25 March 2014
The concept of being “born” is a crazy one; one moment you
don’t exist, the next moment, boom, there you are. The clock starts, experiences happen,
memories form. We have no control over
by whom or how we are born, it just happens to us. I didn’t choose to be born into a family with
kind parents in a developed country, but I sure feel fortunate I was. As we travel around Africa and I interact
with my peers here, I can’t stop thinking how lucky I am. At the same time, I feel kindred to these
women; I could be her, she could be me.
Life is harder for women; some may argue that, but I believe
that is a fact. As women, the world
over, we subject our bodies to the risks of pregnancy and childbirth, we are
more likely to be the victims of sexual and domestic violence, we are sexually
objectified, we earn less money than our male counterparts, and even in
developed countries, we must endure sexual oppression. All of us women of the developed world can
share stories of our experiences with gender-based harassment, abuse,
discrimination and oppression, but our sufferings most likely pale in
comparison to the sufferings of our “sisters” in the developing world.
Let me enlighten you with the facts about life as a woman in
Zambia. She starts off with fewer days
on her clock than we do, with the projected life expectancy for a Zambian woman
being 58 years (compared to 81 in the US).
She might consider herself lucky to even make it past the age of 5,
since 89 out of 1,000 Zambian babies won’t make it that long (compared to 7 of
1000 US ones). She will probably start
bearing children at a young age since 125 of 100,000 live births are to women
aged 15 to 24 (compared to 31/100,000 in the US). She will have a lot of babies, on average,
nearly six. Not all of those babies will
make it through pregnancy, as Zambian infant mortality is 56 of 1000 live
births (versus 6 of 1000 in the US).
There are also fairly good odds that she may not survive pregnancy or
childbirth either since 8% of women of reproductive age will die during
childbirth (compared to 0.8% in Canada and 1.5% in the US). Sometime during her life, she very well may
be contract HIV, with prevalence in Zambia of 14%.
Zambian women might actually feel fortunate when they
compare themselves to some of their neighbors, though. The situation seems to be particularly poor
in Chad and Sierra Leone. Chad has the
highest adolescent fertility rate at 152 of 100,00 births and the second worst
maternal mortality at 980 per 100,000 childbirths, which translates into this
staggering fact: 29% of women of reproductive age will die during childbirth. One
out of three! Sierra Leone has the
highest maternal and infant mortality rates in the world at 1100 per 100,000
births and 117 per 1000, respectively. A
few other countries in Africa had some shocking statistics as well, like the
20% prevalence of HIV in women aged 15 to 24 in Swaziland. Then there is the 39% female literacy rate in
Mali (compared to 56% in their male counterparts). Finally, there is also the fact that 44% of
girls aged 7 to 14 are employed and working in Burkina Faso and Guinea.
The many reasons I listed are essentially why I am here in
Zambia right now. Providing
contraception and educating women about family planning saves lives of women
and children. That is a fact. With an unmet need for family planning quoted
at 27% in Zambia (compared to 7% in the US), there is still room for
improvement. That is why groups like
PSI, the NGO with whom I am working, have helped to establish Family Planning
programs in Zambia and similar countries.
It is not as simple as merely teaching the local providers about
contraception and providing the birth control methods though. There are many barriers to overcome here that
we simply do not deal with in the developed world and many of these barriers
are just inherent to being a woman in Africa.
The first barrier is education and socioeconomics. The women that I have seen in the clinics
here are not a privileged and educated bunch.
In 1998, it was estimated that 63% of Zambians were living below the
poverty line, making less than ONE DOLLAR a day. This number has surely improved since then,
but I hope it illustrates the kind of poverty I am talking about here. Many of the women that I have seen
interviewed seem to have made it about halfway through school, maybe to grade
7. One woman said she never went at all.
There are a whole slew of contraceptive myths we have
encountered during our trip which, to me, also highlight the lack of education
these women have: “the implant can move
from the arm to the heart and pierce it,” “IUDs cause cancer,” “if the man’s
penis is very long, can it move the IUD out of the womb.” Half of the work that I have been involved
with here is focused on educating women, dispelling myths, increasing
awareness, and even identifying women in the community that spread rumors
against contraception.
Transportation, or lack thereof, is another huge
barrier. Driving down the roads, we see
hundreds of women on foot with babies strapped to their backs or fronts, maybe
even simultaneously breastfeeding. If
they are lucky, they may have a bicycle for transportation, but it seems mostly
men get the bikes. Some rural areas may
not have a clinic or hospital any closer than 15-km. Although the majority of Zambians have mobile
phones, the reception in these rural areas is unreliable. All of these realities explain why only 42%
of Zambian births are attended by skilled professionals. This circles back to the maternal mortality
again…
The women here do not have a lot of control over their
lives. The men largely dictate when and
how many children they have. I have
heard a number of women say they don’t want any more children, but they must
defer to their husbands. The men get to
have the final say about contraception and whether they can use it. Many of the contraceptive counselors here
sell the IUD to the patients by reminding them that it is a “secret method”
that their husbands will not be able to tell they are using. She can’t use the female condom for pregnancy
and HIV prevention, because the man will think she is promiscuous and diseased
instead of empowered. In some groups,
the women don’t even get to decide when they can wash or shave their genitals,
as the husband must perform it. If she
were to wash or shave herself, it would lead him to believe she was
unfaithful. Many of the husbands even
send the women to do the manual labor like farming or selling of produce, while
they do the beer drinking. They do it
all while tending to a couple small children at the same time.
Domestic violence is clearly another major problem here
based on the number of billboards and posters around the country making public
service announcements. Nearly every
other woman who is interested in the contraceptive implant (in the arm) has
asked, “If the man beats you and hurts your arm, can the implant move to the
heart?” Domestic violence is clearly all
too common a worry on these women’s minds.
During one of our clinic visits last week, the nurse asked
the patient if she would mind letting us observe the insertion of her IUD. She giggled a little at first, looking shy,
but they said, “Yes, why not, they are my fellow sisters after all.” When you have a rough day and feel like life
can’t get worse, remember your sisters in Africa.
(Statistics I listed came mainly from the World Health Organization but also the World Bank, most stats were from 2013)
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