Showing posts with label equality. Show all posts
Showing posts with label equality. Show all posts

Thursday, January 26, 2012

Huge Birth Control Programs Don't Work: Time to Give Education a Chance

I recently moved from a job as grant proposal writer for an NGO working in several different development areas to a similar job in a secondary boarding school for girls, which is being built in a country where many girls don't even finish primary school. So I was comforted to find an article entitled 'Women's Education Slows Population Growth'. That women's education can have such profound and positive consequences is not the issue, that has been recognized for a long time, at least by those working in education. But the priority is so often given to population growth, rather than to education or any other development area.

A shocking proportion of 'development' money and a disturbing number of development related insitutions concentrate almost exclusively on population control, in some form or other. They bang on about an unmet need for contraception as if many women will have depleted health or lives as a result of lacking birth control methods, when they are likely to be in far greater need of better nutrition, healthcare, security, governance, equality, infrastructure and, indeed, education. Shovelling contraceptives into rural communities may be a lot easier than providing people with what they need, but without the education and other development areas being addressed, the only gain will accure to the pharmaceutical companies who produce contraceptives.

Similar remarks apply to a lot of other 'health' programs, which target whatever health issue is currently fashionable and well funded; many of them are also necessary, but they would work a lot better if people had the level of education to capitalize on them. Otherwise, they can just go through the motions of attending numerous courses, often for the per diem they may be paid or the free lunch or other minor benefits on offer. I have met people who have been to various 'training courses' only to attend the same course several more times, sometimes provided by the same NGO as before. Training courses are a great way to spend money and it's easy enough to gather data that allows the donor to pronounce the intervention successful. Some health drives pick out some particular disease, perhaps a water borne disease, without addressing water and sanitation in the area. The current drive to 'eliminate' polio is a cases in point; those who attend immunization drives go home to drink contaminated water and contract something else.

Education itself, as we found in my own country, Ireland, is not enough when there are no jobs to go to. And here in Tanzania, women are not considered to be able to do many jobs that they would in fact be well able to do, if they had the education. Sadly, they are considered to be able to do many jobs that are not particularly appropriate for them when they are too young, too old, pregnant, childraising or breastfeeding, but that's another matter. I always feel a bit dishonest when I tell people about how important education is when there is little guarantee many of them will ever get to use it, especially girls and women.

As if there are not enough obstacles, also, school-going girls who become pregnant are excluded from school. In the rare instances where they are allowed to return to school, most do not. This is to 'set an example', we are told. And it does. It shows that girls who get pregnant will be treated very harshly, whereas the boys or men who make them pregnant, generally, will not. The fact that underage girls being made pregnant by older men is a serious crime doesn't get the girls off the hook. Men don't appear to be prosecuted, boys are generally not excluded from school and the strong prejudice against females appears to be practiced by the very institutions that might be in a position to change things.

According to the article, the average birth rate is less than half in regions where education is valued; as I'm working in one of those regions, I'm hoping that birth rates are lower because education is valued. However, even expensive schools with nice, well-funded buildings and facilities, don't always have especially high educational standards. As a fundraiser, sometimes I can see funds for all sorts of things, but not so many that clearly improve education. There is not so much available for good teachers or other provisions that would make a difference. And many fundraisers are tasked with raising money for the buildings, which is important, but often distracts from the ultimate purpose of these buildings.

So, as the article suggests, it's not the correlation between higher standards of education and lower birth rates that is important; it is the priority that is given to education. Proponents of the population control theory of development, so beloved throughout the last fifty years (and still loved by the Rockefeller Foundation, the Gutmacher Institute, the Gates Foundation, Population Services International, Family health Internationa and many more), never appeared to realize what needed to come first, that with development of education, health, infrastructure and the rest, lower birth rates would follow. Similarly, poverty is pervasive in Tanzania, but lower birth rates does not have much direct effect on poverty; rather, lower poverty rates result in improved health, education and the like.

For education to be of benefit, many other things need to be in place as well. But one thing is for sure; reducing birth rates and hoping that other development areas will benefit accordingly has not worked. The funding these charlatans have received urgently needs to be directed towards people's true needs, which are still education, health, a decent standard of living, security, food security and the rest, just as these are the true needs of all people.

allvoices

Saturday, February 20, 2010

Punishing Victims; Protecting Perpetrators

Several Christian organisations and churches in Kenya are claiming 'victory' because the draft constitution has been rewritten to specify that life begins at conception. They threatened to sabotage the whole constitution if this was not done. As a result of their threats, other clauses have also been removed. Kenyans will not now have a right to health care, in particular, reproductive health care. Also, the clause stating that no one may be refused emergency medical treatment has been removed. And there is a phrase that specifically rules out abortion unless the life of the mother is in danger.

Abortion is already illegal in Kenya, but this has not prevented several hundred thousand woman and girls seeking abortion every year. The majority of these abortions, an estimated 800 per day, are unsafe, being carried out in insanitary conditions by untrained personnel. Those who go through these unsafe abortions are less likely to seek professional medical attention and less likely to receive it. As a result, over 2000 die every year, adding considerably to the thousands of maternal deaths that occur.

In what sense have these Christian groups achieved a victory? They don't appear to be opposed to the fact that rape and forced sex often goes unpunished because it is carried out by the more powerful against the powerless. It is carried out by adults against young people, even children. Those who should protect the victims, church leaders, political leaders, teachers, police and others, are often the perpetrators.

If, as Christians are so fond of claiming, life is sacrosanct, why are the lives of certain people so unimportant? Why are human lives so unimportant as to be denied the right to health and the right to make their own reproductive decisions? Women should be able to choose when to have children, under what conditions and with whom. Where these rights have been denied, why should they be made to pay for someone else's crime?

Nothing that these Christians have done will reduce the incidence of unsafe abortions, of seriously compromised reproductive health for women, of women suffering and dying unnecessarily. Nothing that these Christians have done will reduce the incidence of rape and forced sex. Victims of crime should be entitled to protection, not punishment. Perpetrators of crime deserve punishment, especially when those perpetrators are in a position that gives them a level of power that they subsequently abuse.

One priest has said 'we should not victimise the innocent unborn children' but what about the woman or girl who has already been victimised and is now to be punished, perhaps for the rest of her life? Kenya is in dire need of good leadership and the interference of interested parties, whether they be political, religious, commercial or whatever else, is frustrating this need. The country also needs good health care and equal rights for all people, regardless of gender, sexual orientation, tribe, wealth and anything else. But some of the Christian churches clearly have other ideas.

allvoices

Tuesday, December 1, 2009

The Aids Industry Sure Knows How to Blow its Own Trumpet

Yesterday was World Aids Day again and in Kenya you couldn't miss the copious amounts of advertising, bunting, leafleting, t-shirts, sun visors and other paraphernalia of the industry. High and not so high officials were out in strength to collect their per diem, without which, presumably, nothing important could happen. There were the mobile testing clinics in areas that already have static testing clinics and millions and millions of condoms distributed.

For all it's faults, the Aids industry has published some figures that certainly look good. Botswana, which has one of the worst HIV epidemics in the world, has the highest percentage in any African country of people on antiretroviral therapy (ART), the highest rates of HIV testing and the highest number of women on ART to prevent mother to child transmission (PMTCT). They also have the third highest percentage of children on ART.

Over several decades, the campaigns to recognise the rights of HIV positive people to receive treatment have been successful in a lot of countries. In many developing countries, a sizable percentage of HIV positive people in need of treatment are on treatment. In the West, very few babies born to HIV positive mothers are themselves HIV positive. Indeed, the percentage of HIV positive babies born to HIV positive mothers is declining in a number of developing countries too and should be relatively low by now in a country like Botswana, where such a high percentage of HIV positive mothers are receiving PMTCT.

But rights seem to be most commonly recognised for those who are already infected with HIV. If you read various developing country HIV strategic plans (which are curiously similar, despite the epidemics being very different in quality), you will notice that the word 'rights' is rarely used except in relation to HIV positive people, mainly in relation to access to treatment. The rights of those who are not yet HIV positive, and that's most people, are rarely mentioned. Yet they have a right to the things that will ensure that they remain HIV negative.

Of course, it is hard to quantify the effects of the various HIV prevention programmes that have been rolled out in Kenya and other African countryies. Most of them were run by wealthy organisations who could afford the 'research' and publicity that would make them look very successful. The reality is that very little is known about preventing HIV and, beneath the hype, few programmes have been truly successful.

I would be the first one to admit that the very idea of cutting HIV transmission is fraught with difficulties. Many things have been tried, some of them perhaps even well thought out. But in the end, there is very little money to be made out of prevention and therefore very little money put into it. Condom distribution is an exception, but where there is little or no health or science education, let alone sexual and reproductive health education, condoms haven't really taken off that well. You may have heard otherwise but there are good commercial reasons for that.

The problem with the majority of the prevention programmes that have received some of the relatively small amount of money that is available for HIV prevention is abstinence. Most programmes relied on the idea that if people would just abstain from sex, they would not be likely to be infected. The more liberal advocated abstinence until marriage, until it was noticed that more and more people are becoming infected by their spouse. But various programmes were cobbled together that, one way or another, advocated abstinence or what amounts to abstinence. People didn't abstain and most of them won't. This is not something peculiar about developing countries. Abstinence campaigns have failed where ever they have been tried.

The reason I mention the rights of people who are HIV negative is that many of them will, sooner or later, become infected with HIV because one or several of their rights are presently being denied. People, whether adults, children, male or female, have a right to health and a right to treatment when they are sick. Yet more people in Kenya and other developing countries are dying of easily treatable and curable diseases than are dying of Aids.

Children have a right to a decent education and part of that should include levels of health and science education that should give them the prerequisites to attain enough understanding of sex, sexuality and reproductive health to avoid becoming infected with HIV or other sexually transmitted diseases and to avoid unplanned pregnancies. In a word, people need education to lead healthy lives.

People have a right to a decent standard of living for themselves and their children, they have a right to adequate food and nutrition, they have a right to good standards of governance and security, water, sanitation, infrastructure and many other things. They have a right to a legal system that protects them from harm and persecution and the like. Women need to be given the same rights as men, in the workplace, in the economy, in education, in health and everywhere else. Men who have sex with men, intravenous drug users and commercial sex workers need their rights protected.

It is the denial of the sorts of rights mentioned above, along with various other rights, that leaves people vulnerable to becoming infected with HIV and suffering many other serious consequences. People in developing countries who are suffering from HIV now, and those who have died of it, were likely denied one or several of their rights. HIV is not transmitted in isolation from people's circumstances, from the conditions in which they live and work.

Those who are HIV positive and those who are HIV negative are equally entitled to their rights, though skewed funding for Aids would suggest that this is not the case. In order to avoid transmitting HIV to others and in order to remain HIV negative, everybody's rights need to be protected. In short, everyone is entitled to these rights and without them, the treatment and care programmes for people who are HIV positive will be, to a large extent, in vain; the half hearted prevention efforts will also be in vain.

Prevention has proved to be a slippery fish. But treatment and care for one disease in isolation from all the other things people can and do suffer from has also been less successful than it should have been. There is little point in treating one incurable disease and ignoring the many others that are more easily treatable and often even curable. But that is what's happening. The Aids industry is just too rich and powerful to allow people to know that.

allvoices

Tuesday, June 2, 2009

Why HIV Is Not Just About Sex

I am not denying that HIV is a sexually transmitted infection and that most infections in developing countries such as Kenya occur through heterosexual sex. I am denying that abstinence or even abstinence, faithfulness and condom use programmes (ABC) on their own will reduce HIV transmission to the extent that the virus will one day cease to be endemic.

ABC programmes on their own are not enough. They are not enough because some people do not get to choose whether to have sex or not, when, how often, with whom and under what circumstances. Even if they have some choices, they probably don’t have any say in the sexual behaviour of their sexual partner or partners.

As for using condoms, they are probably the most important factor in reducing HIV transmission. But people who don’t have a choice about the abstinence or faithfulness options are unlikely to have a choice about the use of condoms either.

My scepticism about the effectiveness of ABC programmes does not mean that I think nothing can be done to reduce HIV transmission. On the contrary, many things can be done and many things can improve the effectiveness of ABC programmes, too.

In no particular order, here are some things that are involved in the transmission of HIV that have little to do with sex:

A number of people I talked to in Nairobi said that they have applied for jobs but when it comes to the selection process, they either need to give money to the prospective employer or they need to have sex with them. Those already in jobs are sometimes expected to have sex with their boss in order to get promotion or even to get paid. The rights of the employed and the unemployed are being compromised here.

Marriage is often seen as a protection against HIV but many women don’t have much say in who they marry, nor do they have much influence over their husband’s sexual behaviour. In many instances in Kenya, the man is significantly older than the woman. Therefore he probably has more sexual experience, more power in the relationship and is more likely to be employed than the woman and consequently have more control over finances.

Where women are forced to have sex for some benefit, whether it is for money, gifts, security or anything else, they risk being treated as a criminal by the police. Men who expect sex in return for some benefit are not usually treated as criminals. Therefore, women are often unable to report cases of forced or coerced sex. Victims of sexual abuse are being treated as criminals.

HIV rates are often high in certain contexts, such as in border towns, around big industries and in slums. Border areas and industrial areas often have demographic imbalances, with huge numbers of single men. Slums grow (partly) as a result of people coming to urban areas to work but only finding very low paid jobs. Transactional sex also grows in such areas and, as a result of poverty and lack of social services, people are extremely vulnerable.

HIV prevention programmes that aim to influence sexual behaviour have not been very successful in reducing HIV transmission. But that’s because these programmes have not always addressed the contexts in which sexual behaviour occurs, the contexts that so often result in sex being unchosen and/or unsafe.

Kenyan law can’t guarantee everyone a job but it should be able to guarantee that people will not have to bribe someone with money or sex to get a job, to keep a job or to get promotion or better conditions. Women need better educational opportunities, their rights need to be protected, their dependents need support, they need to be able to inherit their husband’s property, they need to be able to refuse sex with a partner who has been having sex with other women; and the list goes on.

If the country can’t provide people, especially women, with adequate employment or social benefits, it has no right to criminalise what is for so many people a last resort; commercial sex work. Women and girls are forced into some kind of commercial sex work because of extreme poverty and desperation. This exposes them to numerous dangers, HIV being just one of them.

In order to protect people from HIV, other sexually transmitted infections, unplanned pregnancies, violence and exploitation, commercial sex work needs to be decriminalised. This is one of the most urgent steps that needs to be taken in Kenya and other countries with high HIV prevalence.

So reducing HIV transmission depends on changing laws, improving education, health and other social services, reducing inequalities, especially those relating to the law, education, employment and many other measures. Once these issues have been addressed the question of influencing people’s sexual behaviour seems relatively unimportant. When people are empowered and, where necessary, protected, they will take care of their own sexual behaviour.

So far, little has been achieved in the field of HIV prevention. A relatively small percentage of money spent on HIV goes towards prevention (as opposed to treatment and support for those infected and affected) but most of that has been wasted on programmes that don’t have any effect. And they will never have any effect until these several far more important issues are addressed.

In order to reduce sexual transmission of HIV it is not necessary to influence people’s sexual behaviour; they need to be empowered to the extent that they can choose the conditions under which they have sex, how often and with whom; they need adequate laws, education, health, infrastructure and social services. In other words, people need their basic human rights to be assured. If basic rights are assured, people will be better able to look after their own less basic rights.

allvoices

Wednesday, April 29, 2009

The Excesses of Globalization

The top three revenue earners in Kenya are tea, horticultural products and tourism. There is little interest in tourism after the 2008 post election violence, which has still to be resolved. Sales of horticultural products are depressed due to the global economic climate. And tea is a turbulent commodity; most plantations are owned by multinationals. It's not difficult to work out who benefits from the tea industry in Kenya.

In addition, most of the big players in Kenya in these sectors are foreign. They pay little or no tax; they employ as few people as possible; they pay them as little as possible. The country will never get rich from their top revenue earners because they are in the hands of people and organisations who are allowed to exploit the country for everything they can get, and are happy to do so.

The majority of people in these sectors are not permanently employed, are often part time and have little or no protection from their employers. You might expect the International Labour Organization's (ILO) 'World of Work Report, 2008' to give considerable coverage to Kenya and other African countries. But you'd be disappointed. There are mentions of African regions but there seems to be little data about most African countries. In the light of this lack of data, one may conclude that conditions in Africa are far worse than in other continents.

The report as a whole shows that income inequalities are increasing in most countries and have been doing so for nearly two decades. The conclusion is that the economic model that led to the current financial crisis is not sustainable and that balancing economic with social and environmental goals is vital to recovery, as well as to a reverse in the trend towards higher levels of inequality.

While a few, rich people, gained from the economic expansion preceding the current crisis, the majority did not get richer. Indeed, many became poorer. But it's that poor majority that must pay for the current financial rescue package. Those on high incomes have seen huge increases in their incomes. Those on low incomes have seen small increases or even decreases. Women in all countries, especially developing countries, are less likely to be employed and more likely to be employed on an informal basis. They also receive lower wages than men.

The ILO's report shows that financial globalization has played a major part in these increases in inequality. Unemployment has increased while productivity has decreased. Globalization has resulted in a significant increase in banking crises. The report argues that there is a need for regulation to limit the excesses of financial players and protect the vulnerable, who usually suffer the most when things go wrong.

The ILO also notes the issue of 'performance pay systems' for senior employees. This has resulted in large increases in executive pay that is not reflected in company performance. In 2007 in the US, executive pay in the top 15 firms was 500 times that of the average employee, compared to 360 times higher in 2003. Other countries experienced similar patters. The report suggests that executives are in a dominant bargaining position and the result is both an increase in inequality and a decrease in economic efficiency.

In contrast, the bargaining position of employees, trade unions and other labour institutions has weakened. There have been increases in part time and non permanent employment, which means lower pay. In addition, taxation has become less progressive, shifting the burden of tax from the richer sectors of the population towards the poorer. Redistribution and social protection are thus compromised.

The 'Decent Work Agenda' proposed by the ILO includes "well-designed labour regulations and social protection, and respect for basic workers’ rights" to achieve higher levels of employment and greater equality. They argue that, along with a reform of the financial architecture, this will contribute to a more balanced and sustainable economy. At the same time, it will help to address the social consequences of the current financial crisis.

The above suggests an opportunity for 'development by omission'. It is not acceptable for tax systems to move away from progressive forms of tax, ones that shift the burden from the poor to the rich. Nor is it acceptable for the highest paid individuals in a firm to have the power to award themselves ever increasing salaries and bonuses while the lowest paid get only small increases. The move towards less formal employment with the resulting drop in income only increases vulnerability. Big, private sector, employers have seen their profits swell for many years. The increase in profits has often been a result of cutting wage costs and this cannot continue indefinitely.

It's easy for employers to blame the economic slowdown, the rising cost of fuel, the food crisis and various other trends, but these labour trends have been worsening for a long time. They are inimical to both development and equality. The dogmatic claims for the benefits of globalization have not materialised. Employment has not increased as a result, it has decreased. Conditions have disimproved and there are rising levels of inequality.

Governments need to take into account the social consequences of globalisation, in addition to the economic consequences. This is especially true for governments of developing countries, such as Kenya. The government needs to keep an eye on employers who are increasing their executive pay, cutting employee pay and increasing their levels of temporary and part time employment. So far, they seem more interested in promoting the interests of employers, regardless of the costs to employees and the country as a whole.

The government need also to rebuild the health, education, social services, infrastructure and other public goods that have been allowed to decline for so long. Many Kenyans will not benefit directly from labour reform as most do not work in the formal sector. Any efforts at redistribution and redress needs to take this into account.

allvoices

Tuesday, March 31, 2009

Hate the Sinner, Love the Sin

Recently, a Kenyan friend of mine posted a question on Facebook the jist of which was 'if a promiscuous woman is called a whore, what is a promiscuous man called'? She got some facetious replies but it is a very important question. Why do we vilify women who sleep with men? There are many words for women seen as promiscuous but I can't think of any for men. There must be a lot of men who love sex but there must also be a lot who hate women. Could it really be common for men who love sex to also hate women? It seems likely.

A workshop in South Africa recently argued that "society's expectations and presentation of women makes them more vulnerable to catching sexually transmitted infections (STIs) and HIV". There appears to be a deficit of respect built into societies, languages and behaviours and it seems so self defeating. The workshop pointed to "the need for woman and girls to be empowered for them to make informed decisions when negotiating safe sex".

We (humanity) are facing a dangerous situation and it seems that several decades of HIV/AIDS has done little to change attitudes. Men are very often in a position to do things and talk about things that women are not able to do and talk about without censure. Men often say that there are things they find it difficult to talk about and they would never talk about them in front of women. Women, too, are expected to remain silent about certain things and to only discuss others with other women.

I have talked to people who run HIV prevention programmes and they often mention how the content needs to be different when the audience is young or female. It's true that the content needs to be produced with a particular audience in mind. But maybe there is also a place for discussion between males and females. Perhaps it would be enlightening if men were to get to know what women think and if women were to get to know what men think, especially what men think about women and sex, for example.

Why is it more shocking to hear a woman swear or to see a woman drinking or spending time in a bar or, god forbid, time in a bar with men? Men go to bars to hang out with their friends, to drink and to meet women. If they think the women they meet in bars are 'whores', why don't they stop going to the bars and go to church halls instead? Or perhaps they could persuade their 'nice' female friends to go to the bar with them. But that would take us back to square one because women who go to bars are just not nice, apparently.

The workshops also argued that “[i]n the rural set up mostly, women who [negotiate] for safe sex are viewed as promiscuous and wayward”. It's sensible for anyone to insist on safe sex, whether they are male or female. There is something wrong already if the woman has to negotiate. The fact that she is considered promiscuous or wayward is almost laughable, especially considering the reasons why she might feel the need to negotiate; perhaps she knows that a lot of men are happy to have sex without a condom.

People here, male and female, often tell me that women are not supposed to be forward, they are not supposed to make the first move. Men see women who ignore this code of conduct as objects of suspicion and even as in some way evil. Is there something inherently about men that makes them better at making decisions that relate to friendship and sexual relationships? I don’t think so, but perhaps I’m just lacking in some way.

When it comes to negotiating about or even discussing sex, there is a need for greater levels of mutual respect and equality. People are people, gender is not a species. This needs to start in classrooms and among young people. So, if people object to teaching children about sex and safe sex, the least they could do is teach about equality and respect.

A person who has sex with other people is just a person. A person who has sex with lots of other people is also just a person, though they need to exercise a lot of care, as do the people they sleep with. But a sizeable majority of women who have sex, do so with men. It’s not as if there is a small group (or large group) of people who, in some way, are responsible for all the illicit sex in the world.

Quite frankly, if I was a woman, I would be called a whore. I go to bars, I meet women, I’ve even had the temerity to sleep with some women. But as a man, calling me a whore just doesn’t have the same import. And I don’t think the solution is to find an equivalent term for men to right the balance. I think it would be preferable to see sex as something that occurs between people, male and female.

allvoices