Last fortnight, officials at a hostel in Bhuj checked residents so those who had their periods could be isolated. Such attitudes perpetuate gender inequalities.
Menstruation is a natural and essential part of a woman’s reproductive cycle. Without it, men, boys, women, girls would not exist. Yet, it is surrounded by myths, misconceptions and taboo.
Stigma related to menstruation reinforces discrimination and perpetuates gender inequalities. And while we know that these attitudes still prevail in some homes and communities, it is shocking to learn that educational institutions and leaders – those that are expected to bearers of light – still adopt extreme forms of shaming and blaming.
A United Nations Population Fund-commissioned photo essay in 2017 on girls’ experiences around menarche, the first occurrence of menstruation, revealed harmful practices girls are subjected to in many parts of India: Prohibition from entering the kitchen or the prayer room, being made to stay outside the house, being forced to eat in separate utensils, or not being allowed to touch certain kinds of food because they could get spoilt. These social norms isolate girls from friends and family, in turn impacting their reproductive and mental health.
Girls start considering themselves to be “impure” and “unclean” during their periods. And their trauma doesn’t end there: inadequate access to clean water, sanitation, affordable menstrual management means, and privacy, all serve to reinforce the stigma. They experience shame, fear and embarrassment. And as they grow up to be women, they internalise these gender inequitable values.
Adding to their woes, in some parts of world, including South Asia, puberty and especially menarche, are considered to signal that girls are ready for marriage and motherhood. In such contexts, parents may view child and early marriages as viable options to control girls’ sexuality or to protect against fears related to the “family’s honour”.
In 1994, during the landmark International Conference on Population and Development, and then again in 2019 during the Nairobi Summit to mark ICPD@25, the right to quality sexual and reproductive health services was squarely confirmed as pivotal to women and girls’ participation in family, community and national processes, as well as to the attainment of overall development goals.
The development goals include equal opportunity to education for girls and boys, by ensuring access to clean water and sanitation, medication to treat menstruation-related pain, and creation of safe spaces for girls.
If girls are to miss five days of school every month, how will countries attain that goal? And if women are to be confined during those five days, how will they participate in the labour market, politics, or any decision-making activity in their community?
The good news, however, is that today, India has several policies in place that address awareness about menstruation and menstrual hygiene. Many states have adopted and integrated life skills that include comprehensive sexuality education into their lower- and upper- secondary school curricula. Many civil society organisations promote girls’ education and work with parents and communities to break these taboos.
Thanks to these initiatives, the discomfort around menstruation and menstrual hygiene is beginning to gradually fade. It is now widely accepted that girls’ and women’s access to effective means of managing menstrual hygiene is strictly linked to realising their human dignity.
e must join efforts to break these taboos that have been built over centuries and are ingrained in people’s minds. Until we allow young girls to feel “normal” about menstruating, the best-intentioned policies will fall short of attaining the desired goals of equal participation of women and men.
Girls and women menstruate. Period.
Argentina Matavel Piccin is the India Representative at United Nations Population Fund or UNFPA.
Stepping up in the Pacific at the expense of Pakistani women and girls
Cutting aid has a cost – and Australia should be embarrassed to take aid from other countries to give it to the Pacific.
Since coming into office in 2013, the Coalition has cut aid by 17% in nominal terms and 27% adjusting for inflation. More cuts are in the pipeline, and by 2021 aid will have been subject to a real cut of 31%.
Given that the Coalition’s justification for cutting aid was the budget deficit, you might have thought that now Australia is heading for a surplus, there might be room for increasing aid. But no – in a recent interview with the podcast Good Will Hunters, International Development Minister Alex Hawke said that the last election had been a referendum on overseas aid, that the voters had rejected Labor’s proposed aid increase, and that no aid increases were in the offing. “We’re not revisiting that envelope,” Hawke said.
The suggestion that any election is a referendum on aid is laughable. Find me a person who bases their vote on foreign aid policy. As far as I know, not a single question to either major political leader during the election campaign concerned aid.
But clearly, foreign aid is the lowest priority for the Coalition. It has been singled out. Aid has been cut by 27% since 2013, but total expenditure has increased by 18% over the same period. Answers by the Department of Foreign Affairs and Trade to the most recent Senate Estimates hearings confirmed that next year Australia’s aid-to-gross national income (GNI) ratio will fall to 0.2%, the lowest ever. Among 36 countries in the Organisation for Economic Cooperation and Development, only the much bigger United States and a few much poorer (e.g. Poland) and/or newer (e.g. South Korea) and/or crisis-ridden countries (e.g. Spain and Greece) provide 0.2% or less of GNI in foreign aid.
Because of the cuts, the Coalition has been on the defensive on aid, but that tactic is now changing. In the same podcast, Hawke noted that Australia’s aid to the Pacific was “at the highest level ever”. Likewise, at Senate Estimates last month, Foreign Minister Marise Payne stressed that the $1.4 billion Australia will be providing the Pacific this year is a “record contribution”. Hawke went further – perhaps letting the cat out of the bag, or simply saying what everyone already knows, which is that the proportion of aid to the Pacific is going to continue to “tick up”.
Under what scenario can it make sense to cut total aid, yet increase aid to the Pacific? The government has not yet been able to develop a supportive narrative. Strategic competition with China appears to be the underlying driver, but no one wants to admit it. The best that Hawke could come up with were references to the Pacific as “our backyard” and “our family”.
Given the government’s position, the opportunity cost of more aid to the Pacific is less aid to other countries. Bilateral aid to Africa has already been virtually wiped out, and aid to Asia almost halved.
I personally work a lot on Papua New Guinea and count myself as a friend of the Pacific. But the current practice of taking aid from other countries and giving it to the Pacific makes no sense.
The case of Pakistan is instructive. Australian bilateral aid to Pakistan has already been cut by half, and will be eliminated altogether next year. DFAT has no qualms in documenting that “funding in Australia’s overall aid program [to Pakistan] has been redirected to support new initiatives in our immediate Pacific region”.
What will be sacrificed by abolishing aid to Pakistan? The latest DFAT review of Australian aid noted the strong focus on gender equity of our aid to that country. Specifically, the review noted that in the last year, as a result of Australian aid, 1.7 million Pakistanis received conditional cash and food assistance (55% women and girls). In addition, nutrition supplements were provided to “117,140 women, 14,165 adolescent girls, and 212,510 children under five,” as well as “14 newly renovated, 24-hour health facilities provided reproductive health services to 12,253 women”.
Australian aid also supported 2 million more Pakistani girls going to school. All this (and much more) with only $50 million of aid – just 4% of the amount going to the Pacific.
Of course, the Pakistani government could and should do a much better job of supporting the country’s development, yet the same point could be made just as strongly of the governments of the Pacific. I challenge anyone to find benefits of a similar magnitude to those claimed in Pakistan from our much larger aid program to the Pacific. Indeed, I challenge anyone to argue that the benefits of more aid to the Pacific (already the most aid-dependent region in the world) outweigh the cost of withdrawing our support to Pakistani women and children.
One can debate whether more aid to the Pacific is warranted, but more aid to the Pacific at the expense of aid to countries such as Pakistan is a national embarrassment.
The challenge of getting family planning “right”: Professor Amy O. Tsui on sexual and reproductive health in India
With India facing a plethora of issues related to sexual and reproductive health, ranging from sex-selective abortion to rising rates of infertility, Health Issues India interviewed Professor Amy O. Tsui, PhD of the Johns Hopkins Bloomberg School of Public Health, to discuss India’s family planning, female sterilisation, infertility, female foeticide, and other issues in the field of sexual and reproductive health affecting India.
Professor Tsui, thank you for agreeing to speak with Health Issues India. First of all, could you lend an insight for our readers into the work you do?
I am a social demographer interested in population and fertility trends. As I am a faculty member based in a school of public health, I have an interest in social interventions that influence fertility levels, including marriage, abortion, and contraception. Most of my recent work has been based in Sub-Saharan African countries but I have an enduring interest in the population and fertility dynamics of South Asian countries as well. I largely collect and analyse survey data, whether of women of reproductive age, health facilities or clients.
What do you perceive to be India’s major challenges in the field of family planning?
Getting family planning care “right” at the societal level is a challenge for many countries, including the United States. Globally sexual and reproductive rights are often politicised and remain contentious even as contraceptive use becomes widespread. India faces several major challenges in family planning, the first of which is the prominence of female sterilisation as the most used contraceptive method and one promoted by the government. Although other methods are available (condoms, pills, IUDs [intrauterine devices, or the coil] and recently injectables), female sterilisation accounts for three quarters of contraceptive use. As a result, a second challenge is expanding contraceptive method choice, including vasectomy. Even though India has a history of providing the latter in the late 1970s, today while slightly over one third of married women are using female sterilisation, fewer than 0.5 percent report their spouses having a vasectomy. Other than condoms, there is relatively little use of other methods, especially for spacing births. A third family planning challenge for India is ensuring equity in couples having informed choice for all family planning decisions, whether to prevent unintended pregnancies or to achieve desired ones. Presently the more privileged segments of society enjoy access to such information and means.
Can you identify an area, or areas, where India has made progress in the field of family planning in the past few decades?
Two areas come to mind, firstly India’s progressive record in legislation on elective termination of pregnancy since 1971, amended further in 2002 and, secondly, the transition in norms around family size to where the average women of childbearing age now has just over two births (2.2) and wants just under two births (1.8). Given there are nearly 370 million Indian women of reproductive age today and each has a mother who likely had two or more times that number of births, this transformation of fertility across just two generations is quite profound. Women’s capacity to manage their reproduction has definitely improved. Regarding access to safe abortion, there is still progress to be made but the MTP [Medical Termination of Pregnancy] Act in 1971 preceded the legalisation of abortion in the US by two years. It is easier today for low-income couples to obtain medical abortion pills discreetly from private health providers in India than in the US. I suspect that with more constrained choice of contraceptive methods in India–largely condoms and female sterilisation–some women have felt it necessary to seek out abortions to end unintended pregnancies as a consequence.
Can you identify any current programmes targeting female empowerment, fertility, or sexual and reproductive health which are making a difference in India?
Certainly the Government of India’s national family welfare program, which is the oldest in the world, and implemented through the states has had a major impact on couples’ fertility levels, through the promotion of female contraceptive sterilisation use. While by no means perfect, the government’s universal primary education scheme, along with parents’ own investments in private schooling for their children, has led to a dramatic reduction in the proportion of women under age twenty with no schooling. In 2015, the National Family Health Survey of nearly 700,000 households found 31.0 percent of females with no schooling compared to 41.5 percent ten years before. For female welfare, education and access to birth control are powerful drivers of empowerment.
I have brought in two colleagues into this conversation. We are collaborating on analyses of the National Family Health Survey data from 1992-93 to 2015-16 — Dr. Abhishek Singh and Dr. Kaushalendra Kumar from the International Institute for Population Sciences in Mumbai. They note several government programmes, such as Beti Bachao Beti Padhao, Sukanya Samridhi Yojana and Pradhan Mantri Jan Dhan Yojana which have particularly targeted the girl child and women. BBBP focuses on states and districts in northern India where the child sex ratio at birth is very imbalanced (in favour of males) and seeks to raise awareness of gender equity. SSY encourages parents’ savings for young daughters’ education and marriage expenses. PMJDY has helped open bank accounts with no minimum deposits required to enable females and males to access modern-day financial services more readily. While these are all relatively recent initiatives under Prime Minister Modi, they have the potential to significantly improve educational opportunities for girls and women (and thus their employability) and transform their resource base. It will take time before the full impact of these schemes can be appreciated but they are steps in the right direction.
India’s sex ratio is heavily skewed, with far fewer girls and women than there should be. What drives this imbalance?
Imbalanced sex ratios, in the sense of more boys than girls being born over what is naturally expected, is a problem in China, South Korea, Taiwan and other places in Asia, although not to the extent as is observed in India. Social norms around male roles in society sustain the desire of couples to ensure a male heir among their offspring. Patriarchal customs can protect land ownership with only males having property rights. At the same time social norms evolve around female roles, such as high dowries commanded to marry daughters off, which lowers the value of females and enhance that of males.
Paradoxically, as India’s fertility rates reach replacement level (2.1 births per woman on average), the demand for sons appears to be increasing. It also appears to be strongest for first births and among the better educated females and wealthier couples. The challenge here is to reduce felt pressures by couples to bear sons and also expand opportunities to females to achieve economically and politically on par with males.
Sex-selective abortion is illegal in India but continues to be practised. What do you perceive to be gaps in the legislation allowing for this practice to continue?
This is a very difficult situation to enforce because private conversations of couples around foetal sex are impossible to monitor and health providers are not permitted to facilitate any type of prenatal sex selection decisions of clients. While authorities will need to persist in enforcement where possible, the eventual solution requires a social re-valuation of sons and daughters until parity in gender value is achieved. The norms around son preference are changing and vary geographically across India; but private decisions can still aggregate up to revealing concentrated imbalances in sex ratios at birth at the national level.
As sex selective abortions are continuing to occur despite being illegal, could factors such as providing information to the public help in reducing cases?
I suspect the public is quite aware of gender preferences and discriminations against females. It will be important for social influencers, whether in government or civil society, to promote gender equality and neutralise longstanding opinions about the lesser rights and value of females. One transformative source of influence on public beliefs and opinions is mass media, particularly television and film and their associated celebrities. Positive modelling of the value of females and their lifelong contributions can gradually and permanently alter peoples’ beliefs and behaviors. India has tremendously talented actors, actresses and film producers who could appeal to the social conscience with strong visuals, story lines and re-balance gender preferences. This and continuing education of each generation can correct misguided thinking and actions.
Unsafe abortions are commonplace in India. What are the reasons behind this?
It is very difficult to estimate the number of abortions, both unsafe and safe, in most countries. A recent study estimates nearly sixteen million abortions in 2015 with only one-fourth happening in public health facilities. Another study in nine Indian states suggests that as many as two thirds of induced abortions are unsafe. There are a number of reasons why unsafe abortions appear commonplace – the sheer number of them given unplanned pregnancies resulting from unprotected sex, the legal status of abortions and relatively easy access to abortion means outside of the public sector, and the modest levels of contraceptive use for birth spacing, driven primarily by use of condoms, which have high failure rates. If a woman is not ready for permanent contraception and has limited knowledge of and access to other birth control methods, she is likely to experience an unplanned pregnancy and seek resolution with an abortion. Medical abortion pills are readily available from pharmacies and other private retailers. However, unless proper counselling and monitoring of the use of pills are provided, which often are not, such access is considered “unsafe”.
Lastly, even though a legal procedure, induced abortion often carries social stigma. Females are embarrassed to report seeking and terminating a pregnancy which means they often resort to informal abortion care or unsafe means.
Infertility is on the rise in India. What are the factors contributing to this?
I think the apparent rise needs to be first examined in terms of whether it is voluntary or involuntary childlessness that is increasing. Possibly it is both. Infertility has as its causes both male and female factors—semen quality, uterine structural issues from pelvic inflammatory disease, exposure to environmental chemicals and toxins and stress for example. A first challenge is to properly measure the prevalence of these conditions in males and females by which careful analyses can be conducted to determine the patterns and causes.
How do you evaluate the Indian government’s approach to issues such as in-vitro fertilisation and commercial surrogacy?
I am not knowledgeable enough about the Indian government’s approaches but certainly a comprehensive national family planning program will address couples’ reproductive intentions, whether to space, limit or have desired births. This includes addressing infertility issues. Denmark’s public health system, for example, supports assisted reproduction services (in vitro fertilisation) for women irrespective of marital status and sexual orientation and the proportion of births assisted with IVF is rising.
In regard to family planning, is there a disproportionate focus on sterilisation, and female sterilisation in particular, as the primary method of family planning in India?
I would say yes. One finds few countries in the world, particularly with populations as large as India’s, where permanent contraception occupies such a prominent role as a means of birth control. Female sterilisation is favoured in Central America and China, but women there also use other methods. While female sterilisation is a terminal use status for many Indian women, they appear not to access other contraceptive choices as readily if they wish to space births. Striking is the extent to which female sterilisation has become the birth control option for less educated and low-income women.
Do you feel the emphasis on sterilisation occludes access to other mechanisms of family planning such as contraceptive devices (e.g. condoms)?
The government’s Family Welfare program has recently introduced two spacing methods – Chayya, a once a week oral contraceptive pill, and Antara, a three-month injectable contraceptive. These offer protection against unplanned pregnancies to breastfeeding women and require minimal attention to use. These help complement the other government-sponsored methods. In addition, the government has been promoting immediate postpartum IUD insertions so that women can leave the birth facility protected with a highly effective method. With major surveys such as the National Family Health Survey conducted every few years, it will be possible to monitor the uptake of the new methods and observe how the family planning intentions of couples are being realised.
Finally, do you have anything you wish to add?
Nearly one in every five women on this planet is Indian (seventeen percent). Each of them deserves to be born a wanted daughter, be educated, live a healthy productive life and be a contributing member of society. India should not squander this human resource, which can potentially help accelerate the country’s future economic growth.
Amy O. Tsui, PhD is a Professor in the Department of Population, Family and Reproductive Health of Johns Hopkins Bloomberg School of Public Health and a senior scholar of the Bill & Melinda Gates Institute for Population and Reproductive Health.
Her research interests include family planning, fertility, and related health issues in developing countries and her current research is on the effects of various family planning and health service delivery models on contraceptive, fertility, and sexual health outcomes in sub-Saharan African and other low-income countries. She obtained an MA degree from the University of Hawaii in 1972 and her PhD from the University of Chicago in 1977. Among her honours are the Champion of Public Health award from the Tulane School of Public Health and Tropical Medicine, 2005; the AMTRA Award, JHSPH, 2006-07; the Golden Apple Award, JHSPH, 2009; and the Carl S. Schulz Lifetime Achievement Award, Population, Reproductive and Sexual Health Section from the American Public Health Association, November 2010.
Does Sexual Wellbeing Lead to Better Life And Leadership Skills? This Sextech Company Wants To Find Out
The connection between sexual well-being and mental and physical health has been recently attracting more interest. Sexual wellness brands -many of which endure constant advertising censoring– advocate to position sexual health and wellness as part of the health conversation, to make it more accessible to all.
A rich body of research confirms that sexual satisfaction affects relationship satisfaction, which is key to earning potential. For example, in one longitudinal Harvard study, the data revealed that fulfilling relationships are the key to happiness, health and longevity. And not only that: Those with the most fulfilling relationships earned an average of $141,000 a year more at their highest earning point.
This study, however, was focused exclusively on male subjects, and it inspired a recent study conducted by sexual wellness company Womanizer (WOW Tech) in partnership with The What Collective, a women-centered organization founded by dot com entrepreneurs Gina Pell and Amy Parker. The former co-founders of Splendora (acq. by JOYUS) recently hosted a gathering called The What Summit at the secretive and exclusive Skywalker Ranch. The survey was completed by over 200 high-earning attending women. 80% of respondents were ages 35-64 and in director, management and C-suite positions.
The preliminary results showed some interesting insights: More than 50% of respondents perceived that having a healthy fulfilling sex and relational life would positively impact all other aspect of their lives, including their careers.
The Deficit in SexEd Addressed By Wellness Brands
When it comes to sexuality only 3% of respondents said they had learned at school or with their families. The majority cited the following sources of sex education: peers and friends (34%), magazines and books (28%), and the Internet (10%). In fact, 77% of women who received some sex education stated that it never mentioned that sex should be pleasurable and 70% say there was no discussion about consent. Additionally, 62% state that they have experienced shame around sex and sexuality.
Global expenditure on wellness products and services is on the rise, highly driven by women, and the women’s empowerment movement has added to the conversation issues such as the orgasm gap between men and women, and the right to body autonomy and pleasure of women. This context creates an opportunity for Sextech and Femtech businesses to create innovative solutions to educate and offer resources in underserved categories for people of all ages. Both industries have been estimated at $30 and $25 billion, respectively.
Stephanie Keating, Head of Marketing of WOW Tech, which comprises Womanizer and We-Vibe, said: “Womanizer partnered with The What Summit to facilitate conversations amongst women about pleasure and all that it brings our lives. For many women, experiencing self-pleasure builds confidence, comfort, and agency – yet 75% of us were not taught that sex should be pleasurable. Traditional sex education has failed us. For too many women, pleasure is associated with shame. That limits us in so many other aspects of our lives. The conversations that Womanizer and our experts are having with women free us to talk to each other about this essential part of our lives.
Personal Fulfillment As A Source Of Confidence And Wellbeing
When asked about the impact of their personal sexual wellness in other areas of life, the majority of women believed that feeling fulfilled positively impacted how they showed up in other areas of their lives. Specifically, 51% stated that this translated into a positive impact on their professional lives. Many respondents pointed to the correlation between fulfillment and “confidence”, “lowered stress”, increased overall “happiness and motivation”, feeling “empowered” and “powerful”, and the positive correlation with overall “well-being”.
Emily Morse, Doctor of Human Sexuality, relationship therapist and author, says “Sexual wellness impacts body image, confidence, … These factors can put a strain on our mental health. If you are not connecting with your partner, it is going to affect your day to day life. Additionally, being able to ask for what you want is a skill that translates into other areas of life.”
Sexologist and relationship expert, Dr. Jessica O’Rielly, PhD, said: “Sexual fulfillment, relationship fulfillment and life fulfillment are all positively correlated. It follows that investing in your relationships and sex life (however you define it) and fulfilling those needs leads to greater self-assurance, improved mood, increased motivation and even greater assertion skills — all of which can benefit your career.”
Educators, researchers, entrepreneurs… The business of sexual wellness is a growing one and the merger of Womanizer and We-Vibe, which is about to become the largest sexual wellness toy manufacturer, approaching $100 million in sales, wants to push forward a healthier narrative around sexuality: “ Our flagship products were created to help women achieve personal sexual fulfillment and their pleasure potential. WOW Tech’s mission is to be the premier provider of sexual health and wellness products — products that enable people all over the world to increase the satisfaction of their personal and sexual well-being,” concludes Keating.
Positive Pregnancy Test: “But, I Am Not Sexually Active!”
I can still recall her young face overcome with concern as she learned of her positive pregnancy test. She was just 16 years old and a relatively new patient at the time. Her situation was complicated by the fact that her grandmother, her legal guardian, was sitting in the waiting room. Grandma had met me prior to the appointment and clarified that, although she respected the fact that I wanted to see her ward alone, she absolutely did not want me “putting ideas into the child’s head” by offering her any form of birth control. Grandma further stated that she would not be here with her granddaughter today if someone had not talked about “these things” with her own teenage daughter 16 years ago.
Confidentiality in our pediatric and adolescent practices
is often the key to engendering confidence and trust within our patients. In their article published in the October issue of Pediatrics in Review, Drs Maslyanskaya and Alderman discuss the need to educate both adolescents and caregivers about the importance of confidential care to ensure the patient’s emotional and physical wellbeing. This applies particularly in the sensitive domains of sexual health, substance use, and mental health. Research has shown that adolescents, if not guaranteed privacy, are less likely to access health services for reproductive and substance use issues. The authors further describe that physicians should consider multiple factors when weighing the ability of the adolescents to interpret health information and make health care decisions autonomously.
Laws regarding confidentiality and consent may vary drastically from state to state, especially with regards to consent for reproductive health needs (including abortion). Maslyanskaya and Alderman advise that pediatricians faced with these dilemmas understand the limits of confidential care for adolescent patients and provide resources relevant to different states in the United States. Physicians should be aware that minors may gain legal status as adults under certain state and federal laws, including the concepts of “mature” and “emancipated” minors. The authors emphasize that federal laws like HIPPA, Title X , SAMHSA and MEDICAID override state laws and, thus, familiarity with both is essential to the provider. Pediatricians should also be aware that there are instances when they must “break” confidentiality, in the best interest of the patient, as in cases of child abuse or when there is a risk of suicide or homicide. For public health reasons, sexually transmitted infections (STIs) also must be reported to the local health department to ensure that partners are treated and to prevent the spread of the disease.
Finally, the authors discuss that, with the increased use of electronic records, pediatricians should ensure that they are careful to protect confidential information. Strategies may include blocking sensitive information from after-visit summaries and advocating for institutional policies restricting the use of internet portals by parents of teenagers.
In our case, the teenager chose to continue the pregnancy and consented to her grandmother being included in the conversation and planning for the future. She was also made familiar with different long-acting reversible contraceptive methods that are available to prevent future pregnancies.
Nupur Gupta, MD, MPH, Editorial Board Member, Pediatrics in Review November 25, 2019
Developing nations to lose trillions of dollars due to child marriage by 2030–World Bank
WASHINGTON-(MaraviPost)-The developing nations including Malawi, is projected to lose trillions of dollars by the year 2030 on account of child marriages, The Maravi Post has learnt.
This is in contrast to the end child marriage campaign being advocated by governments and civil societies.
In the World Bank and the International Center for Research for Women (ICRW) report titled, “Economic Impacts of Child Marriage,” released on Tuesday and made available to The Maravi Post, highlights the estimated benefits that would ensue if women had fewer children and later in life, and increase women’s expected earnings and household welfare.
According to the report, in the past 30 years, the prevalence of child marriage, or union before the age of 18, has decreased in many countries, but it still remains far too high.
The Bank discloses that in a set of 25 countries for which detailed analysis was conducted, at least one in three women marry before the age of 18; and one in five women have their first child before the age of 18.
Across the countries considered in the report, three in four early childbirths (children born to a mother younger than 18) are attributed to child marriages.
The report estimates that a girl marrying at 13 will have on average 26 percent more children over her lifetime than if she had married at 18 or later.
This means that ending child marriage would reduce the total fertility rates by 11 percent on average in those countries, leading to substantial reductions in population growth over time.
In Niger, for instance, the country with the highest prevalence of child marriage in the world, the population by 2030 could be five percent smaller, if child marriage and early childbirths, were eliminated.
The analysis suggests that by 2030, gains in annual welfare from lower population growth, could reach more than $500 billion annually.
In Uganda, the benefit from reduced fertility would be equivalent to $2.4 billion, while in Nepal this would be almost $1 billion.
The report confirms that keeping girls in school, is one of the best ways to avoid child marriage.
Each year of a secondary education, reduces the likelihood of marrying as a child before the age of 18 by five percentage points or more.
The World Bank’s Project Director and co-author of the report, Quentin Wodon, observes that child brides are often robbed of their rights to safety and security, to health and education, and to make their own life choices and decisions.
“Child marriage not only puts a stop to girls’ hopes and dreams. It also hampers efforts to end poverty and achieve economic growth and equity. Ending this practice is not only the morally right thing to do, but also the economically smart thing to do,” adds Wodon.
Echoing on the same, Suzanne Petroni, ICRW’s Project Director and co-author of the report, says that very day more than 41,000 girls marry before the age of 18.
She adds that poverty, gender inequality, poor access to quality education and to youth-friendly sexual and reproductive health services, and a lack of decent employment opportunities, help perpetuate child marriages and early childbirths.
“Ending child marriage would also reduce rates of under-five mortality and delayed physical development due to lack of appropriate nutrition (stunting). Globally, the estimated benefits of lower under-five mortality and malnutrition, could reach more than $90 billion annually by 2030.
“Another important benefit from ending child marriages, would be an increase in women’s expected earnings in the labor market. Due in large part to the impact of child marriage on education, women who marry as children have, on average, earnings that are nine percent lower than if they had married later. In Nigeria, this equals to $7.6 billion annually in lost earnings and productivity,” said Petroni.
The Economic Impacts of Child Marriage project was funded by the Bill & Melinda Gates Foundation, the Children’s Investment Fund Foundation, and the Global Partnership for Education.
Sex Education Programmes in Kenyan Schools Are Failing Students
ANALYSISBy Estelle Monique Sidze, Guttmacher Institute and Melissa Stillman
Imagine giving Kenyan students something that has been proven to help them make healthy informed choices about their sexual and reproductive lives.
The solution already exists: comprehensive sexuality education.
To be comprehensive, sexuality education needs to be scientifically accurate, age-appropriate, nonjudgmental and gender-sensitive. The lessons should extend to prevention of HIV and other sexually transmitted infections (STIs), as well as contraception and unintended pregnancy. The students should also learn about values and interpersonal skills, gender, and sexual and reproductive rights. Programmes that cover all of these topics can have a positive impact on adolescents’ sexual and reproductive health.
Previous research shows that nationally more than a third of Kenyan teens between the ages of 15 and 19 have already had sex. About one-fifth are currently sexually active. And while only four in ten sexually active unmarried teenage girls use any modern method of contraception, the vast majority of them want to avoid pregnancy. About one-fifth of them are already mothers, and more than half of these births were unplanned.
Early childbearing may limit girls’ ability to stay enrolled in school and to develop the skills needed to successfully transition to adulthood. Knowledge about HIV infection also remains a concern: around half of adolescents in Kenya do not have comprehensive knowledge of HIV/AIDS.
At a time when a new national school curriculum is starting its pilot phase, our recently released study provides critical evidence of the gaps in the content and delivery of existing sexuality education programmes and an opportunity for strengthening them.
The study, conducted in 2015 in 78 public and private schools, found that three out of four surveyed teachers are reportedly teaching all the topics that constitute a comprehensive sexuality education programme. Yet only 2% of the 2,484 sampled students said they learned about all the topics.
Worse still, incomplete and sometimes inaccurate information is being taught. A majority of surveyed teachers reported emphasising in their classes that abstinence is the best or only method to prevent pregnancy and STIs. Yet numerousstudies have shown that abstinence-only programmes do not work.
Only 20% of students in our study had learned about types of contraceptive methods. And even fewer had learned how to use and where to access methods. The majority of teachers also reported very strongly emphasising that having sex is dangerous or immoral for young people. Furthermore, almost six in 10 teachers who teach about condoms incorrectly tell their students that condoms alone are not effective for pregnancy prevention. Something is wrong with this picture
The reality is that at the time of being surveyed for our study, a quarter of the students – who were mostly aged between 15 and 17 – had already had sex. Students want and need information about how to prevent unintended pregnancies, HIV and other STIs.
Kenya already has the policy infrastructure for a comprehensive programme. Its National School Health Policy was developed by the Ministry of Education and the Ministry of Public Health and Sanitation and their partners in 2009. The policy underscores the need to ensure that students receive quality health education, including sexuality education.
Kenya has also been a signatory since 2013 of a joint health and education ministerial commitment to provide comprehensive and rights-based sex education starting in primary school. Twenty-one other countries of East and Southern Africa are also part of this initiative.
However, implementation has been slow and uneven. Nairobi City county has acknowledged this gap and is working to increase coverage of sexuality education. Recently the county launched a plan of action to strengthen school health programming to increase the number of schools that offer comprehensive sexuality education.
Sexuality education is primarily taught under the subject Life Skills, which is compulsory but not examinable. Teachers face pressure to focus on examinable subjects, such as Mathematics and English. Even in schools that teach a wider range of sexuality education topics, many teachers lack the training to teach them effectively.
We owe it to young people
That’s why the ministries of Health and Education should honour their prior commitments. An immediate priority should be fostering partnerships between schools and community health care providers. Health care providers may be better placed to provide some particularly sensitive sexuality education content, such as where to access and how to use contraceptive methods.
As a longer term priority, the ministries should invest in improved pre-service and in-service teacher training in how to teach sexuality education effectively. They should also ensure that teachers have sufficient time to cover the full range of topics in their classes.
Increased focus on pregnancy and STI prevention strategies should cover a broad range of contraceptive methods and negotiation skills within relationships. This is necessary to ensure that all Kenyan youth have the knowledge to make informed decisions about their sexual and reproductive health. We owe it to young people to do much better.
The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond the academic appointment above.
A new study has revealed that geriatrics not only continue their antics between the sheets, but they explore their sexuality even more.
Professor Liza Berdychevsky at the university of Illinois and Galit Nimrod, from Ben-Gurion University of the Negev in Israel looked at how older generations view sex in their later lives.
And the results were surprising.
They analysed 14 leading online communities for the over-50s across the English-speaking world, including the UK and the US.
Looking at their chats on sex, researchers discovered that many “remained sexually able, interested and active.”
While some were happy to give up their sex lives – blaming health conditions and a lack of drive – others used their twilight years to make up for lost time.
Prof Berdychevsky told Medicalxpress.com: “Although some older adults reported abstaining from sexual activity due to health conditions or loss of interest, others refused to renounce sexual activity.
“Their health problems or society’s ageist stereotypes that portray seniors as asexual were not going to become excuses to give up on life – or sex.”
She revealed how many older people surveyed were inspired to explore their sexuality more and try new ways to spice up their love lives.
Last year, research by The University of Manchester told how more than half of men and a third of women over 70 in England are still sexually active.
In online chats, many revealed the ‘ageist stereotypes’ they faced, with some telling how their concerns about sexual health were dismissed by doctors.
Similarly they were met with disapproval from their children if they were candid about their sex lives.
Popular discussions online included dating advice, continuing a sex life after a bereavement and new sexual relationships.
Despite being happy to swap anecdotes online, some were embarrassed to try sex tips or aids in their own lives – for fear of judgement.
The report concluded that older people who accepted their physical imitation and adopted accordingly continued to enjoy a healthy sex life.
While many admitted they were happy to abstain, advertising for sex enhancements featuring younger models was a focal reason for problems in the bedroom.
Prof Berdychevsky said: “These stereotypes caused performance anxiety in some older men and some older women believed that both partners should have a say in whether sex enhancement drugs are prescribed.”
Those are just some of the things that children see when they view news coverage of violent events, such as thetruck attack in Nice, France, on Thursday.
Screen violence — which includes violence in video games, television shows and movies — is associated with aggressive behavior, aggressive thoughts and angry feelings in children, according to a policy statement released by the American Academy of Pediatrics early Monday.
“Screen violence, particularly when it is real but even if it is virtual, is quite traumatic for children regardless of age,” said Dr. Dimitri Christakis, director of the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute and lead author of the statement.
“It is not uncommon to see increases in nightmares, sleep disturbances and increased general anxiety in the wake of these events. While it is true that the horrific events of this past week can happen at any time, the real risk to individuals remains low,” he said. “Children need [that] reassurance.”
For the statement, which was published in the journal Pediatrics, Christakis and colleagues reviewed and summarized more than a dozen studies and meta-analyses about the effects of virtual violence and aggression on children’s attitudes and behaviors. They defined virtual violence as forms of violence experienced or witnessed virtually on a screen.
After the review, the statement authors made specific recommendations for doctors, parents, the media industry and policy makers to better prohibit easy access to violent media for young children.
“Parents should be mindful of their children’s media diet and reduce virtual violence especially if their child shows any aggressive tendencies,” Christakis said.
During a time of much conflict in the news, Christakis advises parents to reassure their children that there are still mostly good people in the world. He recommends that parents show children stories of people helping each other, and not hurting each other.
“We have done research showing that such eventsfrighten children,” said Brad Bushman, professor of communication and psychology at Ohio State University, who was not involved in the new statement.
The statement authors also called for the federal government to oversee the development of its own media rating system, rather than relying on the entertainment industry’s rating of violent content in video games, movies and television.
“We know from hundreds of studies on thousands of children that there is a link between ‘virtual violence’ and real-world aggression,” Christakis said. “On average, the effect is in what we would deem the small to moderate range, but equivalent to the link between passive smoke exposure and lung cancer — something that municipalities have reacted to by enacting non-smoking ordinances.”
Christakis is quick to point out that there are benefits when children consume nonviolent media. For instance, he led a 2013 study that found that prosocial and educational screen time — including television and video games — can significantly enhance social and emotional competence in children.
What do other scientists think of the new statement? Dr. Douglas Gentile, a professor of psychology at Iowa State University who has studied screen time and children, said the new statement suggests that often it’s not the quantity of media but the quality that can influence aggression in children.
“Often, there are people who like to take extreme positions. Either the studies show games are creating a generation of shooters, which the science does not support, or they say there is no evidence that there are harmful effects, which the science also doesn’t support,” Gentile said.
“It is important to have our public health organizations do these types of reviews so the public can cut through all of that opinion out there,” he said. “Everyone has an opinion, but not all opinions are supported by the science.”
(CNN)“Oh, puberty,” laments Amanda Rodriguez, a mom of three boys, ages 8, 11 and 14.
I had asked her about that moment when she knew that her older boys definitely needed to start wearing deodorant.
“All of the smelly fun a girl can handle,” the Frederick, Maryland, mom joked, noting how the body odor is just beginning with her middle son.
“I would say the first few months are the hardest,” said Rodriguez, founder of the blog Dude Mom. “Initially, they are reluctant, even rebellious, and unwilling to accept the fact that deodorant is a requirement and no longer a fun novelty. It’s like they are nose-blind to the fact that they are ripe. They need constant reminders, lots of smell checks, extra time to prepare for each day.”
As a parent, there is a plenty of adjustment too, she says. “I have to remember to remind them that they need to get up early to shower and put on deodorant before they leave,” she said. “It’s a habit we all have to work together to form.”
Lisa Flick Wilson, a mom of twin boy-girl tweens who are 11, almost feels like she has this “laboratory just exploding at all times right before” her eyes.
“You harken back to that time when you were that one in grade school that stunk and you were like, ‘God, I wish my mom would have told me I stunk!’ “
But how exactly do you give your tween or teen that information, especially if they signal that they have no interest in discussing the topic?
In the second installment of our new CNN Digital Video series “Parent Acts,” we asked parents to act out what their children do and say when it comes to the body odor conversation, and then we had a parenting expert listen to their roleplay to weigh in with advice.
He says parents want to be careful not to use shame, guilt, humiliation or embarrassment to get any message across. “OK, they might feel those things as a result of the discussion, that’s part of the human experience, but when you use it as a weapon, that surrounds the whole thing with something that really doesn’t become the learning experience you want it to be,” he said.
Flick Wilson, who lives in Atlanta, says she’s honest with her kids. She’ll ask whether they put on deodorant in the morning and encourages them to choose their own when they go to the store. ” ‘You go pick it out. It’s for you. It’s your special thing. You’ve got a special place in your bathroom you keep all this stuff,’ ” she’ll tell them. “That makes them want to use it more.”
Being proactive is a good thing, said Fisher, who recommends introducing children as they are coming of age to what is going to happen to their bodies so they’ll know what to expect.
And once you start noticing changes happening, you can ask your kids whether they notice them, too. “You know, often we don’t smell ourselves very well, so you might say, ‘Are you aware of what’s going on? So every now and then check your armpits,’ something like that. ‘What do you smell?’ “
He also says parents can add more science to the conversation. They can tell kids that what’s actually happening is that skin cells are dying on their bodies, and when you have dead skin cells sticking to oils on the body, you get bacteria.
“The best part is, you say … ‘And you know what that smell really is? It’s bacteria poop,’ ” said Fisher, “And my daughter was like, ‘Oh, Dad, I didn’t need to know that.’ … A lot of kids are like that, but then they go, ‘Oh, wow.’ So then they realize why it’s not just that you smell. It’s that there’s a health issue that you have to be concerned about and be aware of as you grow older.”
Sometimes, kids just learn on their own
But even after the conversations, some kids might still be reluctant to accept their new reality, which may be partly motivated with wanting to defy their parents and not do what they suggest, said Fisher.
Some people need the social embarrassment to realize people are noticing, he said. “So you let them learn naturally. You give them enough room, and that’s kind of what I say. I give my daughter enough room to step in it and go, ‘How did that feel?’ ” he said.
Rodriguez, the mom of three, said that with her 14-year-old, and now her 11-year-old, she feels like she spends a few months when everything smells “just really rank” and she is constantly riding one of the boys about “being foul.”
“And then, all of a sudden you’re choking on Axe body spray and scraping gobs of hair gel off your bathroom sink,” she jokes. “The switch is just flipped (probably by some girl, gah!) and the ‘I don’t-want-to-stink-light’ is officially on. Parenting goal achieved.”
She started to talk with her boys about body changes in the fourth grade by giving them a book about boys’ bodies. She let them read it independently and then discusses it with them from time to time. “We try to focus on the positives, that they are going to get taller and stronger, and then we weave in some hygiene lessons as they come up,” she said.
Flick Wilson, the mom of twin teens, says she’s tried to be as open with her kids as possible, about everything from body changes to body hair to deepening voices, which is quite a contrast from the way she grew up.
“I think that as much as I loved my Catholic school upbringing, it was never a conversation you had, whether it was body changes or sexuality or you name it,” she said. “And so, I think for me, I’ve been very much like, ‘I want this not to be an anxiety-ridden conversation’ … and so we’ve kind of always talked about it.”