The April 7-10 health conference Cities and Women’s Health: Global Perspectives, the 18th Congress of the International Council on Women’s Health Issues, is underway at the University of Pennsylvania. Next American City is hosting a liveblog of the event.
By **Rachel Somerstein**
Is there a link between the health of a country’s democratic institutions and the extent to which women can experience free, unfettered labor? An initiative in Mozambique, run by the Johns Hopkins-affiliated Jhpiego program, suggests there may very well be.
In Mozambique, which only gained independence in 1975 and where life expectancy is a dismal 45 years, healthful, humane childbirth is seriously lacking. Hospitals are often ill-furnished (and perceived as such), and in many provinces hospital-based childbirth is highly regulated. In the past, women have been required to maintain specific positions during labor—despite their own preferences—and confined to their beds throughout. In what those in developed countries would consider a dated, gendered scenario, men are banished from the hospital rooms. Other women aren’t allowed in the birthing rooms, either, so mothers often give birth alone. And once they do have the baby, they are separated from their babies immediately.
As a result, many women choose to give birth at home—even though they don’t have the medicine or skills necessary to do so safely. The country’s mortality rates bear this out: 408 maternal deaths per 100,000 births; 48 infant deaths per 1,000 births.
In response, a so-called “humanization of childbirth” movement has taken shape, which Jhpiego’s Veronica Reis presented this morning. There’s something terribly ironic—and darkly funny—about the name; it sounds like something Jon Stewart or Stephen Colbert might dream up. The sad part is that it’s no joke. The program’s initiatives include:
—allowing for an accompaniment for the mother during the birth
—freedom of movement during labor
—choice of positions during childbirth
—immediate, skin-to-skin contact with the newborn
But what’s especially fascinating is the overt connection that women in Mozambique make between the program and their national self-identity. “This is what I call true independence,” said one mother who recently accompanied her daughter during childbirth—and who, presumably, had a very different experience than when she became a mother.
There are sentences that remain with you forever, images that become part of yourself for the rest of your life. I feel that way about the image of the dead puppy floating in the ocean in Joseph O’Neill’s Netherland (which had nothing to do with the plot), even though I didn’t much care for the novel. Same with Dexter Filkins’s description of a Jihadist’s head blowing off, which greets readers in the opening pages of his book, The Forever War. (His book I care for greatly.) Lexi Rudnitsky, before she died in 2005, wrote a lovely poem about this very topic called “Deepest Remains.” (The headline, which she quotes in her poem, comes from Walt Whitman.)
Conferences, while terrific for making new contacts and learning new things, don’t generally offer that type of bone-cracking image.
This afternoon proved the exception. The source: Dr. Susan Martin, Director of Georgetown’s Institute for the Study of International Migration in the School of Foreign Service. When in 1984 Martin visited refugee camps in Thailand, she said, the camps were filled with children and older people, but no adolescents. (The refugees had come from Cambodia.) It was clear, she said, that the young men had been inducted into combat. But where were the women?
“The pretty ones are in Bangkok,” someone finally told her. Translation: the brothels.
And what about the plain young women?
They had been forced—trafficked—into supporting the young resistance fighters. That meant sexual and domestic services—horrific enough. They were also responsible, said Dr. Martin’s source, for clearing the mines.
Clearing the mines? asked Martin. How would they do that?
By walking in the minefields in front of the men—so they get blown up first.
Evidently, Martin couldn’t get this out of her head either. So she did the only thing she could do: she wrote a book about it: Refugee Women.
As an instructor at Lehman College in the Bronx, where some 70 percent of the students are female, I was constantly exposed to the travails specific to school-age young women. One freshman, when asked to write an essay about a “memorable experience,” wrote about giving birth as a senior in high school. She wasn’t the only mother among the girls I taught, who were a decade younger than I.
But in many ways, my girls were the lucky ones. They’d made it to college. In the developing world, 1 out of 5 girls doesn’t finish sixth grade. In older grades, the numbers get worse: Only ten percent of girls who begin primary school make it to university.
It’s no coincidence that girls tend to drop out before sixth grade—it’s just when they are becoming sexually mature. Menstruation poses unique challenges for girls in the developing world, where battered copies of Judy Blume’s Are You There God? It’s Me, Margaret aren’t exactly floating around the house.
Some key challenges:
—Inadequate facilities. It may be difficult to imagine, but as Brad Kerner of Save the Children pointed out, many schools in the developing world—particularly in rural areas—don’t have a bathroom. Others have a bathroom without a door. Still others have a door that doesn’t lock.
—No access to, or availability of, sanitary pads.
—Misconceptions about puberty and menstruation, among adults and girls alike (one panelist spoke of a parent who punished her daughter when she got her period, believing it a sign that the girl, a ten-year-old, had had sex).
—Forced marriages at the first signs of sexual maturity, to ensure that girls don’t become pregnant out of wedlock and embarrass the family.
April 10, 11:22 a.m.
During her talk on planning safe urban spaces for women, Mexico City native Claudia Garcia-Moreno, Coordinator of the Department of Gender, Women, and Health at the World Health Organization , told the audience that 60 percent of women in Montreal are afraid of walking their neighborhoods at night. Only 17 percent of men feel the same.
That statistic illustrates two of the more complex issues that planners must account for when planning safe cities for women: actual safety—and the perception of safety. Although related, addressing actual public-safety issues is somewhat different from vanquishing a culture of fear. Especially because working-class and well-off women alike, from Manhattan to Manila, are accustomed to being afraid.
Garcia-Moreno says that making cities safe for women requires addressing multiple issues: transportation, criminal activity in general, adequate housing, gang violence, poverty, employment, child care. But this morning she focused most specifically on public transportation, which is key to making cities safe and livable for women (and all people). Poor urban women particularly need it in order to access health services and employment. Still, when it comes to traditional public transport models, women are at a disadvantage for several reasons:
They don’t usually use transit as a means of traveling from point A to point B and back, as traditional commuters might. Instead, women often make several stops, zigzagging across cities, as Garcia-Moreno put it, which can also result in paying multiple fares. Because they are often part of an informal economy, women also often travel during off-peak hours, when fewer buses and trains run.
Longer waits for buses and trains in poorly-lit or otherwise unsafe spaces make women especially vulnerable to crime, particularly sexual assault.
As too many women can tell you, a packed train often means harassment—verbal and physical alike.
Garcia-Moreno recalled that when she moved to London to attend the London School of Economics, she rode the Tube free from harassment (for the most part). That made her realize, she said, that in Mexico City she walked around all the time “with a growl” on her face, to fend off approaches. The freedom she experienced in London, she added, was powerful—a force not to be underestimated. This defensive posture is familiar to most women. And it contributes meaningfully to the culture of fear that informs—and impedes—women’s movement across cities, which can only hamper innovation and urban vitality for all people.
Partly as a result of such harassment, in Palwal, India trains include separate carriages for women and for men. That can create problems of its own, a fact to which the spectacular failures of segregation, and its attendant separate-but-equal infrastructure, can attest.
But women in Pune, India had a different idea to change the situation—one which has since been adopted: simply provide more buses to alleviate crowding, thereby thwarting those accidental-on-purpose physical advances.
Copyright 2010 Rachel Somerstein
These posts originally appeared on Next American City.
Rachel Somerstein’s essays and criticism have appeared in ARTnews and Next American City. She recently earned her M.F.A. from New York University and is presently at work on a collection of short fiction. She is a staff writer at Next American City.