Eviction and homelessness: the impact on African children

More than 80 million African children lack access to healthy shelter, and 16 million of these children are living on the streets. This phenomenon of street children represents massive social failure as well as a violation of the United Nations Convention on the Rights of the Child. Urbanization--and the attendant processes of industrial expansion, land speculation, and "beautification"--has created a cycle of poverty, evictions, family disruption, and unwanted and abandoned children. In African cities, at least 60% of the population lives in informal, underserviced, and frequently illegal slums and squatter settlements in households generally headed by a single mother. Increasingly, eviction is being used as a strategy for driving the poor out of urban areas where they have come to seek work. Mothers who are themselves illiterate, malnourished, and constantly facing the threat of eviction are unable to meet their children's basic security needs. Moreover, violent evictions subvert children's educational and health status, cause psychological trauma and the loss of a sense of belonging, and exacerbate the household's precarious economic status. Nongovernmental organizations (NGOs) have been successful in preventing some evictions and have established programs for the care of street children. Recommended is improved coordination between NGOs and local and national governments, as exemplified by the urban child welfare task force established by the Kenyan Government. Above all, however, NGOs need to develop strategies for dealing more effectively with mass urban poverty and providing the necessary infrastructure to improve the lives of slum residents.     

The emergence of maternal-fetal conflict policies

George Washington University Medical Center's Policy on decisionmaking by pregnant patients is being widely circulated by the ACLU; copies of the Policy can be obtained by calling the American Civil Liberties Union Reproductive Freedom Project. There is, of course, much disagreement over the details of the Policy; not everyone will agree with its underlying philosophy favoring maternal rights. Nevertheless, there does seem to be a consensus that wherever possible these conflicts should be resolved in accordance with previously adopted policies rather than by the courts on an ad hoc basis. Had the Policy been in place in 1987, the Carder case would probably not have been submitted to a judge in the first place, nor would Angela Carder have been forced to undergo a Caesarean section. All hospitals should consider adopting a maternal-fetal conflict policy, and those that do so should be aware of the George Washington University Medical Center Policy, whether or not they agree with its provisions. Whatever policy each hospital ultimately develops should be integrated with decisionmaking and informed consent policies already in place. The formulation and implementation of such a policy, reflecting the hospital's legal and ethical obligations to its pregnant patients, will go a long way towards preventing unnecessary resort to the courts.