Happiness Index and Women’s Reproductive Rights in Bhutan- By Youth Champion Wangchuk Dema

Y-PEER trainees watching video clips on safe abortion and gender equality

Y-PEER trainees watching video clips on safe abortion and gender equality

Bhutan is a country known for measuring its progress by the Gross National Happiness rather than the monetary index used the world over ! https://www.theguardian.com/world/2012/dec/01/bhutan-wealth-happiness-counts

While this is wonderful idea that has earned praise, there is still much to be done in terms of women’s health and rights issues to ensure their happiness……

The difficult terrain and simpler life means access to emergency healthcare is not always easy or prompt. This has led to an extremely high maternal mortality rate which hovers around 180 even now.

Currently 26% of its population is under the age of 25 and in this context Y-PEER Bhutan recently conducted a five-day National training of trainers. The discussions focused on sexual and reproductive health including safe abortion, fertility and pregnancy, and the challenges posed by sexually transmitted infections.

During the discussions on early pregnancy a major concern that emerged was the impact on the girl’s health as her body would not be prepared to deliver a baby and later, there could be post-pregnancy complications. Discontinuing studies, financial instability, abandoning of child by father, stigma from society, were identified as social and cultural issues that may even be a trigger for the girl to commit suicide.
These apprehensions then led to a discussion on access to safe abortion services. At present in case of an unwanted pregnancy, women and girls are unable to access safe abortion services since there is no law or policy document specifying if it is legal in Bhutan. In such a situation these women and girls are forced to cross the border to get an abortion done which could be unsafe and dangerous. Through the discussions the participants came to an understanding that Bhutan is no exception in terms of unsafe abortion and that unsafe abortion amongst young women is a major health risk.

On the fourth day of the training the participants discussed at length early pregnancies which are unplanned/unwanted pregnancies and their root causes – the most common cause identified by participants was the unmet need for contraception among the youth; even though contraceptives are available, they are not easily accessible. This means that young girls and boys are embarrassed to go and get the contraceptives, which largely emerges from the lack of comprehensive sexuality and reproductive health awareness.

The trainers recommended to the participants that they could either contact the Y-PEER in most parts of the country (in about 9 institutes) or else, there are three Adolescent Friendly Health Services in the country. The session ended with screening of a video on safe abortion and gender equality, which actually motivated a lot of them and helped them understand the importance of reproductive health and rights among young girls than boys.

The outcome of the sessions and discussions was that many of participants had come with the notion that abortion should remain illegal as it goes against the teachings of Buddhism. As the training proceeded, first discussion on abortion convinced a handful of participants that abortion should be legalized while others remained unmoved. However, in the second discussion, everyone was convinced except two. Fortunately, during the very last session on abortion, they also understood our perspective and the need for safe abortion services for women and girls as a health and rights issue.

We hope that soon the happiness index for women and girls in Bhutan will also include their happiness at being able to understand and control their bodies and their fertility!

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The A Project – Rola Yasmine

Rola_yasmine_photoRola Yasmine is the founder of The A Project (www.theaproject.org) in Lebanon. She is a trained Registered Nurse with a background in Sexual and Reproductive Health Research. She started the A Project because she felt that there is a need to look at sexual and reproductive health and services through a gender lens and feminist politics. She started this project through a small grant awarded by ASAP as a Youth Champion.

ASAP: Can you talk about the inter-linkages between sexual violence and abortion rights in your work with displaced/refugee women?

ROLA: I think actually focusing only on sexual violence may not necessarily be the only angle to talk about displaced citizens and violence against women. I think to some extent people want to see more of sexual violence in refugee settings because there’s a demand to have images that pity and victimize women. But there is so much violence against women who are displaced that is not necessarily sexual by nature. I think that institutionalized racism and xenophobia limits refugees’ access to all sorts of basic services, especially for reproductive health and safe abortions and that is also violence against women.

ASAP: Can you give specific examples of refugee women’s experiences while seeking sexual and/or reproductive services?

ROLA: Women tell me that they go to pharmacies to get contraception or to get misoprostol and pharmacists harass them not because they want to do abortions but because they are Syrian, blatantly saying “is this really the time for you people to be procreating?” These kinds of statements are not only said by pharmacists but also from physicians, midwives and nurses, and not only Lebanese but also Syrian doctors and midwives of middle class upbringing.

The educated middle class do not see that even in the middle and upper classes people have unprotected sex all the time and that women become pregnant and have unwanted pregnancies, they just have money enough to cover it up. The lives of people in poverty are just so exposed and so transparent so it’s so easy to point at them and say “wow you guys are really behind.”

ASAP: Can you talk about women’s experiences accessing abortion?

ROLA: One woman called us from a refugee camp in the North of Lebanon; she was a widow and had 2 children, one whom had an untreated serious health condition of Hydrocephalus. She re-married thinking that it may help her take care of her children, but the man she married was a divorcee who had a child that he wanted someone to take care of which is why he was looking to remarry. He was physically violent and severely abusive and would keep threatening her with divorce although he gave her nothing in monetary value to her or her kids. She was looking for an abortion, but it was a little difficult and when she finally asked for it she faced resistance. She started taking all sorts of over the counter medication.

While less frequent, there have been callers who have faced sexual violence and rape and calling for post-abortion care. A widowed Syrian woman was raped in a refugee camp and she couldn’t tell anyone about the rape because it was a powerful and violent Lebanese man in the camps. She was worried that if she said she was raped, people may think she was doing sex work.

ASAP: What is the role played by the International NGOs (INGOs) involved ?

ROLA: Service providers in INGOs asking women if they are married may be a deterrent to care for those who are separated, widowed, unmarried, divorced, and/ or doing sex work.

Many women have said that they keep getting told to come to counseling and mental health sessions to talk and re-talk rape that she’s experiences and process it, while they are usually looking for safety from a repeat offender or an abortion if the rape resulted in a pregnancy.

It isn’t surprising that talking to a counselor isn’t on the top-ten list of needs to many refugees. What is upsetting is that you hear service providers wrongfully presume that refugees reject mental health counseling because of the stigma around the field and it not be seen as a real science – when it’s just seen as a bit of a luxury at this point or foreign practice at any point in their lives.

ASAP: What do you see as the role of The A Project in this context?
The A project works on giving information about reproductive and sexual health as well as referrals subsidized or free services. We work on politicizing the conversation around sexuality and gender intersectionally, whether with local activists or healthcare providers. We work on producing feminist research and knowledge that responds to the patriarchal hegemony that demonizes and problematizes the agency and autonomy of young women, queer women, refugee and migrant women, sex workers, and gender non-conforming folks. Recently, we published a commentary piece in Reproductive Health Matters on systemic violence against Syrian women in Lebanon and how it compromises their access to reproductive and sexual health, you can check it out here; http://www.rhm-elsevier.com/article/S0968-8080(16)30008-8/fulltext

ROLA: “Part of the A Project really is the launch of a Hotline to talk about all things to do with sexuality and gender so you don’t get a washed down answer on how effective a condom is and its 3% failure rate. But you talk about the politics of how it’s really difficult to negotiate it sometimes, the barriers that aren’t as easy to quantify. So it is to have the conversation within feminist politics and expose medical patriarchy. We also do political sensitization trainings for health care providers.”

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Menstrual Regulation in Bangladesh: is the law effective enough?

Meena, a 17-year-old girl went to a traditional birth attendant to terminate her unwanted pregnancy. The attendant inserted a tree branch into her uterus. This caused severe pain and heavy bleeding. Although the pregnancy was terminated, when in later years she tried to get pregnant, she was told that the unsafe abortion method had damaged her uterus.

Like her, every year, around 572,000 women suffer from unsafe abortion in Bangladesh (research data from the Guttmacher Institute).

Bangladesh is dealing with the topic of abortion in different ways. In the history of Bangladesh, abortion was legalized after the liberation war for those women who had been raped during the war. Later in 1976, Bangladesh National Population Policy tried to legalize abortion for the first trimester but was able to expand it only to allow when a woman’s life was in danger. Menstrual Regulation (MR) was introduced to the people of the Bangladesh in 1979. It has been practiced since then effectively as an alternative to abortion. However the penal code from 1860 is still in place, which means that an induced abortion is illegal unless the woman’s life is at risk.

Now the question arises, what is Menstrual Regulation? It is a procedure that uses manual vacuum aspiration to control fertility so it is not possible to be pregnant after missing period. In Bangladesh, it can only be performed with a maximum limit of 10 – 12 weeks after a woman’s last period and without a test to confirm pregnancy.

MR services have been decentralized and are officially available free of cost in the public sector. Despite this, according to the research, many women still end up with unsafe abortions. Although MR is free in the country, there would be additional charges if the pregnancy is beyond 10 weeks. In addition to that, low level of education and lack of awareness is also a barrier. Only 9% MR users reported getting the information from trained family planning workers. One third of the facilities that could provide MR services either lack trained staff or equipment or both. In some cases service providers turn women seeking MR services away.

Giving training to service providers on MR is not enough. They need adequate knowledge on reproductive rights and MR laws in Bangladesh. Furthermore, proper facilities and equipments are the matter of subject to provide safe MR services. Educating women on the availability of MR services and danger of unsafe abortion is required to make the MR Law more effective.

References:

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Abortion is Black and White!

May 28
May 28th is commemorated as International Day of Action for Women’s Health. Every year activists across the globe call upon governments to ensure comprehensive, inclusive, and rights-based approach to women’s and girls’ health. The theme for this year is ending institutional violence in all its forms, including the denial of the right to access to safe abortion. See- http://www.may28.org

In the recently concluded Women Deliver Conference held in Copenhagen, it was rightly acknowledgedIt’s impossible to holistically address the health, rights and well-being of girls and women without discussing abortion and women’s right to choose”. The sustainable development goals 2030 recognizes “access to safe, legal abortion as an essential intervention in a package of comprehensive sexual and reproductive health (SRH) services that should be available to all women; regardless of age, ethnicity, gender identity, geographic location, marital status, race, religion, socioeconomic status or migration status.”

Because abortion is a deeply politicized issue, policy makers and governments often choose not to acknowledge it as a fundamental human right. May 28th we take this opportunity to remind the policy makers, that women will only be truly empowered when they have autonomy over their body and access to safe abortion is a pre-requisite to achieving this reality.

ASAP along with its Youth Champions has launched a campaign “Abortion is black and white. Women who need an abortion, should get a safe abortion.” our youth champions did a very powerful photo shoot and created a video calling upon policy makers to ensure stigma free access to safe abortion services for women across the globe.

 Watch video here- https://youtu.be/pF6N6eOkjUI

 According to recent study by Guttmacher Institute Abortion rates have declined significantly since 1990 in the developed world but not in the developing world.” Ensuring access to sexual and reproductive health care could help millions of women avoid unintended pregnancies and ensure access to safe abortion.

 We urge you to share this video widely and join us in preventing women dying women from unsafe abortion.

 For more on how you can contribute visit- http://asap-asia.org

 

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Reflection from the 4th Youth Refresher Institute for Safe Abortion Advocacy- By Pushpa Joshi

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The 4th YRI for safe abortion that took place from 28th March to 30th March in Mumbai was really an unforgettable learning experience for me. I really felt sorry for myself for not being able to attend the 1st day of the advocacy institute due to cancellation of the flight on 27th March. Though we missed the 1st day, we definitely enjoyed the rest of the training.

The sessions were eye openers and extremely useful for the young advocates like us. I was overwhelmed by the role-play session; we learned how to deal with possible difficult questions and arguments, especially by anti-abortion advocates. The sessions conducted by senior Youth champions from previous institutes were remarkably inspiring. Refresher institute provided an opportunity to learn and share with such versatile young and talented mentors in the same space and encouraged me to work more rigorously for the sexual and reproductive health and rights of women.

The sharing from the youth champions from different countries of Asia, including Phillippines, Bangladesh, Sri Lanka, Myanmar, Nepal and India made the training more diverse and enlightening. It gave us insights on the everyday plight and struggle of women and girls for reproductive justice. From that, I gained an understanding that the problems being faced by the women regarding reproductive health and safe abortion all over the world are more or less the same. Even though Nepal has comparatively progressive laws on women’s access to safe abortion safe abortion, but even now 47,000 women still die every year due to unsafe abortion. This shows that having legal and safe abortion access is not enough as dominant stigmas and lack of information adversely affect women’s access to safe abortion services.

Through Youth Advocacy Network in Nepal with regular mentorship by Asia Safe Abortion Partnership (ASAP), we are and will always be working for women’s access to information and stigma free safe abortion access.I am reminded of a quote by Martin Luther King Jr. “Injustice anywhere is a threat to justice everywhere”, being a youth champion of ASAP from Nepal, I am not only responsible to advocate within Nepal but with collective effort and support of youth champions from across the region I will continuously work for reproductive justice for women from all over the world.

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