September 04

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Aeroplanes- the modern day storks that deliver babies

Aeroplanes- the modern day storks that deliver babies- Why sexual and reproductive health rights and education are important?

Where do babies come from? Many Tanzanian parents when questioned tell their children that aeroplanes bring babies to parents. Around 50% of births in Tanzania still occur at home and when a child is being born, the other children are sent to neighboring villages to procure household items. By the time they are back, lo and behold their sibling has arrived, dropped off by an aeroplane. Silly as it sounds, most of us can remember those awkward responses we’ve received while growing up about the birds and the bees. Talking about sex, sexual rights and contraceptives is still considered a taboo in many parts of the world. I remember my sex ED class in school being mostly useless considering it was a re-hash of introductory biology. Dissemination of varied or vague sexual education is not reserved solely for developing countries. Recently I saw a show on HBO-Last week tonight with John Oliver which highlighted the gaps in sex ED the way it is currently being taught across schools in the United States of America. According to the reports, sex education being disseminated varied among the different states and even school districts and many programs were either inadequate or peppered with messages of abstinence.
Sexual and reproductive health rights and education (SRHR) is an important pillar of fundamental human rights which empowers people to make informed decisions about their health, safety and well-being. Apart from dealing with high HIV prevalence (1.5 million new infections in 2013*), sub-Saharan Africa also has to deal with poor SRHR status, including the lowest contraceptive prevalence rate in the world (around 30% in 2013^), unmet need for family planning (24% women wanted to delay or avoid pregnancy in 2015, but had no access to contraception*) and the highest teenage (15–19 years) pregnancy rate in the world (116 births per 1000 girls in 2015*).

Tanzania was one of the first countries in this region to implement SRHR policies and youth friendly services. But despite their efforts, vulnerable youth is often missed out on which is why organizations like African Medical Research Foundation (Amref) target the at-risk and vulnerable population. I had a glimpse of the work being done with vulnerable youth (defined in this context as girls working in brothel’s, domestic workers, youth working in bars, victims of trafficking, victims of gender based violence, orphans and out-of-school youth) on SRHR education by Amref along with two centers KIOTA Women and health development organization and International Youth Development Program (IYDP) in Dar es Salaam, Tanzania. Both the centers deal with the dissemination of SRHR services to vulnerable youth which includes conducting psycho-social counseling, handing out contraceptives, advocating on sexual rights, family planning, the importance of consent and conducting testing of HIV/AIDS and other sexually transmitted diseases (STDs). They also focus on vocational training, entrepreneurship, income generating activities (IGAs) and micro financing for the youth. This way, they are kept busy and have alternative sources of income (instead of working in brothels/bars).

Youth friendly services are also a recurring theme while dealing with SRHR and it was evident that these centers also focused on the same. Youth friendly services means a one-stop shop where youth (World Health Organization defines youth as those aged between 10-24 years) can avail all services of SRHR with complete anonymity without discrimination and with gender-sensitivity. To this effect, both the centers are run with the help of peer educators who are youth themselves. The peer educators are trained by Amref and are advocates of SRHR education among their peers. Some of these peer educators had very interesting stories to share:
One of them had had sexual relations with a woman who was HIV+ and known by the community to be so, however, he was not warned. When he realized the possibility of contracting HIV, he came to the center to get tested (he had not contracted the virus) and realized the importance of SRHR and decided to become a peer educator.
Another peer educator was brought to the city by her uncle with promise of enrollment in school. However, once she arrived, she was forced into domestic labor. When she heard of the center running SRHR education she wanted to visit but was not allowed to do so by her guardians. One day while selling water, she got an opportunity to get away and come to the center which counseled and trained her on becoming a peer educator. After becoming a peer educator, she was able to rescue one of her friend who was also forced into domestic labor.
Another peer educator was an orphan who used to beg on the streets and was involved in risky behavior. But after the training he now lives in a house and runs a small business which was micro-financed by IYDP.
Of course, progress does not happen without its fair share of roadblocks and tribulations. It was no easy task getting the government to allocate 21 million Tanzanian shillings for SRHR in their budget from the previous budget of 0 TZ shillings. Some municipalities are still not on-board either due to lack of funds or interest. Talking to the directors in both the centers, it was evident that they faced similar challenges: During advocacy, it was very important to go through the right channel and receive the backing of each channel before moving on to the next. The channel goes something like this: Regional-District-Ward-Streets-Community leaders. Talking to the heads of each channel was imperative yet cumbersome because of the different points of view on a topic as sensitive as SRHR. Also, it was the NGOs responsibility to fund the meetings with the representatives of the government and each of them have their own rates (transportation, food etc.,). Another issue was advocating to religious entities like mosques and churches where religious leaders were not always open to dissemination of sexual education to the youth under their faith. After a lot of back and forth, the institutes negotiated with the mosques and churches to nominate peer educators of their choice to receive training’s from Amref on SRHR. The curriculum was also modified keeping religious sentiments in mind without compromising on the message. Currently, the peer educators conduct small group discussions and distribute leaflets at mosques and churches.
Overall, it was a very fruitful visit and I learnt that over 10,000 youth were targeted overall by both the centers. It was important to note that Amref’s work with these two centers were ending in 2015 and as we get close to the end of 2015, we also get closer to the deadline of meeting the millennium development goals (MDGs). Sub-Saharan Africa has made great strides in achieving MDGs 5 and 6, i.e Improve maternal health (maternal mortality ratio declined by 49% in sub-Saharan Africa over the past two decades*) and combat HIV/AIDS (new infections per 100 people aged 15–49, dropping from 0.68 in 2001 to 0.29 in 2013, a decline of more than 50%*). But the progress has been slow and uneven among the different countries, between the urban and rural population, between different genders and between people of different economic strata. As the world gears up to address the sustainable development goals (SDGs) 2015-2030 (I shall talk about this in my next blog), it will be interesting to see how the SDGs manages to tackle some of the unfinished business of MDGs, particularly in the area of SRHR.

*United Nations Millennium Development goals report 2015 Accessed at: http://www.un.org/millenniumgoals/2015_MDG_Report/pdf/backgrounders/MDG%202015%20PR%20Bg%20SSA.pdf
^ United Nations Population division –World Contraceptive Patterns 2013 Accessed at: http://www.un.org/en/development/desa/population/publications/pdf/family/worldContraceptivePatternsWallChart2013.pdf
If you want more information on:
SDGs: https://sustainabledevelopment.un.org/post2015/transformingourworld
KIOTO Women and Health Development Organization: http://www.kiwohede.org/

KIOTO Women Health and Development Organization

KIOTO Women Health and Development Organization

Buguruni, low income area of Dar es salaam, where the roads were not tarred and with open drains on both the sides

Buguruni, a low-income area of Dar es salaam where KIOTO is based. It was clearly distinct from other areas of Dar- the roads  here were not tarred and had open drains on both the sides.

Leaflets and educational material to hand out to the youth attending KIOTO

Leaflets and educational material used for awareness at KIOTO.

Materials used to talk about contraception

The director at KIOTO showing us some of the materials used to talk about contraception.

Lab for conducting HIV/AIDS testing at KIOTO-Currently in Tanzania, there is a sever shortage of HIV rapid testing kits. I saw this in reality at the centre where they did not have kits and had to send back many who came for testing.

Lab for conducting HIV/AIDS testing at KIOTO- Currently in Tanzania, there is a severe shortage of HIV rapid testing kits. I saw this in reality at the center where they did not have the kits and were trying to procure the kits for many weeks.

Hand made jewelry by the youth at the center

Hand made jewelry and clothes by the youth at the KIOTO center.

A poster about sexual abuse- It gives out a stron message, let us work together to help victims of abuse by putting a face to the abusers (you can notice that only the hands of the abusers are seen in this poster, indicating that many times they remain invisible)

A poster about sexual abuse- It gives out a strong message, let us work together to help victims of abuse by putting a face to the abusers (you can notice that only the hands of the abusers are seen in this poster, indicating that many times they remain invisible).

Vocational training center at KIOTO

Vocational training center at KIOTO

Briskets- Handmade by the youth at IYDP. These are made out of plant based waste, rice husk and saw dust. CO2 is removed from this mixture, made into porridge like constituency by using cassava flower as a binding agent, dried in the sun and packed. It is used instead of charcoal and is smoke free and good for the environment.

Briskets- Handmade by the youth at IYDP. These are made out of plant based waste, rice husk and saw dust. CO2 is removed from this mixture, made into porridge like constituency by using cassava flower as a binding agent, dried in the sun and packed. It is used instead of charcoal and is smoke free and good for the environment.

Hand crafting jewelry at IYDP

Hand crafting jewelry at IYDP

Paintings made by some of the youth at IYDP

Paintings made by some of the youth at IYDP

Glass bottles recycled to make mugs at IYDP

Glass bottles recycled to make mugs at IYDP

Along with the director of IYDP looking at the handmade products

Along with the director of IYDP looking at the handmade products.

With the staff and peer educators at IYDP

With the staff and peer educators at IYDP

Outside the IYDP

Apart from advocacy and counseling, the centers organize football tournaments for boys and girls. Before the tournament begins, SRHR education is imparted along with leaflets. Sadly, due to lack of funds they cannot award prizes for winners and the football used is made out of torn cloth and plastic bags wrapped around tightly.

With some of the peer educators at KIOTO

With some of the peer educators at KIOTO

A peer educator

Posing for the cameras- their enthusiasm was infectious

They sure did love to pose for the cameras

They sure did love to pose for the cameras