Archive for September, 2009

Women of Ethiopia Part II: Escaping Child Marriage

Posted on September 30, 2009, by Hanna Ingber, under International, Uncategorized, women.

Cross-posted on the HuffPost here. Make sure to go to the HuffPost for the photos that go with this piece.

Editor’s note: Hanna Ingber Win, the Huffington Post’s World Editor, was recently invited by the UN Population Fund to visit its maternal health programs in Ethiopia, which has one of the world’s worst health care systems. In the U.S., a woman has a 1 in 4,800 chance of dying from complications due to pregnancy or childbirth in her lifetime. In Ethiopia, a woman has a 1 in 27 chance of dying.

This is the second of a five-part series on what she learned on her trip.

ADDIS ABABA, Ethiopia — The first time Tadu Gelana’s mother suggested she get married, Tadu thought she was kidding. Only 14 years old, Tadu had not yet finished school or had her first menstruation cycle. Tadu laughed at the suggestion. The second time her mother mentioned it, Tadu told her she wasn’t interested.

Her mother did not relent.

Tadu’s brother, who was about twice her age and had taken care of her for many years, had recently passed away. Tadu felt she should be grieving for the loss of her big brother, not preparing for a joyous wedding ceremony.

“My beloved brother died at that time, and I had that sorrow in me,” she says, wiping away tears. “I was very much against [getting married]. I wanted to continue my education with my friends.”

Tadu, wearing a grey hooded sweatshirt and black T-shirt, looks like a typical teenager. Her braided hair is pulled back into a bun and small shiny earrings add a sparkle to her face. She tells me her story as we sit in Biruh Tesfa (”Bright Future”), an informal school for runaway girls in Ethiopia’s capital, Addis Ababa. The school receives funding from the UN Population Fund (UNFPA), which has sponsored my trip, is operated by the Ethiopian government and gets technical support from an international non-governmental organization called Population Council.

Tadu never formally met the man whom she was assigned to marry but she saw him in her small town in central Ethiopia. He was tall with brown skin. She does not know how old he was - only that he was “an adult.”

“When I was alone, I was afraid of him,” she says. “When I was with other girls, they protected me. We all laughed at him.”

Tadu solicited her uncle to try to convince her mother to let her stay in school and not get married. Her mother agreed. But after Tadu’s uncle left, her mother again demanded that Tadu get married.

“My mother told me, ‘Either you have to marry, or you leave this house,’ ” she says, as she stares down at the school’s metal desk.

Tadu decided to leave her mother, friends and school and move from Ambo to Addis with her aunt and uncle. Her aunt found her a job as a domestic worker with her neighbor. Tadu, now 16, lives with her employer and spends her days cleaning the house, washing clothes and dishes and cooking for the family.

I ask Tadu about her friends in Addis and what they do for fun. I try to get her to smile and laugh like other girls her age, but she does not. She maintains a solemn look, staring down at her hands or the desk, quietly answering my questions.

For a few hours every day, the family allows Tadu to go to Biruh Tesfa, where we meet one morning in late August. Two centers in Addis serve about 600 girls between the ages of 10 and 19, says Habtamu Demele, the project coordinator of the center.

Most of them have escaped early marriage. Even though the legal age to marry in Ethiopia is 18, more than 30 percent of girls living in rural parts of the country are married by age 15, according to the Population Council. In Amhara region, where most of the girls at the center come from, almost half of the girls have married by age 15 and close to two-thirds by age 18. Ethiopia ranks among the top 10 countries for child marriage, according to the International Center for Research on Women’s analysis of the country’s Demographic and Health Survey data.

Families marry their daughters early due to cultural beliefs and practices related to attempting to keep a girl’s chastity, ensuring a young bride’s obedience and subservience, maximizing childbearing years and enhancing a family’s status, according to UNFPA.

Early marriage can cause higher rates of maternal and infant mortality, vulnerability to HIV/AIDS, abuse, isolation and long-term psychological trauma from forced sex, according to UNFPA.

Girls aged 15 to 20 are twice as likely to die during childbirth as women in their 20s and girls under the age of 15 are five times more likely to die of maternal causes, according to UNFPA. This is because girls’ bodies are often too young and undeveloped to endure child birth. When a girl gives birth before her body is fully developed, she often has difficulty during labor and a higher chance of developing a maternal complication such as hemorrhaging or obstetric fistula. (See tomorrow’s installment of this series on battling obstetric fistulas in Ethiopia.)

A 2005 UN Children’s Fund (UNICEF) report on child marriage also found that girls who marry young have a much higher chance of being victims of domestic violence.

The majority of the girls at the Biruh Tesfa center fled their rural villages, took a bus to Addis and got off at a bustling, chaotic station close to the program site. They arrived in Addis alone without access to services or support, says Habtamu.

“These girls are the invisibles. No program is covering them,” he says.

So-called brokers found the girls at the bus station and got them jobs as domestic workers for low-income Ethiopian families in Addis. They often work under demeaning and difficult conditions, with no time to go to school or make friends.

The Biruh Tesfa project employs mentors, young women who come from the community, to go to the homes where the girls work and convince their employers to let them participate in the program.

Aynalem Kibebew, 25, lives in a tiny house made of corrugated metal across the street from the center and serves as a mentor for about 30 of the girls. Since the employers often do not allow the girls to attend school, the mentors like Kibebew provide them with informal education for an hour or two every day at the center. They also teach the girls life skills like reproductive health, HIV education and hygiene. Once the girls finish the program, they are eligible to enter formal school in the fourth grade, Habtamu says.

Another girl at the center, Kelemua Wondimu, says she fled her village in Amhara region to Addis when she was 17 because she too did not want to get married. She had seen what happened to her older sister and did not want that life for herself.

When her sister turned 15, Kelemua says, her parents prepared a wedding ceremony and made her marry a man she had never met. She then had a baby within a year.

“I saw that and decided not to marry at that age,” Kelemua says, clutching her notebook as she sits at a desk in one of the center’s classrooms. Charts teaching numbers and punctuation marks cover the walls. “Instead, it is better to continue my education and learn more.”

Tomorrow: Battling pregnancy complications in Ethiopia

Read the first installment here.

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Women of Ethiopia PART I: Zemzem’s Journey

Posted on September 29, 2009, by Hanna Ingber, under International, women.

My five-part series on maternal health in Ethiopia for the HuffPost started today.  Make sure to go to HuffPost for the photos that go with the piece.

Cross-posted on the HuffPost here.

Editor’s note: Hanna Ingber Win, the Huffington Post’s World Editor, was recently invited by the UN Population Fund to visit its maternal health programs in Ethiopia, which has one of the world’s worst health care systems. In the U.S., a woman has a 1 in 4,800 chance of dying from complications due to pregnancy or childbirth in her lifetime. In Ethiopia, a woman has a 1 in 27 chance of dying.

This is the first in a five-part series on what she learned on her trip.

JIMMA, Ethiopia — When Zemzem Moustafa went into labor with her fifth child - at age 30 - she could sense a problem. Living in a thatched-roof hut in Ilebabo, a rural village in western Ethiopia, she and her husband walked to the local health post. A health extension worker there could tell that the baby was in the wrong position, but the worker could not help Zemzem and referred her to the hospital. And so Zemzem’s journey began, one that ends in tragedy for thousands of women in Ethiopia each year.

She and her husband, a poor farmer, collected 50 birr (US$4) from their neighbors for the trip to a hospital in Jimma, the closest big town. Leaving at around 4 p.m. on a Friday afternoon, they walked through the fields for an hour until they arrived at a road. Standing at the side of the road, they hailed a rickety old minibus packed with other villagers.

August is the rainy season in western Ethiopia and the minibus got stuck in the mud. Zemzem, whose contractions became more and more intense, spent the night on the side of the road with her husband and the other passengers. The next morning the men freed the minibus from the mud and the trip continued.

Zemzem and her husband reached Jimma at noon on Saturday, a full 20 hours after the trip began. They drove down the dirt road that runs through the center of the town, past the young boys herding sheep, the donkeys with bushels of hay strapped to their backs and the women sitting on the side of the road selling vegetables.

By the time Zemzem arrived at Jimma Referral Hospital, her uterus had partially ruptured as a result of the prolonged labor. A gyno/obs resident and a health officer operated on her immediately, and they successfully saved the lives of Zemzem and her baby.

“If she [had been delayed] two or three hours more, the baby - and even the mother - would have lost her life,” Dr. Chuchu Girma, a surgeon and the clinical director of the hospital, tells me as we chat with Zemzem in the maternity ward.

Maternal health specialists say that there are three ways in which necessary treatment is delayed: when the mother or family first decides to seek appropriate medical care for an obstetric emergency, as the family tries to take the woman to a hospital and faces transportation impediments and once the woman reaches the health institution and faces setbacks in being admitted and getting medical attention.

I am visiting the Jimma Referral Hospital as part of a trip sponsored by the UN Population Fund (UNFPA), which provides support for the government’s program to train non-physician clinicians to perform procedures, such as obstetric surgery, traditionally performed by doctors. The health officer who operated on Zemzem is being trained to become one of these non-physician clinicians.

Zemzem is lying on an old metal bed with the paint chipping off, under a heavy blanket that looks itchy and dirty. A used surgeon’s glove is tied to the bedpost. The sheet has fallen down, exposing a thin plastic mattress.

When I enter the maternity ward at Jimma Hospital, the stench practically smacks me in the face. The smell, a combination of urine and feces and other bodily fluids, overpowers all my other senses.

Each room along the maternity ward has a sign posted above the door in English and Oromiffa, the local language: “Labor Room”, “High Risk Room”, “Delivery Room”. Zemzem stays in “Septic Room.” The Septic Room houses women who have had pregnancy complications like ruptured uteri and fistulas that involve extra discharge.

When Dr. Chuchu and I enter the Septic Room, Zemzem is lying flat on the bed with her baby under the blanket. I ask about the baby, and Zemzem’s face lights up. She pulls the blanket back to reveal her newborn. I ask if the baby is a girl or a boy, and Zemzem, saying he is a boy, smiles and laughs.

“They are very happy when they get men,” Dr. Chuchu says to me.

Zemzem has remained at the hospital for three weeks because she has an infection. Dr. Chuchu lifts up Zemzem’s gown to reveal a large white bandage from the surgery.

Her husband has returned to her village to take care of the other four children, a medical intern says, translating Zemzem’s answers in Oromiffa, the local language, into the national language, Amharic, for Dr. Chuchu, who translates into English for me.

The hospital treats girls as young as 10 or 11 who have ruptured uteri, Dr. Chuchu says. The girls’ families force them to marry at an early age, and they then get pregnant before their bodies fully develop. This increases the likelihood that they will have obstructed labor. A ruptured uterus is a very simple, manageable problem, he says. But the girls or young women, living in rural villages, usually give birth at home and lack access to a health professional during delivery — like 94 percent of Ethiopian mothers.

Without help during delivery and without surgery and a blood transfusion if the mother’s uterus ruptures, the girl or woman often dies. In the United States, eight women die during childbirth for every 100,000 live births, according to the UN Children’s Fund (UNICEF). In Ethiopia, 673 women die, making the maternal mortality rate 84 times higher. UNFPA considers every single maternal death preventable.

Zemzem’s other children range in age from 2 to 12, the intern translates as he gently pulls down her gown to cover up her back.

I bring out my camera, and Zemzem smiles glowingly at her new son.

No one else in the “Septic Room” can empathize with Zemzem’s joy. The other three patients all had fully ruptured uteri and lost their babies.

Dr. Chuchu and I stand next the bed of another patient. The blanket engulfs her tiny body, so small it looks like it belongs to a child. An intravenous drip stands next to the bed, pumping antibiotics into the young woman. Dr. Chuchu looks at her chart — she has lost almost two-thirds of her blood during her operation and now waits for a blood transfusion. He pulls down one of her lower eyelids. The entire eye is white, not a trace of red veins.

“This is a case [where the mother] usually dies,” Dr. Chuchu says. If she had been at a rural health post or health center, she would not have had access to a surgeon or to equipment necessary for a blood transfusion.

The woman looks so vulnerable that I whisper in Dr. Chuchu’s ear, asking if he thinks she will make it. Yes, she will survive, he says. She will get blood here.

Dr. Chuchu asks the patient where she comes from, but she is too weak to answer. He looks at her chart. She comes from Gatera, 112 kilometers from Jimma. She is 22 years old and has been pregnant four times. This is the third child she has lost. When she arrived at the hospital, her uterus had already ruptured. She therefore lost the baby and had to have her uterus removed.

If she is Muslim, her husband will take another wife to have more children, Dr. Chuchu tells me. He checks her chart. “Oh, she’s Muslim,” he says. “He will definitely have another wife.”

Part II: Escaping Child Marriage in Ethiopia

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Queen Noor: ” “We Are Reaching A Nuclear Tipping Point”

Posted on September 24, 2009, by Hanna Ingber, under International.

I interviewed Queen Noor of Jordan about her work promoting nuclear non-proliferation and today’s UN Security Council meeting for the HuffPost. Here it is:

As President Obama prepares to push the UN Security Council to adopt a resolution on nuclear non-proliferation on Thursday, Queen Noor of Jordan and a group of international political and military leaders have mobilized forces to drum up political and grassroots support for the measure.

“I personally believe that the two most urgent issues facing us today are climate change and nuclear proliferation,” Queen Noor told the Huffington Post. “I have children and grandchildren and see — as do these former leaders, defense ministers, security leaders and military commanders from around the world — that we are reaching a nuclear tipping point. And if we don’t pull back now … we may reach the point of no return.”

Continue reading here.

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