Utilisation of maternal health services in Ethiopia: a key informant research project

This article explores the application of key informant research to examine barriers and facilitators to maternal health services in rural and pastoralist Ethiopia. The key informants were health extension workers (HEWs) who assist women with birth preparedness and facilitate timely referral to health centres for birth. While women encounter many barriers to giving birth in health facilities, where HEWs are supported by their communities and health centre staff, they can effectively encourage women to travel to health centres to give birth with skilled birth attendants rather than at home with unskilled relatives or traditional birth attendants.     

Older women, health, and social care in Singapore

A key demographic feature in the high-income country of Singapore is that women have longer years of life than men, and the aging pattern in Singapore is similar to that of Northern Europe. This paper describes how this current generation of older Singaporean women aged 65 and above experiences declines in health status and well-being as they age. Their vulnerability is the higher risk of chronic illnesses stemming from longer life expectancy and a lower likelihood of access to appropriate health and social care. This is because health and social care in old age are mainly financed by individual out-of-pocket spending which includes support from adult children. Unlike Northern Europe, Singapore does not yet have a well-developed social welfare system to support women in old age.     

The small miracle

Although the standard argument for distributing birth control pills throughout the Third World is that they are less dangerous than pregnancy or abortion, irregular use of the pill increases riks of both. The irregularity of use can be attributed to both poor delivery systems and side effects. Side effects occur because of poor screening and lack of alternative dosages. Because of the lower price of buying in bulk, family planning groups distribute only 1 kind of pill. The woman who experiences side effects, e.g. headache, dizziness, weight gain, depression, has no choice but to discontinue use. Few women are screened by having their blood pressure taken, therefore the pill exacerbates illness in those with circulation problems. Breast-feeding mothers who take the pill provide less sustenance from their breastmilk, which can increase infant mortality rates. In Bangladesh a USAID-funded study on contractive distribution found that the "trained" family planning workers did not know what advice to give a woman who missed her pill on 5 consecutive days, or what type of side effects might be anticipated, or how many days after the onset of menstruation a woman should begin the pill. A more level headed approach to delivery of contraceptives in developing countries is needed.     

Women in water management: the need for local planning

This article on women's role in water resource management is based on a paper delivered at a seminar organized at the Water and Land Management Institute in Anand, India, in 1994. The article reflects Family Planning International's (FPI) experience in community-based water resource development. Most analyses of village and household water management data exclude women's role. The reasons are identified as the lack of inclusion of women's thinking in land-development research and planning, the dominance of males in planning and consequent male assumptions made about women's work and use of water, the lack of valuation of the nonmonetary nature of women's relationship to water, and the ease of ignoring women. Women's roles that are obstacles to inclusion in research and planning are identified as the lack of effective women's lobbies, the undervaluation by women of their work, and the lack of professional recognition of women as potential users of water or spokespersons for more than their own self-interests as women. National water policies are shifting to community-based management because local authorities are in daily contact with users, of whom about 50% are women. Historically national policy shifted from attention to distribution of investments in the water sector to reorganization of water agencies and to building up the capacity of private or voluntary agencies. The local context allows for more efficient and effective responses to local conditions. Local institutions and groups are better equipped to solicit local participation. One primary lesson learned by FPI is that local water resource planning is very important in strengthening the economic and individual capacity of poor people in underdeveloped areas. FPI's experience in Mahesana, Banaskantha, and Sabarkantha in Gujarat state supports this lesson learned. Water resource development policies resulted in mixed outcomes, and national control has been inefficient and disrespectful to local authorities. Another obstacle in Gujarat to water resource development is identified as increased demand for public water services and inadequate provision of services due to remoteness of the area and financial limitations of central agencies. Infrastructure is poorly maintained.     

Participatory appraisal in the UK urban health sector

Rapid Rural Appraisal (RRA) and Participatory Rural Appraisal (PRA) emerged in the context of working with rural communities in developing countries. But the principles of participation and of action-oriented research are equally valid for development work in the urban sector, and in industrialised countries. This article describes the use of participatory appraisal techniques in disadvantaged communities in the UK, in the fields of health and social welfare. Drawing on a case-study of her work, the author looks at the practical, organisational, and political difficulties inherent in bringing together multi-agency professionals and public-sector workers, and members of local communities, and in developing a functional consensus between them.     

“I know! I live here”: poor women and the work of empowerment

To trace the effects of empowerment programmes in the Global South, attention needs to be focused on the everyday practices of frontline staff, or fieldworkers, who convey empowerment ideas and practices at the grassroots. This is especially critical when fieldworkers work in the marginalised communities where they also live. Instead of looking outward towards a programme’s outcomes, this article turns inward to examine the impact of women fieldworkers’ dual experiences of development on their decisions and practices in the field. The ethnography of women fieldworkers in a government-led women’s empowerment programme for the poor in Delhi, India reveals the uneasy relationship of women’s empowerment to the larger contradictory development paradigm that they work within. Fieldworkers used their experiences as poor women to meet programme quotas, while also side-lining social change in favour of shielding clients from ineffective programme activities.     

Globalisation and women in India

Globalization arrived in India through an external and internal alignment of political and economic forces that led to the opening of the country to the outside world. The five processes under globalization are: 1) commercialism wherein more services become monetized and incomes are received in money rather than in kind; 2) more capitalization; 3) foreign trade becomes important for the production and distribution process; 4) greater financialization develops; and 5) international capital moves freely. These changes affect women more than men in different ways. Capitalization results in more self-employed marginal farmers becoming wage workers, making it less possible for women to manage domestic duties alongside their productive work. In general, macro-economic policies affect women through the household, market, and gender relations. In countries like India where women suffer from serious discrimination, whatever affects the household will worsen women's position. Thus, the process of liberalization, privatization, and globalization will put the clock back for women and for the poor in general.     

Assessing the fit of RapidSMS for maternal and new-born health: perspectives of community health workers in rural Rwanda

This article examines field results that show the potential for mobile health (mHealth) technologies to support community health workers (CHWs) in delivering basic maternal and new-born services in Rwanda. The fit of RapidSMS, a UNICEF/Ministry of Health (MOH) mHealth technology is examined through focus groups with CHWs. The results highlight the need for more training in the use of RapidSMS, continued upgrading of mobile phones, devising innovative ways of charging mobile phones, and ensuring the availability of ambulances. We suggest that CHW supervision be a two-way process built into RapidSMS utilising real-time communication to enhance effectiveness.     

Dealing with hidden issues: trafficked women in Nepal

This article discusses approaches to dealing with prostitution in Nepal and exportation of women prostitutes to Asia and the Middle East. It is estimated that over 200,000 Nepalese women are in Indian brothels, and tens of thousands are exported each year to other countries and forced either into prostitution or other oppressive conditions. In Nepal, women prostitutes are rejected as wives or daughters, regardless of the reasons involved. Women Acting Together for Change (WATCH) organized a national public hearing in June 1995 on these issues. During the hearing, 11 women and one man shared their views about being forced into prostitution, the ineffectiveness of the law, and social rejection. Participants at this forum questioned the legal practice of human rights and decided that law was a hindrance. Government representatives on the "listening bench" responded defensively and argued that prostitutes were unwilling to use the law, but agreed that the government should punish traffickers and commit politically to ending the trafficking in women. Roundtable discussions among concerned people after a day of hearings decided to initiate a nationwide coalition against the trafficking in women. The alliance would consist of 17 people and include nongovernmental representatives, lawyers, women who testified, representatives of the National Planning Council, and representatives from women's groups. The sex trade is viewed as a part of the national economy and a very profitable enterprise. Extreme poverty and few employment options are strong incentives for the continuation of prostitution. Patriarchal norms reinforce the view of women as born for the sexual pleasure of men. Nepal's national economy and policies have contributed to family poverty and to migration to other countries where women are exploited. The forum revealed schisms in the government commitment to Article 20 of the constitution.     

Women and NGO professionalisation: a case study of Jordan

This article examines the impact of NGO professionalisation on the recruitment of NGO staff. Based on an in-depth survey of employees in 20 advocacy NGOs in Jordan, it demonstrates the gendered impact of professionalisation. The majority of NGO employees are highly educated women, often Western-educated, who work in NGOs primarily for career opportunities and because they are attracted by the NGO's goals. In contrast to existing literature, this article argues that gender considerations, such as job flexibility to accommodate household duties, play less of a role in determining the reasons why women seek work in NGOs and their degree of job satisfaction.     

Community involvement in constructing village health buildings in Uganda and Sierra Leone

Three public health projects in Uganda and Sierra Leone are used to illustrate a new approach to construction of health buildings in villages. Emphasis is placed on community involvement. The health projects were comprehensive and relied on health education, employment of local village health workers, and establishment of village health committees. The objective of community involvement was described as encouragement of people to change their own diets and living conditions. This approach to primary health care is considered to be a strong basis for sustainable social development. Each of the three communities initiated the building projects slightly differently. There was a range of structures: traditional meeting halls, simple rooms with imported materials and a pit latrine, new buildings combining local and imported materials and labor, new nontraditional buildings, rehabilitated existing nontraditional buildings with imported labor and materials, and temporary mobile clinics. Community involvement was at different levels. All three projects were the result of a combined effort of national governments or mission hospitals, nongovernmental organizations, and the host community. The following should be considered before beginning construction: a suitable site, appropriate staff accommodation, the likely motivation of the host community, seasonality, local materials available, availability of skilled labor, and design. A plan of work during construction should include a building design, site supervision, transportation of local and non-local materials, unskilled labor, and skilled labor. Village health committees with or without government help would be responsible for maintenance of buildings after construction. A key feature of this approach is the assessment of the community's ability and capacity to contribute.     

Management and safety of a medical mission: occupational hazards of volunteering

Medical aid missions involve travel to conflict or danger zones, posing safety risks in addition to the usual occupational risks arising from daily medical work. The note reports on a volunteer mission, using personal reports, anecdotal experiences, and the formal annual report to undertake an assessment similar to worksite assessments for hazards and control measures. Hazards were found to be prevalent, including physical noise and heat, infectious exposure from patients and local vectors, poor water sanitation, and psychosocial stress from unfamiliar environments and large patient numbers with limited means. Implementable preventative measures include increasing awareness with appropriate protective equipment usage and safety guidelines. Mission planning and management should also involve occupational health input.     

打击跨境诱拐儿童妇女的现状及措施

拐卖儿童妇女是最严重地侵犯儿童妇女权利的行为,也是人类社会绝对不能容忍的行为。杜绝这类犯罪需要国际间的通力合作。今天,非常高兴能够与越南妇联以及亚洲基金会和中国的同事们一起探讨反对拐卖儿童妇女的问题。一、中国拐卖儿童妇女犯罪现状分析拐卖儿童妇女犯罪可以有多种方法。为了更深入地了解该类犯罪在中国广西的现状,我们从被拐卖儿童妇女的去向分析拐卖犯罪的实质。当然,在我们调查的过程中,无论是一线的办案警察还是老百姓,也都十分关注被拐卖儿童妇女的去向问题。(一)在中国,被拐卖的儿童妇女至少有以下但不止以下4种去向:1.…     

The dynamics of contemporary local-government policies and economic development in West Papua

There have been enormous political, economic, and social changes in West Papua. Every governor of West Papua has designed programmes to boost economic development and reduce poverty. The influx of migrant workers under the ‘transmigration programme’ into West Papua has limited the job opportunities for indigenous people in the labour market. This article concludes that the local government's strategies failed to deliver suitable development programmes to the local people, which resulted in increased poverty, the continuing poor development of the education system, and the deterioration of the population's health condition, with a rise in the number of Papuans infected with HIV and AIDS.     

Combining worker and user interests in the health sector: trade unions and NGOs

This paper examines the relationship between workers in the health sector and users of health services as seen through two case studies of trade unions and NGOs working together, one in Malaysia and the other in South Africa. Despite a history of tensions between these two types of organisation, when they work together effectively the results can be influential. The Malaysia Citizens' Health Initiative has set up a separate organisation and now has the power to mediate differences between trade unions, NGOs, and the government. The partnership between the Treatment Action Campaign and the Congress of South African Trade Unions (COSATU) in South Africa is providing a unified voice demanding government action on HIV/AIDS.     

Who will guard the guardians? Amartya Sen's contribution to development evaluation

An Action Learning process integrated with Sen's Capability Approach can support development agencies to formulate interventions that enhance freedom. The authors show that putting this approach into practice has important implications for the manner in which ‘development’ is undertaken as an ideological project. It may help to examine and challenge those who hold power in development: the guardians. This finding is the result of an emergent Action Learning process that was initiated by applying Sen's principles to focus-group interviews with women who care for people affected by HIV and AIDS. One of the findings of these focus groups was that the participants valued the process because it opened a space for them to influence the work of the implementing NGO. Essentially, they could hold the implementing agency to account. Reflection on this outcome by the agency led to important shifts in processes that are more supportive of freedom.     

Chinese investment and European labor: should and do workers fear Chinese FDI?

The rapid increase in Chinese foreign direct investment (FDI) into Europe raises important questions about the implications of such for workers and organized labor in Europe: (1) does Chinese FDI flow more or less to regulated labor markets than do other investment sources?; (2) what are the strategies of works councilors and union representatives in dealing with real or expected investment from China?; and (3) how do individual workers view the propriety of Chinese FDI given China’s low-wage, labor-unfriendly profile in the global economy? Quantitative and qualitative data on Chinese FDI, individual opinions about China and globalization, and on strategies of labor representatives provide some leverage to preliminarily answer these questions. First, Chinese FDI does not seem to be more (or less) focused on investing in the least regulated labor markets than other sources of FDI. Second, interviews with works councilors and union representatives in Germany, France and the Netherlands affirm a cautiously optimistic view of Chinese investors as no more or less threatening to organized labor than other investors. Third, analysis of attitudes about Chinese and European interests in managing globalization suggest that less-skilled, more vulnerable, pro-labor-union workers in Europe tend to be more rather than less enthusiastic about Chinese management than their fellow citizens. These patterns suggest a surprising, if tentative, embrace by workers and their representatives in Europe of that investment.     

WaSH as a maternal health issue: three perspectives from rural Uganda

Inadequate water, sanitation, and hygiene (WaSH) knowledge and practices affect maternal and newborn morbidity and mortality. This article describes postpartum knowledge, resources, and practices in three rural Ugandan hospitals. A lack of WaSH resources was problematic for both staff and newly-birthed mothers who demonstrated a lack of knowledge about the appropriate use of WaSH resources and the links between WaSH and health protection. These results suggest that in addition to increasing the availability of medical interventions, basic preventative public health practices should be reflected in policy and practice integrated across the spaces inhabited by pregnant women to achieve improved maternal and newborn outcomes.     

Trade liberalisation in the garment industry: Who is really benefiting?

World trade is increasingly conditioned by the rules of the World Trade Organisation. In the case of the garment industry this means the phasing out of the Multifibre Arrangement, which has dominated trade in textiles and garments since 1974. This phase-out is seen as benefiting developing countries and criticism focuses on the manner in which the USA and Europe are holding up the process. However, it is important to look at who exactly will gain or lose. Not all poor countries will benefit. Furthermore, the main profits from garment production go to the Northern companies who control the industry. These companies will benefit from more open markets and associated competition between global suppliers. Meanwhile, for workers North and South, this increased competition brings insecurity and the threat of deteriorating conditions of work.     

Everyday health security practices as disaster resilience in rural Bangladesh

Health security is a relatively new concept in terms of how it is practised in disaster-prone locales. We observed 10 rural households in Bangladesh for four months using informal interviews, field diaries, and observation. The findings suggest that the everyday practises of health security involve the capabilities of “caring for themselves” in resource-constrained contexts. Understanding how households care for themselves prior to and during disasters presents an opportunity to examine how improved health might reduce the effects of disasters, ill health, and poverty. Some interventions are proposed to improve health security for poorer households in general and women in particular.