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