Category Archives: WHO

FGM: the Dynamics of Change

This blog, by Wikichild Co-ordinator Melinda Deleuze, is part of the Wikiprogress Series on the Wikiprogress Africa Network. This post provides a summary of the UNICEF report entitled “Female genital mutilation/cutting: a statistical overview and exploration of the dynamics of change.” 


When I first heard of female genital mutilation/cutting (FGM/C), I was mortified. Upon reading this UNICEF report, I realized that my previous impressions – that this practice it only occurs in small African villages and affects very few women –  were misconceptions. Only now is reliable data on FGM/C available, giving us a clearer picture about the practice, at least for all 29 countries where the practice is concentrated. The report addresses key questions: How many girls and women have undergone FGM/C? Where is the practice most prevalent? How does this concentration vary within countries and across population groups? 
This WHO report defines FGM/C as “all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons,” and the Organization categorizes the procedure into 4 types. In 2012, the UN General Assembly unanimously passed a resolution that banned FGM/C. Twenty-six countries in Africa and the Middle East have prohibited FGM/C by law; however, the legislation has proven ineffective. The practice remains widespread in 24 countries where FGM/C is illegal. 
There is a social obligation to perform the procedure and the belief that if one does not, then the consequences could include exclusion, criticism, ridicule, stigma or inability to find suitable marriage partners. Relatively few women reported concern over marriage prospects as justification for FGM/C, except in Eritrea and Sierra Leone. The primary benefit cited among men and women was social acceptance and preserving virginity.
In the 29 countries assessed, more than 125 million girls and womenalive today have undergone FGM/C, and in the next decade, another 30 million are at risk. There is a large variation in percentages of cut females across the countries. The countries are divided into 5 categories based on their prevalence levels of FGM/C. One in five cut girls live in one country: Egypt.
 
Variation among regions within a country can be striking, as seen in this map of Senegal (right).
The age at which the procedure is carried out varies across countries. In Somalia, Egypt, Chad and the Central African Republic, at least 80% of cut girls were between 5 and 14 years old. In Nigeria, Mali, Eritrea, Ghana and Mauritania, at least 80% of cut girls were younger than 5. Half of cut girls in Kenya were older than 9 when they had the procedure performed.
Initially, opposition towards the practice focused on health risks, which may have unintentionally encouraged medical professionals to carry out the practice. Traditional practitioners and, more specifically, traditional circumcisers usually perform FGM/C. Though, in countries such as Egypt, Sudan and Kenya, many medical personnel now complete the procedure. In Egypt, for example, 77% of procedures were carried out mostly by doctors, and around half of those procedures were performed at the girl’s home.
Ethnicitystill plays a strong role in some countries, as it may be a proxy for shared norms and values. Also, the practice remains to be a physical marker of insider/outsider status. This graph belowshows the degree of variability in FGM/C prevalence among ethnic lines by contrasting ethnic groups with the highest and lowest prevalence in countries.
Regarding religion, the practice is most prevalent among Muslim girls and women; however, it is also found among Catholic and other Christian communities. In Niger, for example, 55% of Christian girls and women have undergone FGM/C, compared to 2% of Muslim girls and women.
There is also a rural-urban divide, an incomedivide, and an education divide. In Kenya, for example, the percentage of girls in rural areas was four times that of those in urban areas. In most instances, daughters of wealthier families were less likely to be cut. In terms of education, the prevalence of FGM/C was highest among daughters of women with no education, and tends to diminish considerably as the mother’s educational level rises. The reason given for these trends is due to the fact that those in urban areas, in wealthier households, or with a higher educational level are more likely to interact with individuals and groups that do not practice FGM/C, shifting normative expectations around FGM/C as a result.
Supportfor the continuation of FGM/C varies across countries. In most countries (19 out of 29), a majority of girls and women think the practice should end (see graph below). Nevertheless, more than half the female population in Mali, Guinea, Sierra Leone, Somalia, Gambia and Egypt think FGM/C should continue. More men than women favored stopping the practice, especially in Guinea, Sierra Leone and Chad. When fathers were included in the decision-making, their daughters were less likely to be cut. 

FGM/C remains a complicated issue, and this reportdoes not give the whole picture; FGM/C is being performed outside these 29 countries, including  in Europe and North America. The fight against FGM/C has just begun. Stronger efforts will be essential in order to transform the cultural traditions and expectations ingrained in these societies. 

Fortunately, this report gives us a better understanding of FGM/C and, more importantly, an evidence base to begin measuring progress in this area. We know there have already been steps forward in terms of awareness, decreased health risks and legislative bans, but now we can track progress inside countries regarding specific population groups, procedures and attitudes. Hopefully, this evidence base will help us be more effective in promptly eliminating the practice.

Melinda Deleuze

*This week’s Wikiprogress spotlight is on the e-Frame Net (European Network on Measuring Progress).  

Abstinence doesn’t do the trick

This blog, written by Wikichild co-ordinator Melinda Deleuze, discusses the negative impact that adolescent pregnancies can have on the child, the mother and all of society. It is a contribution to the last day of the Wikiprogress spotlight on the Wikigender Network.

When I was 16 years old, I had one week of sex education required by my American high school. However, my state’s curriculum revolved around abstinence as the preferred means of birth control, along with fear as the method to encourage restraint until marriage. In my class, at least one girl, aged 15, already had an abortion before taking the course, and one boy, also aged 15, was a father. The course provided too little, too late. YES, abstinence has a 100% success rate. YES, it is the best way to avoid catching a sexually transmitted infection. NO, I’m not surprised that the US ranks second to last among the rich countries for number of teen births: 36 per 1,000 births among 15-19 year old girls (read more in this blog). 
Rich countries vs. the US in teen births (per 1,000 15-19 years old)
*Legend: In the lefthand graph, the UNICEF 
colors  represent the first, second and third 
Teen births per 1,000 15-19 year olds
Data from UNICEF’s 11th Report Card and KIDS COUNT Data Book

tiers of countries’ ranking. In the graph on the right, the colors match states with the country tiers. In this case,  the darkest blue indicates the 21 states which have a higher rate of teen births than the lowest ranking country (i.e. Bulgaria).

This year’s UN World Population Day focused on adolescent pregnancies, a persistent occurrence in both developing and developed countries. Around 16 million adolescent girls aged 15 to 19 give birth each year, according to the WHO. While there may be varying opinions on this issue, the fact is that adolescent pregnancies gravely affect the teen mother, the child and the rest of society (i.e. you and me). Despite misleading perceptions, these consequences can occur among married and unmarried adolescents in developed and developing countries for both intended and unintended pregnancies.

 How does it affect the well-being of the child?

The immediate health of children born to adolescent mothers is at risk, and the younger the mother, the higher the risk. This WHO Reportstates that “in low- and middle-income countries, stillbirths and death in the first week and first month of life are 50% higher among babies born to mothers younger than 20 years than those born to mothers aged 20–29 years.” Also, babies born to adolescent mothers are more likely to be pre-term, have a lower birth weight and have asphyxia, which all increase the baby’s chance of death or future health problems. Substance abuse during pregnancy is higher among adolescent girls, which contributes to a higher percentage of low birth-weight babies and infant mortality, along with other health issues.

How does it affect the well-being of the young mother?

First of all, the health of young mothers is severely compromised, as pregnant teenagers face double the risk of dying from pregnancy-related complications relative to women in their 20s.* This UNFA report summary states that “across developing countries, complications from pregnancy and unsafe abortion are the leading cause of death for girls aged 15-19.The younger the mother, the more she is at risk of maternal complications, death and disability, including obstetric fistula. Up to 65% of women with obstetric fistula developed this during adolescence, says this WHO Report. Additionally, adolescent pregnancies are at higher risk for sexually transmitted diseases. Younger girls are less likely to practice safe sex and make up 64% of all new infections among young people worldwide, states this UNFPA factsheet.

Additionally, adolescent pregnancy contends with secondary education. In developed countries, motherhood during adolescent years increases girls’ chances of dropping out of school. In the United States, teen mothers are 10% less likely to obtain a high school diploma, as shown in this UNFPA report summary. Whereas in developing countries, the longer girls remain in school, the less likely they are to become pregnant in their teens. In Timor-Leste, for example, total fertility rates vary from 6 to1 ratio births per woman with no education to only 2 to 9 ratio births for women with secondary schooling or above, as indicated in this Women Deliver background paper. Delaying childbearing also increases chances of obtaining a higher income and better careers, among with other aspects of well-being, such as mental and psychological.

How does it affect the overall well-being of society?

Adolescent pregnancies concern us all as they negatively impact the development of a society. This UNFPA report summary states that “investing in family planning helps reduce poverty, improve health, promote gender equality, enable adolescents to finish their schooling and increase labour force participation.” In the UN Secretary-General Ban Ki-moon’s message for this year’s World Population Day, he stated that “when we devote attention and resources to the education, health and well-being of adolescent girls, they will become an even greater force for positive change in society that will have an impact for generations to come.”

I’m grateful that the World Population Day addressed adolescent pregrancy. While we often talk about maternal and infant mortality rates, as well as low birth-weight babies, we overlook at times this major proponent. I hope that there can be more open conversations with teens in order to overcome some of the obstacles to preventing teen pregnancies. And believe me, teaching abstinence just doesn’t do the trick.

Melinda Deleuze

* Gennari, Pamela, J. 2013. “Adolescent Pregnancy in Developing Countries.” International Journal of Childbirth Education 28:57
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From the Bottom to the Top: One Step to Improving Global Sanitation

This article by Robbie Lawrence, Wikichild Coordinator, considers how global sanitation can be improved in the context of the International Federation of Red Cross’s ‘Getting the Balance Right’ report. This is part of the Wikiprogress #Health Series. 
“Communities in rural areas and urban settlements must be empowered to increase their resilience through access to safe water, improved sanitation and effective hygiene promotion.” Getting the Balance Right, International Federation of Red Cross, 2013

This post follows on from Wednesday’s blog on the dangers of diarrhoea by focusing on the disease’s chief causation: poor sanitation. Currently 3.4 million people die each year from water, sanitation and hygiene-related causes (Water.org). An estimated 2.5 billion do not have access to basic sanitation and 1.1 billion of those people practice open defecation. This is not only degrading but a severe health risk as fecal matter-oral transmitted diseases cause at least 1.5 million deaths per year in children under the age of five (Getting the Balance Right). As Gary White and Matt Damon so bluntly put it, by the time you’ve read this paragraph, another child will have died from something that is eminently preventable.  
In the same way that inequality has reared its head in the post-2015 discussions, forcing global leaders to consider how poverty reduction might be carried out more equitably in the future, it is evident that we need to address water and sanitation issues. The “Progress on Drinking Water and Sanitation 2012” report by the WHO and UNICEF highlights that, although the MDG target of halving the number of people globally without access to improved water source will be fulfilled by the MDG 2015 deadline, the target for sanitation is unlikley to be met.  
More often than not aid donors and development agencies have aimed at providing clean and safe water supplies rather than making sanitation a priority. As it stands, sanitation only receives 12 percent of global aid put towards combatting water and sanitation related issues. In the short term this trajectory make sense, since water is usually in more immediate demand, however, if diarrhoea and other hygiene related illnesses are to be dealt with, access to sanitation facilities must be increased. The ‘Getting the balance right’ report emphasizes that ‘neither water nor sanitations is more important: both elements are required to maintain and improve health and dignity.’
Water.org argues that the inability of philanthropic efforts to efficiently deal with the problem of poor sanitation has been a problem in the past. Even the money that has gone towards solving the issue has largely missed the goal of providing relief for those most in need. The organization recognized that if local communities were to make progress, independent of donors, then they must be viewed and view themselves as the owners of the project. Community ownership is the linchpin of Water.org’s philosophy. Without an active engagement from communities from the start of a project to its completion there is a strong likelihood that previously entrenched social norms such as public defecation will continue.
The ‘Getting the Balance Right’ report delivers a similar message, and uses a number of examples of community-based initiatives that have succeeded in improving sanitation. In Eritrea, a country where only three percent of its rural population has access to sanitation, the IFRC and the EU implemented a program focused on mobilizing and educating women in hygiene knowledge that reached a total of 145,000 people in 120 villages. By empowering these local women and providing them with  information, the program motivated them to become promoters of sanitation within their own communities. The Water.org website also lists various bottom to the top initiatives that have shown remarkable success rates. An Emory University review of a Water.org community based ventures in Lempira, Honduras reported that 100 per cent of the project sites were still operational after 10 years with 98 per cent of respondents satisfied with the system.
Since poor sanitation is now firmly in the crosshairs of policy makers and aid groups, it seems that the Water.org and IRFC have laid out a fairly effective framework for combating the problem. Changing intrinsic social norms from the routes of a community appears a far more effective means of catalyzing change than large, trickle down cash injections. The flow of international water aid must of course be rebalanced towards sanitation, but organizations, governments and NGOs need to go further and ensure that it reaches the right groups and individuals. The stark reality of IRCF’s report brings to light the vital role that sanitation plays in human health and dignity:  
“Let us speak clearly; the single largest cause of human illness globally is faecal matter. A society – regardless of how many clinics or water supply points it has – can never be healthy is human waste is not safely disposed of.” Getting the Balance Right



Robbie Lawrence

Childhood Pneumonia and Diarrhoea KILLS!

This article, by Ousmane Aly Diallo, Wikiprogress Africa Advisor, is part of the Wikiprogress Health Series. Wikiprogress Africa aims to  provide a platform for knowledge sharing on measuring progress and well-being in an Africa context. 

We know what works against pneumonia and diarrhoea – the two illnesses that hit the poorest hardest. Scaling up simple interventions could overcome two of the biggest obstacles to increasing child survival, help give every child a fair chance to grow and thrive, Anthony Lake, UNICEF Executive Director.


The Lancet recently published a series of papers on Childhood Pneumonia and Diarrhoea in collaboration with the Aga Khan University of Pakistan, in April 2013.  The series demonstrates that it is possible to eradicate the prevalence of these two diseases among children through a comprehensive strategy involving all the stakeholders and highlights the barriers that have enabled children’s death from it.

Pneumonia and diarrhoea are low in incidence in the developed world but remain serious health concerns in the developing world. Childhood Pneumonia and Diarrhoea are particularly lethal in the developing world; nearly 90% of the children who died from these diseases are from Sub-Saharan Africa and South Asia, according to a recent World Health Organization report.

Assessing  the global burden of childhood pneumonia and diarrhoea in the world,  Walker and Alii’s paper show that these two diseases remain the leading infectious causes of death in children younger than 5 years, and caused an estimated 700 000 and 1·3 million deaths, respectively, in 2011. 

According to the study, more than half of the burden (56% of severe episodes of diarrhoea and 64% of severe episodes of pneumonia) is upon 15 countries and among this category, 10 of them are Sub-Saharan Africa’s ones: Angola, Burkina Faso, Democratic Republic of the Congo, Ethiopia, Kenya, Mali, Niger, Nigeria, Tanzania, and Uganda. Most of these deaths could have been prevented through vaccines and other means of prevention according to this study. Besides, undernourishment constitutes another obstacle to these children’s survival. Any program to tackle childhood pneumonia and diarrhoea should include a facet on improving child nutrition.

Lack of national leadership in the fight against these diseases and a lack of financial resources are important bottlenecks. This, coupled with the inadequate training of health workers, and a lack of health indicators, are key obstacles that need to be addressed to lower the morbidity rate of pneumonia and diarrhoea among children and to improve their survival rates, for these authors.

The second paper on “Interventions to address deaths from childhood pneumonia and diarrhoea…” shows that scaled interventions could save 95% of diarrhoea and 67% of pneumonia deaths in younger children (under 5 years) by 2025. But to reach that goal, the emphasis must be put on community-level healthcare as it is the best way to reach the most exposed populations. 

This series show that childhood pneumonia and diarrhoea are serious health concerns in many developing countries, particularly in Sub-Saharan Africa, but that they could be eradicated through prevention (immunisation campaigns) and effective intervention. In its subject and objectives, this series echoes the recent publication by the World Health Organization and UNICEF, the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea. This plan aims to reduce by 75% (with 2010 levels as reference) the incidence of severe pneumonia and diarrhoea, as well as the death from both these diseases among children under-five. It also aims for a 40% reduction in the global number of children under five who are stunted since undernutrition is one of the key risk factor for children suffering from pneumonia and diarrhoea. There’s a global commitment to ending child death from preventable diseases and these two Lancet publications show that this objective is reachable if all means are galvanised.

Childhood diarrhoea and pneumonia are deadlier in low-income countries of Sub-Saharan Africa and South Asia than in the developed world. Closing the gap is one of the ultimate aims of the Lancet series as shown through different models, it is an objective that is within our reach.

To find out more about Wikiprogress Africa, click here

Ousmane Aly DIALLO
(Wikiprogress Africa Advisor)

Nutrition and Obesity Week in Review

This Week in Review blog is part of the Wikiprogress Health focus. See the full range of health articles on Wikiprogress

The theme of this Week in Review is nutrition and obesity as part of wider focus on health during April. Highlights from this review include: IDS UK’s new Hunger and Nutrition Commitment Index, a collaborative report from PBS News Hour and the OECD on obesity in America, a joint paper on global malnutrition from UNICEF, WHO and the World Bank and more.
*The Institute of Development Studies’ new Hunger and nutrition commitment index is a measurement of political commitment to tackling hunger and malnutrition in 45 developing countries. The index was created to provide greater transparency and public accountability by measuring what governments achieve, and where they fail, in addressing hunger and undernutrition.
*PBS News Hour has released its first commentary in a collaborative series with the OECD, which explores how health care and health policy in the latter’s member countries compare with the US. New data reveals relatively promising figures with obesity rates slowing in the America, England, France and Korea. However, these encouraging trends show that obesity has become one of the biggest threats in developed countries and increasingly so in emerging economies, as today’s article from the Guardianrelating to the growing problem of obesity, diabetes and heart disease in Africa shows.  The article references the OECD’s “Better Life Index” tool, which allows members of the public to firstly rank what they value in life and then see how their own country measures up on the topics they value most.
*For the first time UNICEF, WHOand the World Bankreport joint estimates of child malnutrition for 2011 and trends since 1990. The aim of the initiative is to alleviate the double burden of malnutrition in children, starting from the earliest ages of development. To find out more, visit our Wikichild page.
*While it was released last year, the EFA Global Monitoring Report has been an important touch point for preceding publications related to malnutrition, particularly in relation to its effects on children. Despite a decline in the global number of deaths of children under five from 12 million in 1990 to 9.6 million in 2000 and 7.6 million in 2010 (EFA 2012), this drop is not sufficient if the fourth Millennium Development Goal of reducing child mortality by two-thirds by 2015 is to be met. 

In 2005the WHO reported that more than half of all deaths among children are caused by malnutrition. It is therefore arguable that if governments seek to provide adequate quantities of higher quality food with more micronutrients, child mortality levels may drop to the targeted percentage. Malnutrition, through lack of both macronutrients and certain micronutrients has long-term negative impacts on brain and nerve development and function, including on mental skills and activity, and the acquisition of skills needed to interact well socially.
*A new report by UNICEF to be published next week reveals the high prevalence of stunting in children under five years old, but also outlines the tremendous opportunities that exist to make it a problem of the past. In response to nutrition crisis in Chad and the Sahel Belt region, UNICEF, the Government of Chad and partners such as ECHO have scaled up services and facilities to treat the growing number of children affected by malnutrition. Check out the video below to find out more about the initiative. 



Look forward to more health related articles, blogs, tweets, spotlights and videos over the next few weeks. 

Robbie Lawrence
Wikichild Coordinator  
The Wikiprogress Team