women in cri­sis

Sex­ual and re­pro­duc­tive health is­sues are a harsh re­al­ity of cri­sis-struck so­ci­eties.

The Star Malaysia - Star2 - - FASHION - By SHARMILLA GANE­SAN

Sex­ual and re­pro­duc­tive health is­sues are a harsh re­al­ity of cri­sis-struck so­ci­eties.

ANA­TIONAL cri­sis like the flash floods in Pak­istan last month will nat­u­rally thrust a coun­try into the in­ter­na­tional spot­light. As na­tions around the world start fundrais­ing cam­paigns and hu­man­i­tar­ian aid agen­cies move in to help mit­i­gate the dis­as­trous con­se­quences, hope­fully the prob­lems can be al­le­vi­ated with min­i­mum im­pact on the peo­ple.

Hid­den away from the glare of the pub­lic eye, how­ever, is an is­sue that af­flicts thou­sands of peo­ple in post-dis­as­ter sit­u­a­tions: sex­ual and re­pro­duc­tive health (SRH). Women in these ar­eas of­ten lack the most ba­sic ne­ces­si­ties that the rest of us take for granted.

From not hav­ing san­i­tary nap­kins or ad­e­quate birthing fa­cil­i­ties, to rape and sex­ual ex­ploita­tion, and get­ting preg­nant when they don’t want to or con­tract­ing sex­u­ally-trans­mit­ted in­fec­tions, the chal­lenges for women in post-dis­as­ter sit­u­a­tions are con­stant.

While such con­cerns may not seem press­ing, par­tic­u­larly in re­gions al­ready suf­fer­ing from star­va­tion and dis­place­ment, SRH-re­lated is­sues are a harsh re­al­ity of cri­sis-struck so­ci­eties. Yet, it is an area that still does not re­ceive the at­ten­tion it de­serves from aid agen­cies or donors.

Lo­cal ac­tivist Nabila Nasir, 25, first had her eyes opened to the is­sues sur­round­ing SRH in post-dis­as­ter sit­u­a­tions when she vol­un­teered in Acheh af­ter the tsunami in 2004, and again, in Jog­jakarta af­ter the earth­quake in 2006. She found that women kept talk­ing to her Cham­pi­oning SARA is cur­rently fundrais­ing to help vic­tims of the flash floods in Pak­istan. about SRH is­sues. She re­alised that while these were very real prob­lems, the women didn’t feel like they could speak openly about them.

The is­sues en­com­pass four main ar­eas, namely, fam­ily plan­ning, ma­ter­nal and child health, sex­u­ally-trans­mit­ted in­fec­tions and gen­der-based vi­o­lence, in­clud­ing sex­ual vi­o­lence. Among these con­cerns, in­ter­na­tional or­gan­i­sa­tions have iden­ti­fied three main pri­or­ity in­ter­ven­tions: pre­vent­ing sex­ual vi­o­lence and pro­vid­ing med­i­cal care af­ter­wards; care for preg­nant women, es­pe­cially emer­gency ob­stet­ric care; and pre­ven­tion of HIV in­fec­tions.

Hence, when the Pak­istan floods oc­curred, Nabila’s im­me­di­ate re­ac­tion was to pro­vide aid that fo­cused on SRH. With that in mind, she formed Cham­pi­oning SARA (SARA stands for Sex­ual And Re­pro­duc­tive health Aware­ness), a fundrais­ing plat­form that also ad­vo­cates the in­te­gra­tion of SRH aware­ness into health­care, med­i­cal and aid items sent to post-dis­as­ter and con­flict sit­u­a­tions.

“I wanted to show that you don’t have to work in the United Na­tions or have a de­gree in pub­lic pol­icy to do some­thing about a sit­u­a­tion like this,” ex­plains Nabila. “And since not a lot of peo­ple wanted to talk about (SRH), I thought I would.”

Be­sides writ­ing to Malaysian re­sponse agen­cies and cre­at­ing pub­lic aware­ness, Cham­pi­oning SARA is cur­rently fundrais­ing for money, drugs and sup­plies to as­sem­ble 10,000 clean de­liv­ery kits, 5,000 fe­male hy­giene kits and 5,000 male hy­giene kits. Other items needed in­clude soap, san­i­tary pads, hand tow­els, tooth­brushes and tooth­paste.

Nabila is hop­ing multi­na­tional com­pa­nies and man­u­fac­tur­ers will step for­ward to do­nate the nec­es­sary items; so far, Durex has con­trib­uted 20,000 con­doms, while Cran­berry Malaysia pro­vided 10,000 med­i­cal la­tex gloves.

She re­alised, how­ever, that high­light­ing these is­sues was fraught with chal­lenges, es­pe­cially since many peo­ple don’t un­der­stand the im­por­tance of deal­ing with SRH con­cerns.

“I’ve re­ceived back­lash from peo­ple who ask me why I’m send­ing the flood vic­tims san­i­tary nap­kins and con­doms when they lack food and med­i­cal care. What peo­ple need to un­der­stand is that SRH is­sues en­com­pass much more than that. It’s also about em­pow­er­ing women to take charge of their own bod­ies, and about teach­ing them how to pro­tect them­selves,” Nabila ex­plains.

The lack of sup­port and un­der­stand­ing stems from the fact that peo­ple gen­er­ally do not wit­ness the prob­lems as­so­ci­ated with SRH. In­ter­na­tional Planned Par­ent­hood Fed­er­a­tion’s (East, South-East Asia and Ocea­nia Re­gion) sex­ual and re­pro­duc­tive health in emer­gen­cies ad­viser Sarah Chynoweth, 33, ex­plains that many of the is­sues are “be­hind the scenes”.

“The rea­son for the lack of sup­port and ac­tion is that you don’t see it. Un­like star­va­tion, in­juries and home­less­ness, con­cerns like child­birth, rape and HIV in­fec­tions are not out in the open. Plus, it’s such a sen­si­tive is­sue; most women won’t come out and say, ‘I was raped,’ or ‘I don’t want to be preg­nant’,” she says.

She ex­plains, how­ever, that SRH-re­lated prob­lems in­crease dur­ing crises, while ac­cess to so­lu­tions be­comes more dif­fi­cult. And, SRH is­sues are the lead­ing cause of death for women around the world.

“Any time there is a dis­rup­tion in the so­cial fab­ric (such as dur­ing a nat­u­ral dis­as­ter), sex­ual vi­o­lence in­creases. Women get preg­nant when they don’t want to and can’t af­ford to be. They may be forced to sell their bod­ies for food or sup­plies be­cause they’ve lost ev­ery­thing.

“The to­tal vul­ner­a­bil­ity of peo­ple in a sit­u­a­tion like this is hard to un­der­stand,” Chynoweth says.

She adds that cul­tural ta­boos make the topic a dif­fi­cult one to broach, both to the af­fected com­mu­nity and po­ten­tial donors.

“Con­doms, for ex­am­ple, can be con­tro­ver­sial, even though women may not want to get preg­nant in the mid­dle of the cri­sis, and need to pro­tect them­selves from sex­u­ally-trans­mit­ted in­fec­tions. You will even hear peo­ple say, ‘ We can’t deal with rape right now.’ But then, when should it be dealt with?” as­serts Chynoweth, who has been work­ing with re­pro­duc­tive health in emer­gen­cies for seven years.

She ex­plains that SRH is of­ten not part of emer­gency re­sponse teams’ train­ing, and is usu­ally seen as “women’s is­sue”.

“What we’re try­ing to show is that SRH is not sep­a­rate; it should be part of the ba­sic health­care in­ter­ven­tion. If you are a health­care provider, you need to pro­vide these ser­vices,” she says.

Nabila and Chynoweth both point out that peo­ple from ev­ery sec­tor of emer­gency re­sponse need to be in­volved in deal­ing with SRH is­sues – even sim­ple el­e­ments can make a big dif­fer­ence in women’s pro­tec­tion.

Sep­a­rate shower stalls for men and women, for ex­am­ple, can help pre­vent sex­ual mo­lesta­tion; yet, many camps for dis­as­ter vic­tims don’t have sep­a­rate shower fa­cil­i­ties. Proper light­ing in all ar­eas, which is lack­ing in many camps, is an­other sim­ple step to pro­vide pro­tec­tion for women.

Chynoweth points out that aid agen­cies should also think about po­ten­tial ex­ploita­tion when it comes to dis­tribut­ing food.

“Agen­cies of­ten give food in re­ally big bags, which women can’t carry. So men take it in­stead, which gives (them) the power to ex­ploit women in re­turn for the food,” she says. “Reg­is­tra­tion cards for ra­tions are also usu­ally given to the head of the fam­ily, who is usu­ally a man. This, too, is open to abuse.”

Hav­ing women dis­tribut­ing aid would be one way to stem the prob­lem. She also sug­gests that ev­ery adult be given a ra­tion card. An­other dan­ger is when food ra­tions don’t in­clude fuel for cook­ing. Women are forced to then for­age for brush or wood away from their liv­ing ar­eas, which puts them at risk of rape.

Cul­tural norms also need to be con­sid­ered when it comes to pro­vid­ing so­lu­tions. In Pak­istan, for ex­am­ple, the ma­jor­ity of women only go to fe­male health­care work­ers for treat­ment. There­fore, even if there was a qual­i­fied male gy­nae­col­o­gist present, the women wouldn’t seek treat­ment from him.

“SRH is a hu­man rights is­sue that needs to be in­cor­po­rated across the board into all stan­dards of emer­gency re­sponse. It’s not just a women’s is­sue, it’s a com­mu­nity is­sue,” says Chynoweth.

She also lauds Nabila’s ef­forts with Cham­pi­oning SARA, call­ing it a woman-towoman ap­proach.

“It’s es­sen­tial to talk to the women to know the best ways to ac­cess and en­gage them. If not, it is likely that the ef­forts will fail. That is what is so great about Cham­pi­oning SARA: it is about the av­er­age Malaysian woman help­ing the av­er­age Pak­istani woman,” she con­cludes.

Nabila Nasir

Sarah Chynoweth n Cham­pi­oning SARA is rais­ing funds till the end of the month. For de­tails, e-mail cham­pion in­gsara@gmail.com, nabila.csara@gmail.com or visit cham­pi­oningsara.word­press.com.

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