Religion and governance: strange bedfellows #Vaw #womenrights


BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3715 (Published 7 June 2013)

Cite this as: BMJ 2013;346:f3715
  1. Anita Jain, India editor, BMJ

Author Affiliations

  1. ajain@bmj.com

An unexpected turn of events saw a woman referred to as Beatriz get a life saving caesarean section, thanks to doctors in El Salvador who supported her cause, and a rousing international movement. She was earlier denied an abortion, it being criminalised in predominantly Catholic El Salvador, with the ensuing imprisonment of women and doctors (doi:10.1136/bmj.f3612). Timely intervention prevented Beatriz going the same way as Savita Halappanavar did a few months back in Ireland. Savita died after being denied an abortion on the grounds that “it [Ireland] is a Catholic country” (doi:10.1136/bmj.f2208). Her death and Beatriz’s struggle for life raise the question: Why does religion interfere?

A parallel conflict between religion and governance is taking place in the Philippines. At the Women Deliver conference I attended last week, it pained me to hear Filipino women with 16 and 22 children talk of how they were tired of having children, of having to provide for them under conditions of extreme poverty, and fearful of dying in the process of childbirth. Senator Pia Cayetano provided an inspirational narrative of having the reproductive health bill passed last year after five congresses and nearly 15 years. Recognised by President Aquino as a “matter of urgency,” the law marks a momentous achievement to make available free contraceptives, sex education, and comprehensive obstetric services (doi:10.1136/bmj.e8535). The struggle is not over however. With a largely Catholic, conservative, and patriarchal hierarchy, the constitutionality of this law has been challenged in the Supreme Court.

In a review of abortion policies worldwide, Sophie Arie reports a threat that countries may be headed towards being more restrictive (doi:10.1136/bmj.e8161). Closer to home, India may laud itself for a progressive abortion law but it continues to have one of the highest rates of unsafe abortions. Suchitra Dalvie, coordinator of the Asia Safe Abortion Partnership, shares grim statistics whereby, “every year about 11 million abortions take place [about 700 000 are reported] and around 20 000 women die due to abortion related complications.” Clearly the law has not translated into enabling physical, social, or financial access to these essential reproductive health services (doi:10.1136/bmj.f3159). Contrary to what may be expected, states are further imposing severe curbs on medical abortion pills (doi:10.1136/bmj.f1957). In the latest BMJ poll we look forward to hearing what you think of this.

Signifying a commitment to make comprehensive family planning services a reality globally, the London Summit on Family Planning (FP 2020) laid the ground for collaboration among donors and governments (doi:10.1136/bmj.e4160). At Women Deliver, Kavita Ramdas from the Ford Foundation emphasised, however, that “access to contraceptives” needs to be the message, and not just family planning. The importance of this is immediately evident in a similar conflict between the state and religion in Muslim dominated Indonesia where unmarried women are denied reproductive health services including contraception. Shereen El Feki, author of Sex and the Citadel, shared voices of young unmarried men and women from the Arab region who are “sexually active, but not sexually informed” as “marriage remains the only the only socially accepted context for sex—state-registered, family-approved, religiously-sanctioned.” The needs of this large and growing community of single men and women often tend to be neglected in the discourse on family planning.

Nozer Sheriar, secretary general of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), shared that, with an estimated 21.6 million women worldwide experiencing an unsafe abortion each year and with about 70 000 deaths, it is a silent tsunami knocking door to door. As symbolised by Salvadoran doctors who stood strongly behind Beatriz so she would not die giving birth, there is a role for healthcare providers to support women’s choice on this reproductive right that society is so reluctant to give.

Notes

Cite this as: BMJ 2013;346:f3715

Footnotes

  • Follow Anita Jain on Twitter @ajain247

Open letter to DG, WHO regarding Pentavalent vaccine


English: Margaret Chan, director-general of th...

English: Margaret Chan, director-general of the World Health Organization (WHO). (Photo credit: Wikipedia)

 

ALL INDIA DRUG ACTION NETWORK,

 

  • 57, Tejaswinagar, Dharwad 580002,
    Tel & fax 0836-2461722
  • A-60, Hauz Khas, New Delhi 110016,
    Tel: 91-11-26512385,

http://aidanindia.wordpress.com/

———————————————————————

Date 16th January 2013

OPEN LETTER TO THE DIRECTOR GENERAL, WHO

To

Dr. Margaret Chan,

The Director General,

World Health Organisation,

Geneva.

chanm@who.int
wrindia@searo.who.int

Dear Dr Margaret Chan,

All India Drug Action Network (AIDAN) is a network of not-for-profit civil society organisations that has been campaigning and working for rational use of medicines, largely in the Indian context. In March last year some of us sent you as DG, WHO an open letter about deaths from Pentavalent vaccine (DPT + Hib + Hepatitis B) which is supported by WHO.

Last week we had another death in Kerala, India after the vaccine. The 47 day old child Akilesh the son of Mr Anil and Liggy Vadekethil received his first dose of the vaccine. He was found dead in bed at 3 AM that night.

The Vietnam Government has stopped the programme with the vaccine after 3 deaths and they have asked the WHO to investigate[1]. Perhaps this will not come up to you but we thought you should know.

This follows a pattern. The vaccine is harmless for the vast majority but in a few, it causes reactions and death. It is wrongly said to be, Sudden Infant Death (SIDS). This was in fact the explanation given by the WHO experts investigating the deaths in Pakistan showing the experts neither understand the cause of the deaths nor the definition of SIDS.[2] Other deaths have been attributed to be anaphylaxis. In the cases of deaths in Sri Lanka the committee of the WHO said that the deaths were ‘unrelated to the vaccine but they could find no other explanation for the deaths’ – thereby contradicting themselves.

There is no way of testing children before they are given this vaccine to know if they will react adversely. Therefore any healthy baby coming for preventive vaccination may be the next victim. This will likely shake the confidence of the public in the entire immunization regime and the steady progress we have been making with routine immunization may be reversed.

blog in the British Medical Journal has calculated from data gathered from Kerala in the first 6 months of introducing the vaccine in that state, and projected that the vaccine will likely cause 3000 deaths in India each year where a WHO sponsored study showed that the deaths from Hib meningitis is about 175 per year[3].

This pattern of sudden unexpected death has been seen in many Asian countries besides India and Vietnam in Bhutan , Sri Lanka, Pakistan, Indonesia, so that it no longer possible to suggest that the deaths were just coincidence.

We did not receive any response to our last letter but as an organisation we feel we must place this information to you so it can be viewed in its entirety rather than piecemeal. It is being placed in a publicly accessible website so it may be used by all for rational decision making. We are concerned that these continuing deaths from a vaccine supported by the WHO will erode not only the credibility of this international organization but also of all vaccines.

Looking forward to your early action in the regard.

Yours truly,

1.      Dr Mira Shiva, +91 9810582028, mirashiva(at)gmail(dot)com,

2.      Dr Anant Phadke, +91 9448442142, anant.phadke(at)gmail(dot)com,

3.      Mr Srinivasan S, +91 9448442142, chinusrinivasan.x(at)gmail(dot)com,

4.      Dr Gopal Dabade, +91 9448862270, drdabade(at)gmail(dot)com,

5.      Mr Naveen Thomas, +919342858056, navthom(at)gmail(dot)com,


http://novartisboycott.org/petition

 

 

 

#India-The right to food security #mustread


BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8273 (Published 10 December 2012)

Cite this as: BMJ 2012;345:e8273
  1. Veena Shatrugna, formerly deputy director, National Institute of Nutrition1,
  2. R Srivatsan, senior fellow2

Author Affiliations

  1. veenashatrugna@yahoo.com

Communities must push back against global policy decisions that fuel Third World hunger

The report from the Right to Food and Nutrition Watch published during October 2012 considered the effects of globalised food policies on populations in the Third World.1 It offered a very different perspective on food insecurity than that provided by official United Nations/World Bank documents. The authors of the report considered food security in light of social determinants of nutrition, such as food availability, agricultural policy, land transactions, cropping patterns, and agricultural finance. The report focused on the lack of accountability of large food producers that also own vast tracts of land to the people who face hunger and who have a right to food. Their damning indictment is that “the right to food of people around the planet has primacy over the need to fuel cars and economies in the European Union or North America.”

The report included a review of the progress of the Committee on World Food Security (an international body set up by the UN) after it was reformed in 2009 to include people’s organisations. The report stressed the importance of keeping the right to food as a benchmark in policy decisions. The World Trade Organization routinely takes major policy decisions that affect communities’ right to food without due consideration. Other offenders include international investment groups that negotiate the terms of bilateral trade agreements, public-private partnerships that promote directly delivered medicalised nutritional intervention, and those that engage in speculative trading in food. The report reviewed finance capital in agribusiness and outlined the devastating effects on poverty of speculative trading in food. Speculation on food prices has resulted in dangerously volatile food prices since 2007. Agribusiness trades through individual contracts and with little market transparency. The source of finance is surplus funds in the West, but speculation wreaks havoc and impoverishment in the Third World.

The report also presents several case studies that are eye openers to what happens on the ground. They illustrate, for example, how coercive land acquisition (grabbing)—a historical legacy of colonialism in the Arab Spring countries—and allocation of prime agricultural land to non-local industry cause food crises and impoverishment in agricultural communities. The increasing diversion of agricultural land away from food farming and to the cultivation of biofuels needed by Western countries is another major problem currently contributing to hunger in Africa. Widespread economic havoc has been caused in Mexico under the unfavourable North American Free Trade Agreement, which sees Mexico trading agricultural commodities with the United States.

India has had enormous growth in gross domestic product with no evidence of a trickle down effect. In 2006 it was estimated that 51.5% of Indian children were stunted and 54.9% were underweight. About 34.6% of adults reportedly had a body mass index of less than 18.5.2 It seems that there has been little recent change.

India’s long term food policies have resulted in an epidemic of stunting and decreased muscle mass in the children of poor families. Indian national policy has for decades emphasised cheap cereals as the major source of energy for its population. In a 1968 publication, nutrition experts suggested that a mixture of cheap foods like cereals, pulses, and vegetables could provide a mixture of amino acids that was very nearly as good as if animal proteins were consumed.3 This particular statement was reproduced in the 1971 edition of the Indian National Institute of Nutrition’s report Nutritive Value of Indian Foods and every reprint until the latest in 2011. Furthermore, it has influenced policies on food and wages, including the calculation and classification of the “poverty line.”

In 1970, people were regarded as being above the poverty line if they could afford to consume 10 042 kJ (2400 kcal) daily from the cheapest food source. Minimum wages were then calculated to provide this level of intake for a family of five on the assumption that they would consume cheap cereals. The famous “myth of protein gap,” based on an observation in 1971 that undernourished children (1670-2090 kJ daily deficit) could consume adequate protein (20 g/day) from cereal if only “they ate more of their usual foods,” changed the way the diets of poor adults and children were regarded.4 Promotion of a cereal-pulse vegetarian diet effectively removed animal proteins from Indian diets.3 Even consumption of pulses diminished over time. The more affluent vegetarians, a minority, consumed adequate daily protein requirements through sources such as milk and almonds.

In addition to widespread malnutrition and stunting, which underpins negative metabolic consequences in adulthood, more than 70% of women and children in India have anaemia and deficiencies in intakes of most vitamins and minerals.2Against this background of chronic poor nutrition, more food shortages have worsened malnutrition and hunger in the Indian population. A more recent concern in India, however, is the complex association between adult onset obesity and food insecurity. Accumulating evidence suggests that, although severe food insecurity leads to wasting, mild to moderate food insecurity is associated with obesity.5 This hunger induced morbidity pattern will continue to plague India for decades.

The Right to Food and Nutrition Watch 2012 report concludes by discussing how hungry people can regain control over those decisions that affect their food and nutritional situation. The authors highlight several successes, including the first international instrument that applied a human rights approach to agree on tenure of natural resources—the new Guidelines on Responsible Governance on Tenure of Land, Fisheries and Forests. These guidelines were adopted in May 2012 by the Committee on World Food Security after an inclusive and participatory process. They urge communities to occupy the newly created political spaces for inclusive decision making on food and nutrition.

Notes

Cite this as: BMJ 2012;345:e8273

Footnotes

  • Competing interests: Both authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

References

  1. Right to Food and Nutrition Watch. Who decides about global food and nutrition? Strategies to regain control. 2012. www.rtfn-watch.org/fileadmin/media/rtfn-watch.org/ENGLISH/pdf/Watch_2012/R_t_F_a_N_Watch_2012_eng_web_rz.pdf.
  2. National Nutrition Monitoring Bureau. Diet and nutritional status of population and prevalence of hypertension among adults in rural areas. Technical report 24. National Institute of Nutrition, 2006. www.nnmbindia.org/NNMBReport06Nov20.pdf.
  3. Gopalan C, Rama Sastri BV, Balasubramanian SC. Nutritive value of Indian foods. National Institute of Nutrition, 2011.
  4. Gopalan C, Narasinga Rao BS. Nutritional constraints on growth and development in current Indian dietaries. Indian J Med Res1971;59:111-22.
  5. Townsend MS, Peerson J, Love B, Achterberg C, Murphy SP. Food insecurity is positively related to overweight in women. J Nutr2001;131:1738-45.

Global Health and Feminism


One of the symbols of German Women's movement ...

One of the symbols of German Women's movement (from the 1970s) Deutsch: Ein Logo der deutschen Frauenbewegung (aus den 70er Jahren) (Photo credit: Wikipedia)

Feminism might be a taboo word within academic medicine, but it clearly has made an important contribution to global health

By Richard Smith

The Lancet, the leading journal for global health, has mentioned feminism only twice in its 189 years. The BMJBritish Medical Journal– hasn’t mentioned it at all. Does it indicate that feminism has had no impact on global health? All three speakers at a meeting at the London School of Hygiene and Tropical Medicine in January this year, strongly disagreed.

Richard Horton, editor of the Lancet and a man, told us that the Lancet had mentioned feminism only twice, and Tony Delamothe, deputy editor of the BMJ and another man, told me that the BMJ had no entries. I, a third man, didn’t check, but Jane Smith, another deputy editor of the BMJ and a woman, did. She found that theBMJ has had 102 mentions of “feminism” and 302 mentions of “feminist” and the Lancethas 23 mentions mentions of “feminism” but none of “feminist.” Thank God for women.

One reason that the journals might not have mentioned it is because “feminism” is a taboo word within academic medicine, said Richard Horton, editor of the Lancet. Lori Heise, one of the speakers and a senior lecturer at the London School, said how she had to think carefully before “coming out” as a feminist.

Feminism can mean many things, said Andrea Cornwall from Sussex University, but all definitions coalesce around inequalities and inequities. It is a political practice concerned with reducing those inequalities and inequities—and such a programme is central to global health.

Read more here

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