness is hampering early diagnosis, according to healthcare professionals.KARACHI Wednesday, November 04, 2009 (IRIN) - Anecdotal evidence suggests breast cancer is on the rise in Pakistan but budgetary constraints, bogus healers and a lack of awareness is hampering early diagnosis, according to healthcare professionals.

“While we do not have any official data on breast cancer, from my experience I have seen the numbers go up,” said Rufina Soomro, consultant general and breast surgeon at the Liaquat National Hospital (LNH) Breast Clinic in Karachi, one of the country’s leading breast cancer treatment centres.

LNH records shows that in 1994, 1,574 patients visited the clinic and 28 breast cancer surgeries were performed, whereas in 2008, 11,644 patients visited the clinic and 244 surgeries were performed.

A 2008 report [http://www.pinkribbon.org.pk/index.htm] by the Pink Ribbon Campaign Pakistan said 90,000 new breast cancer cases are detected annually, and the disease caused 40,000 deaths a year in an estimated population of about 172 million.

Entitled A Life Worth Living, the report said Pakistan had the highest rate of breast cancer in Asia and spent the lowest percentage of its gross domestic product on health - 0.57 percent. In Pakistan, about one in nine women is likely to get breast cancer at some point in their lifetime, while in India it is one in 22, the report said.

According to information gathered by IRIN at two of the biggest government hospitals in Pakistan - the Civil Hospital Karachi and Jinnah Postgraduate Medical Centre (JPMC) - one in five female patients screened for breast cancer was positive.

The LNH’s Soomro said there was an alarming rise in the number of breast cancer cases and that the situation was made worse by alternative treatments and misconceptions.

“People shy away from this topic. When I came back to Pakistan and joined a public sector hospital, I was stopped from using the resource material I had brought from the UK as it was deemed culturally unsuitable… Things are better now but still there’s a long way to go,” she said.

Soomro said the government needed to do more to promote breast self-examinations and the usage of mammograms. She also recommended that gynaecologists, lady health visitors and general practitioners guide women on how to examine themselves.

Faith healers

“Breast cancer is a disease that is physically, psychologically and financially draining. The whole family unit is hit hard if a female is diagnosed with it. In the long run for treatment to be successful, a patient needs the maximum support of her family. But people generally are so scared they resort to alternative treatments. Going to a `pir’ [faith healer] is very common and so is the use of homeopathy. By the time women come to us, the cancer is in later stages,” Soomro said.

‘Pirs’ are believed to be intermediaries between Allah and the community. There are thousands of them across Pakistan, with millions of followers, particularly in poorer rural areas.

Breast cancer survivor Suriya Suleman, 45, said when she first felt a lump in her breast she ignored it until the pain became unbearable, even with painkillers.

“My mother took me to a `pir’ who gave me some herbs and an amulet saying that the pain would go away. It never went away and then I moved on to homeopathy for a while. I finally went to a doctor when the breast started looking really bad and that’s when my worst fears were confirmed,” she said.

Having breast cancer proved to be more than a health problem for Suleman. “Our finances drained and I could not undergo a breast reconstruction. Moreover, my husband found a younger, `complete’ wife, although he insists that it was kindness on his part that he did not divorce me. I made it through thanks to my children and the support of my doctor,” she said.

Taboo

While `hakims’ (traditional doctors) and homeopathic practitioners distribute pamphlets claiming to cure breast cancer, the disease continues to be taboo in Pakistan’s mainstream media.

A content producer for a private TV channel, who requested anonymity, said breast cancer was a sensitive issue for TV. “Breasts are a very sexual part of the anatomy and it’s hard to get away with talking about them. On TV shows when issues like pregnancy are discussed, people call us up and complain,” he said.

But slow progress is being made. Throughout October, the internationally accepted breast cancer awareness month, TV stations dedicated segments to breast cancer awareness in their morning shows.

Breast cancer survivor Suleman feels much more should be done. “I wish the media was open about this issue. We show people fondling in soaps and music videos, so why is it that a woman touching her breast for detecting a lump is considered a no-no?”

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http://www.irinnews.org/report.aspx?ReportId=86869NAIROBI Tuesday, November 03, 2009 (IRIN) - Three years after being diagnosed with HIV, Alice Mworia, 28, went for a routine medical check-up during which she told the nurse she had noticed an unusual vaginal discharge; a test revealed she had pre-cancerous lesions on her cervix that could develop into cancer if untreated.NAIROBI Tuesday, November 03, 2009 (IRIN) - Three years after being diagnosed with HIV, Alice Mworia, 28, went for a routine medical check-up during which she told the nurse she had noticed an unusual vaginal discharge; a test revealed she had pre-cancerous lesions on her cervix that could develop into cancer if untreated.

"I was experiencing a bad smell from my private parts and I wondered whether it was because I was HIV-positive; I could not keep quiet any more and I shared with one of the nurses and she referred me to the doctor," Mworia told IRIN/PlusNews. "I did not even know there was anything called cervical cancer, which I was informed can kill very easily."

According to the UN World Health Organization (WHO) [http://apps.who.int/hpvcentre/statistics/dynamic/ico/country_pdf/KEN.pdf], some 2,635 Kenyan women are diagnosed with cervical cancer every year, with 2,111 dying from the disease, making it the most prevalent cancer among women in the country. About 38.8 percent of women in the general population are estimated to harbour cervical human papillomavirus (HPV) infection [http://www.cancer.gov/cancertopics/factsheet/Risk/HPV] - a leading cause of cervical cancer - at any given time.

High risk, low knowledge

For cervical HPV infection to progress to cancer, certain co-factors must be in place, including smoking, long-term hormonal contraceptive use and co-infection with HIV.

"Women who are HIV-positive have weak immune systems and this makes them very susceptible to persistent human papillomavirus that develops into cancer of cervix," said Lucy Muchiri, a senior lecturer in human pathology at the University of Nairobi's College of Health Sciences and a member of the sub-Saharan Africa Cervical Cancer Working Group.

"It takes a relatively shorter time for the HPV virus to develop into full-blown cancer of the cervix for women who have the HIV infection … It would take relatively longer in women who are not infected with HIV."

Pap smear tests - which check for changes in the cells of the cervix - are available at most district health facilities in Kenya, but according to WHO, fewer than 6 percent of women access them.

"I think many women die from the disease for a number of reasons - one is ignorance because knowledge about the disease among women and in the general population is very low and it is mistaken for other diseases," she said. "It is appalling that despite most cancer-related deaths in women happening because of cervical cancer, it is the least talked about or even known by people, including women."

According to Francis Kimani, director of medical services at the Ministry of Health, Kenya is planning a screening programme for early detection and treatment of cervical cancer as well as a widespread education campaign.

Education gap

"I think our best bet is to carry out education to let people know about the disease and that early detection of it can be very helpful," Kimani told IRIN/PlusNews. "It is true that not many people - especially in rural areas - know about the disease."

Studies [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631263] have shown that HPV is higher among women who have multiple sexual partners and unprotected sex.

"Maybe to prevent it in the first place, the same methods used in combating HIV, like condom use, abstinence and keeping to one faithful partner, should be encouraged in this case too," Muchiri suggested.

She noted that the government also needed to invest in making the HPV vaccine - which protects against four major types of HPV, including two types that are responsible for 70 percent of cervical cancers - widely available in public hospitals.

Vaccine availability

The Kenya Pharmacy and Poisons Board approved the sale of an HPV vaccine in the country in 2007, but its availability is extremely limited and it is still prohibitively expensive for most Kenyans.

"HPV is a sexually transmitted virus and with the vaccine in place, it is important to encourage parents to take their young girls between the ages of nine and 15 to be vaccinated before they debut into sex," she said.

A recent study by the local NGO, Centre for the Study of Adolescence, found that four in 10 Kenyan girls had sex before the age of 19, many of them as early as 12.

"Once they [women] become sexually active, it is important to encourage [them] to go for Pap smear tests or visual detection of the pre-cancerous lesions but even vaccination at this stage is still feasible so long as one has not contracted the virus," Muchiri added.

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http://www.irinnews.org/report.aspx?ReportId=86853ADDIS ABABA Monday, November 02, 2009 (IRIN) - Being a university freshman is an exciting time for any young person, but many students get carried away, partying too hard and taking sexual risks.ADDIS ABABA Monday, November 02, 2009 (IRIN) - Being a university freshman is an exciting time for any young person, but many students get carried away, partying too hard and taking sexual risks.

"It's a chance to experience life; there is no family, there are no restraints," said Biniam Mohammed, project coordinator of the Modelling and Reinforcement to Combat HIV/AIDS (MARCH) [http://www.aau.edu.et/march] project in the Siddist Kilo Campus of Addis Ababa University (AAU). "Some use it in a good way but some do risky things, such as chewing khat [a mild stimulant] … having [unprotected sex] and using commercial sex workers.

"Some of these students will have limited awareness of the risks of HIV/AIDS, and then there is peer pressure as well," he added.

Ethiopia's overall HIV prevalence is a relatively low 2 percent, but prevalence in the capital, Addis Ababa, is 7.5 percent. According to the Federal HIV/AIDS Prevention and Control Office (FHAPCO), anecdotal evidence of widespread unsafe sexual practices suggests students may be among the more high-risk groups in terms of HIV vulnerability.

MARCH statistics show that 50 percent of AAU students are sexually active, but only half of them use condoms, said Biniam.

High-risk behaviour

"Often they do not use condoms… they are doing it emotionally, without any thought," said Selam, a 19-year-old AAU student.

Selam added that students coming to the city from the countryside usually had less information about HIV and were not as street-smart as Addis youth, leaving them unprepared to resist unwanted sexual advances or insist on protected sex.

Former student Girma Tesfaye, now Addis Ababa project coordinator for HIV-focused NGO Mekdim, says female students often fall prey to “sugar daddies”.

"There are lots of beautiful girls at university and older people with beautiful automobiles stop around the university and look for them," he said. "It is common to take students this way. They have lots of money; they will provide the girls with money and different [presents].

"The older 'daddy' may have three or four partners in such a way, which facilitates the spread of HIV," he added.

Selam agrees that this is a significant problem, noting that in the early evening, heavily made-up and scantily clad female students make their way to the area outside the main gates known as the Debab to try to find a rich boyfriend, usually one who already has a wife, and quite possibly a string of other girlfriends.

"If you have sex because of a threat, or you have a 'sugar daddy', it is one-sided and that makes them more at risk," said MARCH's Biniam. "Influenced or coerced sex is high risk."

Evidence also suggests that male students use local sex workers; a survey [http://siteresources.worldbank.org/INTHIVAIDS/Resources/375798-1103037153392/EthiopiaSynthesisFinal.pdf] of Addis-based sex workers found that 5.8 percent of their clients were students. Sex workers in the nearby Arat Kilo area confirmed that many of their clients were AAU students.

MARCH, with funding from the US President's Emergency Plan for AIDS Relief, produces Life 101, a quarterly photo graphic novel that follows the story of three students and one couple at AAU as they experience daily university and city life and deal with issues such as transactional sex, condom use, relationships, testing for HIV, and gender equity. MARCH also facilitates student-led entertainment events to stimulate discussion of the issues.

Recently, more than 20 Ethiopian university presidents initiated a request [http://hapco.gov.et/index.php?option=com_content&task=view&id=103&Itemid=2] to the Ministry of Education and FHAPCO for more HIV activities, including a national HIV/AIDS policy and strategy for universities, an HIV/AIDS research and information centre, gender and HIV/AIDS advocacy efforts and sustainable training and discussion forums.

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http://www.irinnews.org/report.aspx?ReportId=86837DAKAR Monday, November 02, 2009 (IRIN) - Health organizations have joined forces to launch the first World Pneumonia Day, urging governments, donors and civil society to act to prevent and treat the world’s leading child killer.DAKAR Monday, November 02, 2009 (IRIN) - Health organizations have joined forces to launch the first World Pneumonia Day, urging governments, donors and civil society to act to prevent and treat the world’s leading child killer.

Pneumonia kills over 4,000 children daily – more than measles, malaria and AIDS combined, says the UN Children’s Fund (UNICEF). However, to date, stamping it out has not been prioritized by policy-makers or donors, says the coalition of over 50 health organizations launching the pneumonia movement.

“There has been little traction on the pneumonia issue for years but it now feels like we are at a tipping point,” Orin Levine, executive director of the pneumonia research programme at Johns Hopkins Bloomberg School of Public Health, told IRIN. "Now it is critical for donors, international partners and countries to make protection, prevention and treatment available to all children everywhere with no delay.”

UNICEF and the World Health Organization (WHO) in a Global Action Plan for the Prevention and Control of Pneumonia are calling on donors and national governments to commit US$39 billion to improve prevention and treatment in 68 high-prevalence countries between now and 2015.

Preventing pneumonia requires increasing the number of children vaccinated against common causes of pneumonia, such as streptococcus pneumonia (pneumococcal disease) and Haemophilus influenzae type b (Hib), and improving community-level treatment of pneumonia through training and access to antibiotics, according to the plan.

The plan also calls for improving health, hygiene and nutrition practices by promoting exclusive breastfeeding, hand-washing, reducing indoor air pollution and giving zinc to children during diarrhoea outbreaks.

“Nearly half of [pneumonia] deaths could be prevented with existing vaccines and the vast majority of cases could be treated with inexpensive antibiotics,” Save the Children Board member and former US Senator Bill Frist said in a communiqué launching Global Pneumonia Day. “Yet lives continue to be lost from this preventable and treatable disease, and until recently there was very little outcry.”

Research groups specializing in pneumonia say vaccine roll-out in Africa and Asia has been slow due to lack of money and awareness.

Vaccines

Vaccines against two of pneumonia’s common bacterial causes, Hib and pneumococcus, are routinely used in industrialized countries but are not yet available in most of the developing world, according to GAVI Alliance, a public-private partnership providing immunization and health system support worldwide.

"Vaccine coverage is improving but at a “slower pace than we would like to see," WHO spokesperson Olivia Lawe-Davies told IRIN.

GAVI plans to speed up the introduction of pneumococcal vaccines in 42 countries to reach 130 million children by 2015.

“Millennium Goal four cannot be met without this investment...Immunization is one of the most cost-effective ways to save lives. And improved health is a fundamental driver for long-term development,” said Julian Lob-Levyt, head of the GAVI Alliance, in a 2 November communiqué.

Millennium Goal four aims to reduce by two-thirds the deaths of under-five children by 2015.

Affordable treatment

GAVI Alliance has developed a funding mechanism to encourage pharmaceutical companies to produce a pneumococcal vaccine at 10 percent of the normal price, costing developing country governments on average 15 cents per dose.

For those children who contract pneumonia the antibiotics that could save their lives cost less than $1, but currently less than 20 percent of children receive them, according to WHO and UNICEF.

''Pneumonia contributes to 60 percent of the in-patient admissions in any hospital in Uganda, and the worst scenario is seeing a mother walk into the emergency unit…because she was not aware of the seriousness of her child's illness, and seeing that child pass away because it was too late to intervene,” said Sabrina Bakeera-Kitaka, President of the Uganda Paediatrics Association in a 2 November statement.

Donors who sign on to the Global Action Plan at the 2010 World Health Assembly would agree to increase the supply of antibiotics to health clinics in hard-hit countries and train community health workers in pneumonia case management.

“With increased donor support, we can save many more lives and make an incredible leap towards further reducing child mortality in the world. This is an historic opportunity we must not ignore,” said GAVI’s Lob-Levyt.

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http://www.irinnews.org/report.aspx?ReportId=86838BISSAU Wednesday, October 28, 2009 (IRIN) - Contraceptive use is on the rise in both urban and rural areas in Guinea-Bissau, as access to reproductive and infant healthcare improves and family planning messages start to sink in, say health officials and UN staff.BISSAU Wednesday, October 28, 2009 (IRIN) - Contraceptive use is on the rise in both urban and rural areas in Guinea-Bissau, as access to reproductive and infant healthcare improves and family planning messages start to sink in, say health officials and UN staff.

In Guinea-Bissau 98 of 114 health centres now offer family planning services and 10 percent of women use contraception which while low is an improvement, said Antonieta Martins, a UN Population Fund (UNFPA) adviser to the Ministry of Health.

UNFPA estimates that giving women access to modern contraception could prevent 40 percent of maternal deaths worldwide.

In Guinea-Bissau one in 13 women dies in pregnancy or childbirth, according to the UN – one of the highest rates in the world.

The service

At San Domingos government hospital 90km north of the capital Bissau, health staff distribute the birth control pill, condoms and contraceptive implants, said hospital director Inghala Na Uaie.

UNFPA helps fund the provision of free contraception nationwide, trains health workers on family planning and reproductive health and advises the Health Ministry.

Health workers in San Domingos use several methods to spread family planning messages, Na Uaie said, including speaking to teenagers in schools about the dangers of starting a family too young and suggesting contraception options to women who have come to the hospital with pregnancy-related or birthing problems.

They also try to spread the message in non-reproduction-related health visits as part of a government and UNFPA drive to mainstream family planning messages.

“Women want family planning here – we meet with very little resistance to our messages,” he told IRIN.

But with inconsistent stocks the hospital cannot guarantee contraception to all who want it, he said.

Dada Saar, 36, mother of five children, spoke to IRIN while waiting to receive her next contraceptive implant at Simao Mendes hospital in Bissau.

“Five [children] is enough,” she told IRIN. “We don’t have enough money to support them. My husband has no fixed job. Even if one of my children were to die, I wouldn’t want more.”

Next to Saar sat Florence de Silva, 28, who has one daughter and wants another child, but plans to stop at two. “Otherwise I will not be able to educate them…even if I have just two and they are both educated, they will be able to look after me when I am older.”

Economic security or better health?

Economics increasingly sways urban families’ decisions to expand or not, said Alfredo Claudino Alves, director of health and reproductive services in the Ministry of Health.

“In towns people are more conscious that they want fewer children. They understand life is expensive.”

But receptivity to the family planning message has a lot to do with contraception being free, and with reproductive and infant health improving. “People have more faith in medicine working, so are starting to think their babies won’t necessarily die [when ill],” Alves said.

Far more women now come to San Domingos hospital to give birth than did a few years ago, Na Uaie said. And while statistics cannot be confirmed – a countrywide survey is due out in 2010 – health workers told IRIN maternal and under-five mortality is declining across the country.

While reportedly dropping, however, under-five death rates are still high in Guinea-Bissau; mothers still have a one-in-five chance of losing a child before the child reaches age five, according to UNICEF. This perpetuates high birth rates, Martins said.

Choices

Concerned about the slow progress of international efforts to reduce maternal mortality to meet 2015 Millennium Development Goals, health ministers, government officials, UN and NGO representatives from around the world gathered in Addis Ababa on 27 October to urge governments to make family planning a priority.

Reducing the rate of unintended pregnancies and stopping women from dying in childbirth worldwide would cost US$23 billion per year, they said in a communiqué.

However in Guinea-Bissau, where ministry budgets are small and in some cases are almost 100 percent dependent on donor funding, deciding priorities is difficult, said Alves.

Martins said: “The government is committed [to family planning], but there is always something else to prioritize first because this country has so many other problems.”

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http://www.irinnews.org/report.aspx?ReportId=86788ADDIS ABABA Friday, October 23, 2009 (IRIN) - With non-skilled jobs in the Ethiopian capital, Addis Ababa, paying as little as US$16 per month, the financial incentives to engage in commercial sex work are overwhelming - earning 30 times a domestic worker’s salary.ADDIS ABABA Friday, October 23, 2009 (IRIN) - With non-skilled jobs in the Ethiopian capital, Addis Ababa, paying as little as US$16 per month, the financial incentives to engage in commercial sex work are overwhelming - earning 30 times a domestic worker’s salary.

Many of the women entering into sex work in Addis are rural migrants who have failed to secure formal employment, or are escaping poor-paying jobs in the city or unwanted marriages in the country, according to a 2008 article [http://download.interscience.wiley.com/cgi-bin/fulltext?ID=119387830&PLACEBO=IE.pdf&mode=pdf] published by the UK's Royal Geographical Society.

Teguest, a 16-year-old girl from Gonder, a town 700km northwest of Addis Ababa, fled to the capital four months ago after the death of her parents and a dispute with her brothers.

The relative she contacted in the capital was already engaged in sex work, so the decision to enter the trade was an easy one. Teguest charges 10 Ethiopian Birr or $0.80 per client and has sex with as many as 20 men a day in her tiny room; she is adamant that under no circumstances would she have unprotected sex.

"No, I would not do that for any money. I need my life," she said. "They sometimes offer 200 Birr [$16] and beg me, but life is more important than money."

Teguest says in the past four months, at least 10 men have asked her for unprotected sex at a higher fee.

The good news, according to research by Wise-UP - a condom-promotion project implemented by local NGO Timret Le Hiwot [http://timretlehiwotet.org] and funded by social marketers DKT-Ethiopia [http://www.dktethiopia.org] - is that 99 percent of sex workers in 42 Ethiopian cities said they used a condom with their last paying partner, compared with 91 percent in 2002.

Shame factor

But according to health workers, not all sex workers are as fastidious about condom use as they claim. When Abeje Israel, monitoring and evaluation officer at Wise-Up, posed as a paying customer for random surveys, some women did agree to have sex without a condom for a higher fee.

A 2006 study [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576726] published in the British Medical Journal found that results of sex worker studies obtained using surveys and questionnaires may be biased as they will not always reveal the truth because of "pride, fear, or shame".

"They may say that they do not have sex without a condom, but the reality may be different; they may pretend and not show the real circumstances," Abeje said.

"All these [sex] workers are very vulnerable," he added. "They are not very powerful and they receive a very small sum of money; if you offer them more money, they may be willing to have sex without a condom."

Education vital

Further investigation makes it clear that the city's sex workers still need education on protecting themselves from sexually transmitted infections.

Meron, 25, also says she would never have sex without a condom, but added that she took the “precaution” of insisting her clients used two condoms - a practice roundly advised against as it increases the chances of a condom tearing.

Low levels of education and alcohol use also affect the likelihood of female sex workers using condoms, according to a study [http://ejhd.uib.no/ejhd-v20-n2/93_98_EJHD_20%20no%202%20final.pdf] by Addis Ababa University.

Wise-UP aims to achieve 100 percent condom use among sex workers in the capital, which has an HIV prevalence rate of 7.5 percent, almost four times the national average of 2.1 percent.

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http://www.irinnews.org/report.aspx?ReportId=86718MBABANE Wednesday, October 21, 2009 (IRIN) - A search for ways to curb the spread of HIV in Swaziland has led to a public debate on legalizing sex work, which would have been unheard of 10 years ago in this poor, food-insecure country.MBABANE Wednesday, October 21, 2009 (IRIN) - A search for ways to curb the spread of HIV in Swaziland has led to a public debate on legalizing sex work, which would have been unheard of 10 years ago in this poor, food-insecure country.

The woman at the centre of the debate is Senator Thuli Mswane, who is also director of Hospice at Home, a local home-based care organization headquartered in Matsapha, between the capital, Mbabane, and the country's industrial centre, Manzini.

Swaziland's new tourism developments lie in the Ezulwini area, east of Mbabane, and the combined lure of large population centres and foreign visitors has inevitably given rise to a thriving sex industry.

Mswane has announced her intention to champion the cause of legalized sex work by requesting that the justice ministry introduce a bill legalizing the sex trade as a means of controlling the spread of HIV; Swaziland has the highest prevalence rate in the world.

"Studies have shown that the trade of prostitutes [in countries where it is legal] is not risky to clients, as sex workers protect themselves; hence my appeal for government to consider legalizing brothel ownership and sex work," said Mswane.

Her announcement has created a sensation in this small conservative country. Although roadside sex workers have been a fixture in Matsapha and Ezulwini for years, the illegal profession has gone largely unacknowledged by health officials and ignored by the police.

Last year the first media exposure of an operating brothel was thought a shocking story; moreover, underage girls were found living and working there. The girls dispersed to other homes - later to resume their trade - and no arrests were made.

The incident also exposed a growth in prostitution that has mirrored rising poverty and the continuing marginalization of women. Traditional views on the role of women prevail in Swaziland's deeply patriarchal society.

"In most instances, women are the ones who engage in the trade as a result of abuse meted out by their [male] partners at home ... whilst also struggling to earn a living," Mswane noted.

Sex work does exist

Mswane's call to legalize the sex trade has been welcomed by some NGOs. "If we don't legalize sex work, women will continue to be exploited and violated, so legalizing it would mean their protection is guaranteed," said Cebile Henwood, director of the Manzini-based Swaziland Action Group against Abuse (SWAGAA).

"These people [sex workers] have rights, and deserve to be protected just like anyone else ... If sex work is legalized then women will have access to services such as health ... they will be able to insist on protection such as ensuring clients use condoms."

Because sex workers engage in an illegal activity, reporting abuse to SWAGAA or gaining access to the justice system, as other victims of abuse could, was extremely difficult, she added.

Emmanuel Ndlangamanda, executive director of the Council of Non-Governmental Organisations (CANGO), told IRIN/PlusNews that the illegal nature of sex work made it difficult for sex workers to access health facilities, but they were at higher risk of HIV as they did not receive adequate support and education.

The proposed Sexual offences and Domestic Violence Bill, which sparked Mswane's campaign, would outlaw brothel ownership and impose a 10-year prison sentence; anyone caught residing in a brothel would also be breaking the law.

"The Bill criminalizes running of a brothel and outlines a fine for it - in other countries sex workers are part of the economy, as they are taxed and assessed on a continuous basis," Minister of Justice and Constitutional Affairs Ndumiso Mamba admitted to MPs.

However, he dismissed any suggestion that his ministry would pursue decriminalization. "Based on Christian principles, government cannot be seen to be condoning it," he said.

Most Swazis seem to agree. A non-scientific on-line poll conducted by the Swazi Observer, a local newspaper, found that 87.5 percent of respondents did not want prostitution legalized, compared to 12.5 percent who supported decriminalization.

The Council of Swaziland Churches, an umbrella body, has slammed Mswane's call to decriminalize sex work. "As a faith-based organization we cannot be seen promoting sex work," said Khangezile Dlamini, secretary-general of the umbrella body.

"Sex workers are responsible for the spread of HIV and while ... [they do not have] multiple concurrent partners, [they have] a number of clients. Besides being Biblically wrong, in Swazi culture sex work has never been ... [condoned]."

The debate has, at least, established the reality of sex work, and highlighted the exploited lives of the women who make their living from it, even if government and the traditional authorities have shown no desire to entertain, much less pursue decriminalization of the trade.

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http://www.irinnews.org/report.aspx?ReportId=86667NAIROBI Monday, October 19, 2009 (IRIN) - Julia Nyaberi's* "clinic" in Majengo, a slum in Kenya's capital, Nairobi, caters to one type of client only - pregnant women seeking abortions.NAIROBI Monday, October 19, 2009 (IRIN) - Julia Nyaberi's* "clinic" in Majengo, a slum in Kenya's capital, Nairobi, caters to one type of client only - pregnant women seeking abortions.

Young women writhe in pain on the floor of the poorly lit house; the neighbours all know what happens here and have become immune to the moans and wails.

"They come to me and each pays me 50 shillings [US$0.70]," Nyaberi told IRIN/PlusNews. "Most of them are sex workers who operate here in Majengo and have conceived by mistake."

She uses a concoction of herbs to induce abortion, and admits there have been fatalities. "Even qualified drivers at times cause accidents; I do not do this job to kill anyone, but at times some are unlucky and go together with the child they came to abort," she said.

Diana Awuor*, 21, is a sex worker in Majengo, and fell pregnant after unprotected sex with a regular client.

"Not that I have sex without a condom every day but there are some regular clients you can excuse at times and I think that is how I became pregnant," she said. "We cannot do our work while pregnant because nobody will want you, so I have to abort to stay in business, and also, I don't want a baby."

Back-street clinics

Ministry of Health statistics put the number of Kenyan girls and women who have abortions every year at 300,000; abortion remains illegal so many of these take place in back-street clinics like Nyaberi's. According to the International Planned Parenthood Federation, http://www.ippf.org/NR/rdonlyres/8D4783F5-D516-47D3-8B34-61F6D510202A/0/Death_Denial_unsafe_abortion_poverty.pdf, unsafe abortions account for between 30 and 50 percent of maternal deaths in Kenya.

"One person attending to up to even five women without sterilizing whatever instruments are being used can spread HIV," said Jacky Abuor, a counsellor at the faith-based Kenyan NGO, Crisis Pregnancy Ministries, which works with young women dealing with unwanted pregnancies.

The legalization debate

A recent study by the local NGO, Centre for the Study of Adolescence (CSA), http://www.csakenya.org found that four in 10 Kenyan girls had sex before the age of 19, many with multiple partners and often in exchange for gifts such as mobile phone airtime or food. Along with the predictable public outcry, http://allafrica.com/stories/200910131192.html the report re-ignited the legalization debate.

Women's rights groups have long urged the government to legalize abortion to prevent the high number of maternal deaths from unsafe procedures. A Reproductive Health and Rights Bill proposing that "safe and accessible abortion-related care" be enshrined in the constitution as a reproductive right was tabled in Parliament in 2008 by the Federation of Women Lawyers and the Coalition On Violence Against Women; MPs have yet to vote on the issue.

The country's anti-abortion movement has powerful backers, from religious leaders to politicians, such as Vice-President Kalonzo Musyoka.

Sex education

"When you say four out of 10 girls have engaged in sex, how do we keep the remaining six from being lured into early sex? The window lies in counselling and education," said Anne Muisyo, “Abstinence and worth the wait” programme coordinator at Crisis Pregnancy Ministries.

"Sex education at the early stages of life and especially targeting young people can significantly turn the tide and prevent new cases of HIV," Paul Mitei, head of gynaecology in western Kenya's Nyanza Provincial Hospital.

Kenya's Ministry of Education has an HIV/AIDS prevention and sex education curriculum that focuses on upper-primary and secondary school, but no specific time is set aside for this during the school day, leaving teachers and school heads to fit in the subject at their discretion.

Speaking at a recent meeting in Nairobi, Kenya's director of public health, Shanaaz Sharif, admitted that opposition from parents, religious groups and some civil society bodies had led to a "censored sex education campaign" in schools.

Agnes Odawa, in charge of guidance and counselling at the education ministry, told IRIN/PlusNews the government had plans to introduce a more detailed sex education package as part of the school curriculum.

Responding to the CSA's findings, the head of the National AIDS Control Council, Alloys Orago, said the government was also looking into the promotion of condom use among teenagers.

Currently the government's HIV prevention programme for teens revolves around the promotion of abstinence, with a nationwide media campaign urging young people to "chill", or abstain, from early sex.

"Many young girls and even boys in rural areas and poor settings do not really know about contraception; those of them who use the condom only know it as a means of preventing HIV," said Mitei. "There is a need to promote condoms to young people both as an HIV preventive measure and birth control measure."

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* not her real name

http://www.irinnews.org/report.aspx?ReportId=86641NAIROBI Friday, October 16, 2009 (IRIN) - A draft bill before the Ugandan parliament that seeks to impose stricter sanctions on homosexuality would drive men who have sex with men further underground, making it even more difficult for them to access HIV services, according to AIDS activists.NAIROBI Friday, October 16, 2009 (IRIN) - A draft bill before the Ugandan parliament that seeks to impose stricter sanctions on homosexuality would drive men who have sex with men further underground, making it even more difficult for them to access HIV services, according to AIDS activists.

According to Uganda's New Vision newspaper [http://www.newvision.co.ug/D/8/12/697859], the draft bill, tabled by ruling party MP David Bahati, proposes a seven-year jail term for anyone who "attempts to commit the offence" or who "aids, abets, counsels or procures another to engage in acts of homosexuality".

"If this bill is passed it will be a clear violation of human rights and will push men who have sex with men even further underground than they are," Beatrice Were, a Ugandan HIV/AIDS activist, told IRIN/PlusNews.

"Our national strategic plan for HIV/AIDS aims to achieve universal access to HIV prevention, treatment and care, but if people are criminalized and not allowed to exist, how can they access these services?" she added.

Homosexual acts, or "carnal knowledge against the order of nature", are already criminalized in Uganda, carrying a maximum penalty of life imprisonment.

Under the draft bill, “promotion of homosexuality”, including publishing information or providing funds, premises for activities, or other resources, is also punishable by a seven-year sentence or a fine of US$50,000.

If passed, the bill would see the death penalty handed down for the crime of “aggravated homosexuality” - a sexual assault committed against a member of the same sex who is under 18 or disabled. Anyone found guilty of the offence of homosexuality would be forced to take an HIV test.

"Bahati's proposed bill also supports stigma and discrimination against HIV-positive people, and would undermine years of efforts to tackle the epidemic," Solome Nakaweesi-Kimbugwe, a human rights activist, and Frank Mugisha, co-chair of the rights group, Sexual Minorities Uganda, said in a statement.

"Uganda has been considered a 'best practice' leader in the fight against HIV and AIDS," the statement continued. "If [the bill is] passed, this leadership status would be put in serious question."

The Uganda AIDS Commission classes men who have sex with men (MSMs) as “most at risk”, yet there are no HIV programmes targeting them and no action has been taken in response to a 2009 study [http://www.unaidsrstesa.org/files/u1/Uganda_MoT_Country_Synthesis_Report_7April09_0.pdf] by UNAIDS and the Uganda government recommending that "legal impediments to the inclusion of most-at-risk populations, including commercial sex workers, MSMs and IDUs [intravenous drug users], in the HIV/AIDS national response should be reviewed".

"Morals do not stop HIV; what stops HIV is the evidence from science - we know that using condoms can prevent infection, using PEP [post-exposure prophylaxis] after exposure can stop infection, and ARVs [life-prolonging anti-retroviral drugs] prevent mother-to-child transmission," Were said. "People must feel comfortable enough to seek these services regardless of their sexual orientation."

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http://www.irinnews.org/report.aspx?ReportId=86620NAIROBI Thursday, October 15, 2009 (IRIN) - Khadijo Mahamud, a mother of five, goes to Bakara market every day to look for work, despite the constant shelling. Her youngest child is 10 months old but Mahamud knows she has no choice but to leave him with her 10-year-old and venture out to find food for the family.NAIROBI Thursday, October 15, 2009 (IRIN) - Khadijo Mahamud, a mother of five, goes to Bakara market every day to look for work, despite the constant shelling. Her youngest child is 10 months old but Mahamud knows she has no choice but to leave him with her 10-year-old and venture out to find food for the family.

“I have to leave the children and try and find something for them to eat; I will do almost any job," she told IRIN on 14 October. "Some days I get to wash clothes, but other days I work as a porter or clean stores.”

On a good day, Mahamud makes 50,000 Somali shillings (US$1.50). “There are days I don’t make even that much.”

Like Mahamud, a growing number of women in Mogadishu has been pushed into tasks that were traditionally considered men's work, such as serving as porters and pushing handcarts in the market.

Mahamud said most women risked a lot coming to Bakara market but had no alternative. She said she had lost many friends in the market, killed by shells.

“You will be carrying something for a client and then the shelling starts and you have nowhere to run; many friends died trying to earn some money for their children,” Mahamud added.

Sharifo Adow, head of the Coalition of Grassroots Women's Organizations (COGWO), said more and more women were carrying heavy loads in Bakara - the largest open-air market in the country - and one of the most dangerous places in the Mogadishu, with regular shelling by various fighting groups.

“In the past, we were used to seeing women selling tea or drinks in the market but now you see more and more women porters or pushing handcarts,” she said.

Adow said most of the women had lost their husbands and had no one else to help them, "so they do whatever is necessary to provide for their children. They are so desperate they will do anything to be able to get food to the children.

“It is not only women who lost their husbands who work," she said. "There are many whose husbands are alive but are the family's breadwinners.”

She said many of the men would not do some of the things the women did to feed their children.

“These [women] are the poorest of the poor who could not even afford to get out of the city and go to the IDP camps,” Adow said. “They live a hand-to-mouth existence and cannot even afford to get sick for one day.”

The Bakara market has suffered many casualties in fighting between government forces and two Islamist insurgent groups trying to topple the government.

Nuurto Ali, a mother of four, also does labourer’s work in the market. She lost her husband five years ago when a shell landed on him. “I have been working here ever since.”

Ali said the only help she gets is from her eldest son, Ali, 14, who works as shoeshiner in the streets of Mogadishu.

“Every morning, even when there is fighting going on, I am here at dawn, so I can get the early work,” Ali said.

Adow said aid agencies should think about setting up income-generating activities to help these women and their families.

“These are people that have fallen into a black hole; they are not where the aid agencies are and no one else is helping them,” Adow said.

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http://www.irinnews.org/report.aspx?ReportId=86584MOGADISHU Thursday, October 15, 2009 (IRIN) - Halima Hassan, 42, a mother of five, fled her home in Hodan district of the Somali capital in 2007 after intense fighting between insurgents and government forces. Now, home is a makeshift shelter in a camp for the internally displaced within the Elsha biyaha area, 20km south of Mogadishu.MOGADISHU Thursday, October 15, 2009 (IRIN) - Halima Hassan, 42, a mother of five, fled her home in Hodan district of the Somali capital in 2007 after intense fighting between insurgents and government forces. Now, home is a makeshift shelter in a camp for the internally displaced within the Elsha biyaha area, 20km south of Mogadishu.

Hassan is one of at least 900,000 internally displaced persons (IDPs) struggling to survive under extremely desperate conditions in Mogadishu-Afgoye corridor. Her family used to receive monthly food rations comprising 75kg of sorghum, 10kg of beans, 10kg of porridge and 3l of cooking oil from aid agencies but this has been cut in half due to lack of funds and insecurity.

Hassan has since taken up casual work to supplement the aid. She spoke to IRIN on 14 October:

"My husband was killed in 2007 when shells hit our home in Hodan; he left me with five children and nothing else. The house was almost completely destroyed. We could have stayed on but the fighting got worse and I couldn't even go to the market, so I took the children and came with other families to this place.

"We have been here ever since. I sometimes find myself wondering how God decided to put us in this country; I know I should not but sometimes I find myself wishing I was not Somali.

"I am losing hope, I don't know whether or not the situation will ever get better. Every day, I keep wondering where our next meal will come from. I struggle to make sure my children have at least one meal a day.

"Some days I even go up to Mogadishu to look for work. It is very dangerous but I have no option. I am a good cook, so people hire me to cook for them when they have celebrations such as weddings, but this does not happen too often. Other days, I wash clothes or cut grass for sale.

"I will do anything so my children don’t go hungry as I am the only one they can depend on.

"They [the warring sides] are merciless. They fire heavy weapons indiscriminately, where is their kindness? They don’t think about the weak and the mothers struggling with orphaned children.

“There is no peace and no food to speak of; I don’t how long we can live like this. It is very hard to explain to anyone who is not here what is happening to us. Wars end but ours seems endless.

"In Somalia, every new dawn brings its own problems. We can’t endure any longer what is going on here. It is better to be in a grave than living here."

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http://www.irinnews.org/report.aspx?ReportId=86597NAIROBI Thursday, October 15, 2009 (IRIN) - Countries where women's literacy rates and access to education are significantly worse than men's tend to have higher levels of hunger, according to the International Food Policy Research Institute (IFPRI).NAIROBI Thursday, October 15, 2009 (IRIN) - Countries where women's literacy rates and access to education are significantly worse than men's tend to have higher levels of hunger, according to the International Food Policy Research Institute (IFPRI).

"Wherever women are not empowered you see high levels of hunger," Suresh Babu, a senior research fellow with IFPRI, told IRIN.

The institute’s 2009 Global Hunger Index (GHI) calls for policy action on gender empowerment, social protection and governance to improve food security.

The index lists 121 countries using a scale of one (no hunger) to 100, describing values under 4.9 as "low hunger", between 10 and 19.9 as "a serious problem" and values of 30 or greater as "extremely alarming."

It quantifies hunger according to the availability of food per capita in terms of calories required per day, weight of children under five, and the proportion of children dying before age five.

"Gender equality is a key factor in solving the problem of hunger. The more women are educated, the more likely they are to take children to hospital," noted Babu.

For example, Chad, where 13 percent of women are literate against 41 percent for men, has a GHI of 31.3.

Botswana, by contrast, which provides universal access to 10 years of basic schooling and has greatly reduced gender disparity at all education levels, has an index of 12.1.

"We hope that the GHI will not only generate discussion but also stimulate action... to overcome extreme vulnerability and gender inequality, which are extremely [closely] connected," said Constanze von Oppeln, food security policy officer with the German NGO, Welthungerhilfe.

Alarming levels of hunger

According to IFPRI, "equalizing men’s and women’s status would reduce the number of malnourished children by 13.4 million in South Asia and by 1.7 million in sub-Saharan Africa".

Twenty-nine countries in Africa and South Asia have alarming or extremely alarming levels of hunger; nine out of 10 of the worst are in sub-Saharan Africa.

Africa also has the highest proportion of undernourished people (76 and 68 percent of the population in Democratic Republic of Congo (DRC) and Eritrea, respectively) and the world’s highest child mortality rate.

Burundi had the highest prevalence of underweight children at 35 percent, followed by Ethiopia and Eritrea, at 34.6 and 34.5 percent. The worst overall performer was the DRC, with a hunger index of 39.1, a considerable decline from the 25.5 in 1990.

"The DRC is doing so badly that it is pulling the rest of the continent down," said Babu. "Because of instability, the DRC is not able to invest in and reach rural areas where food can be grown."

South Asia’s progress

Comparing Africa and South Asia, he noted that while South Asia had made remarkable progress in increasing food production, it performed worse than Africa in under-five health. South Asia's GHI is 23.0 compared with sub-Saharan Africa’s 22.1.

"The causes of food insecurity in the two regions are different. In South Asia, the low nutritional, educational, and social status of women contributes to a high prevalence of underweight… children under five.

"In sub-Saharan Africa, low government effectiveness, conflict, political instability, and high rates of HIV and AIDS lead to high child mortality and a high proportion of people who cannot meet their calorie requirements."

IFPRI recommended investment in social safety net programmes such as school feeding, improved nutrition for pregnant and lactating mothers and direct cash transfers.

In the long term, Babu said, good governance was key. "Governance is not just about corruption but worrying about those who will be affected by hunger," he added.

"The challenges [of hunger] are not new. What is surprising is the lack of action from governments."

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http://www.irinnews.org/report.aspx?ReportId=86602BANGKOK Tuesday, October 13, 2009 (IRIN) - Women are being excluded from the debate over climate change, despite being most at risk, and governments should do more to ensure their situations and views are represented, campaigners and experts say.BANGKOK Tuesday, October 13, 2009 (IRIN) - Women are being excluded from the debate over climate change, despite being most at risk, and governments should do more to ensure their situations and views are represented, campaigners and experts say.

So far, climate change negotiations have responded poorly to the effects on women, activists say. And while global policies advocate a gender perspective, and including women in environment and development efforts, few governments have incorporated such policies into their national plans.

"Extreme events and environmental degradation become a women's issue because we are responsible for providing for the whole community," said Anna Pinto, programme director with the Centre for Organisation, Research and Education (CORE), based in northeastern India.

"If the rice yield is bad, men have to migrate, find a job and send money back, while women have to ensure the day-to-day survival of the helpless.

"When the environment degrades it becomes more of a women's problem. These issues need to be genderised on behalf of everyone," she said.

UN Secretary-General Ban Ki-moon last month called for women to have a greater role in climate change debates. "The special perspective of women is often overlooked in global discussions on climate change," Ban told an event on women's leadership held in New York.

Climate change-related weather events claim between two and three times as many female as male victims, according to the Asian Development Bank (ADB).

"Women are prone to more danger," Robert Dobias, the ADB's senior adviser on climate change, told IRIN. "It's the clothes they wear. Maybe they will run back and get the kids. They are often not in public places where information surfaces about disasters," he said at the sidelines of recent climate-change negotiations in Bangkok. [http://www.irinnews.org/Report.aspx?ReportId=86430] [http://www.irinnews.org/Report.aspx?ReportId=86405]

Excluded from adaptation

"Well-designed, top-down approaches to adaptation can play a role in reducing vulnerability to climate change; yet they may fail to address the particular needs and concerns of women," said Christina Chan, senior policy analyst for CARE International. [http://www.careinternational.org.uk/12685/media-releases/no-climate-justice-without-gender-justice.html]

In Africa, women farmers produce up to 80 percent of the continent's food, according to the UN Food and Agriculture Organization (FAO).

However, because most women work in the subsistence sector, they cannot take part in market-based adaptation schemes, according to Rose Enie, from Women for Climate Justice (GenderCC). [http://www.gendercc.net/]

"It doesn't work for women because they are mostly in the informal sector," she said.

Campaigners say such omissions mean women will continue to be bypassed by resilience-building initiatives - including access to land, credit, support services, new technologies and decision-making.

In addition, women are particularly overlooked when it comes to the development of environmentally friendly technology that can be used in their daily activities, said GenderCC's Ulrike Roehr.

"Men tend to look at big-scale technology, while needs for smaller-scale technology, such as energy-efficient cooking stoves, are not taken into consideration," Roehr told IRIN.

"These are the technologies which help in reducing women's double and triple burdens, having benefits not only for emissions reduction, but also for poverty reduction and health," she said.

Alternative energy

Women and the communities they look after could be big losers in schemes being considered by governments to mitigate the emission of greenhouse gases, activists say.

These include plans to preserve forests, so trees can absorb and store carbon in the air. The UN's Reducing Emissions from Deforestation and Degradation (REDD) scheme, for example, will see large areas of land closed to women who had hitherto depended on the fuel, medicine, food and fodder they could find there, said Jeannette Gunung, director of Women Organising for Change in Agriculture and Natural Resource Management (WOCAN). [http://www.wocan.org/]

"Women's exclusion from forests is not new, but as long as forest land had little economic value they could get away with these practices," Gunung told IRIN.

"When the resource becomes of central importance, women have little voice in decision-making and are denied access," she said.

Yet environmentally friendly solutions, such as the use of biogas - flammable gas produced by the fermentation of organic material - as an alternative and cleaner source of energy than firewood, are available, Gunung said.

"Once planners put rural women's needs as a priority, they will come up with solutions that involve sustainable forest management and alternative energy resources," she said.

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http://www.irinnews.org/report.aspx?ReportId=86561MANILA Monday, October 12, 2009 (IRIN) - Nine months pregnant with her first child, Chona de la Cruz, 30, waded through murky flood waters amid heavy rain to reach a government hospital in Manila's suburban Cainta district.MANILA Monday, October 12, 2009 (IRIN) - Nine months pregnant with her first child, Chona de la Cruz, 30, waded through murky flood waters amid heavy rain to reach a government hospital in Manila's suburban Cainta district.
 
But the hospital, which was partly submerged by floods brought by tropical storm Ketsana on 26 September, was overwhelmed and almost turned her away.
 
"I don't want to deliver my baby in an evacuation camp," De la Cruz sobbed, as more than 500 other pregnant women crowded the Bagong Cainta Municipal Hospital seeking medical and hygiene kits. "This is my first time to be a mother and I don't know what to do."
 
De la Cruz and her husband, a construction worker, had been crammed into an evacuation camp with more than 800 people in a covered basketball court at Lakas-Tao, a Cainta slum. Some areas were still submerged in sludgy water more than two weeks after Ketsana hit.
 
When the flood waters first rose, her husband found a tyre tube, which they used to float through neck-deep waters to safety. "But it was too cold and I spent many hours in the water. I am afraid I may have caught diseases," she said.
 
Nearby, Racquel Pascual, 21, eight months pregnant with her fifth child, and all her belongings washed away - including the money she had saved for the birth – said she too had nowhere to go.
 
"I am resigned to the fact that I may give birth in an evacuation centre, and my poor baby may get infections there," she said.
 
Neglected
 
The women are only two of the estimated 14,000 pregnant women exposed to septic surroundings at evacuation camps. Their plight has been neglected as an overwhelmed government struggles to come to terms with the magnitude of the flooding.
 
After Ketsana, super-typhoon Parma slammed into northern Luzon island on 3 October, bringing week-long rains that triggered heavy landslides and flooding, further deepening the crisis. The death toll from Parma has reached almost 300, while the toll from Ketsana is 337, the government said.
 
More than 6.3 million people have been affected by the killer storms, over 400,000 of whom are in evacuation centres. Many areas were still isolated by landslides as of 12 October, and the UN World Food Programme (WFP) and the US military have scheduled airlifting tonnes of food to the devastated areas.
 
When Ketsana hit, the priority was to save those trapped by the floods, then find evacuation sites for the hundreds of thousands who lost their homes. And with much of the health infrastructure destroyed in Manila's eastern suburbs, these pregnant women have been largely neglected, the UN Population Fund's (UNFPA) Philippines country director, Suneeta Mukherjee, told IRIN.
 
"They are very vulnerable because they can't stop from delivering when their time comes," Mukherjee said. "The number one problem is that the whole thing could be septic, the mother and the baby could get infected and die."
 
Appeal for help
 
Mukherjee said UNFPA had done rapid assessments of various evacuation camps, and linked up with volunteer organizations, including enlisting the help of an association of midwives, who have been dispatched to selected areas.
 
"There are a lot of pregnant and post-partum women in the evacuation centres who do not have access to prenatal, natal and post-natal care. We cannot allow this situation to continue," Mukherjee said.
 
Cainta's municipal health chief, Glenda Abellanosa, said that only three of the area's 27 free health centres were still standing. With medical workers themselves left homeless, she said all international help was welcome.
 
"Many of these pregnant women may return to their homes, and we will not be able to monitor them," she told IRIN. "We want to help everyone, but we simply can't, because we have gone beyond our capacity."
 
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