Credit: WHO

By Mary Assunta
BANGKOK, Thailand, Jun 9 2023 (IPS)

The second session of the Intergovernmental Negotiating Committee on plastic pollution (INC-2), held in Paris, France, from May 29 to June 02, 2023, concluded with optimism and the prospect of ending plastics pollution. Over 700 delegates from 169 Member States agreed to prepare a zero draft of agreement ahead of the third session in November this year.

Among the more important and interesting debates, health advocates attending the negotiations reported that it was essential to discuss “how to categorize the thousands of types of plastics, chemical precursors and products in a way that allows for a coherent approach to ending plastic pollution.

Some favoured focusing on the chemical precursors, eliminating the most toxic and polluting ones,” while others acknowledged that not every type of plastic could be recycled or reinvented, and certain plastics like cigarette filters need to disappear for good.

Leonce Sessou, speaking on behalf of Action on Smoking and Health (ASH), Corporate Accountability (CA), African Tobacco Control Alliance (ATCA), and other members of the Stop Tobacco Pollution Alliance (STPA), urged Member States to align the future legally binding instrument on plastics with the public health objective of ending the tobacco epidemic, to which most have already committed via the WHO Framework Convention on Tobacco Control (FCTC).

Tobacco control groups, for example, called for the elimination of cigarette filters. They drew attention to the fact that cigarette butts are some of the most prevalent forms of plastic pollution on the planet and harm land and marine ecosystems.

They reminded delegates to align with human rights and health treaties, particularly the WHO FCTC, and make the tobacco industry pay for its pollution and legacy waste. The WHO FCTC health treaty seeks to reduce the supply and demand for tobacco and protect health policies by keeping the tobacco industry out of policy meetings.

According to a WHO report which called for a ban on cigarette filters, about 4.5 trillion discarded filters (butts) from the almost six trillion cigarettes consumed globally find their way into the environment annually.

They are the top waste item collected from coastlines and urban settings. Cigarette filters are small enough to be ingested by marine animals, and when these plastic filters break down, they release thousands of microplastic particles.

Microplastics have been detected in commercial seafood, other food items, drinking water, and human tissue; this contamination is a threat to food safety and security.

Research shows cigarette butts are a source of microplastic contamination that creates chemical pollution (due to the toxic chemicals found in tobacco products) that leach into the environment. Cigarette butt leachates are found to harm various forms of aquatic organisms, including key food sources for fish and shellfish.

Experts agree that banning cigarette filters is the best solution to this plastic and toxic waste problem. Clean-ups, anti-littering legislation, and redesigning filters for recyclability or biodegradability have not worked and are not viable solutions.

Government committees from Belgium, the Netherlands, and Denmark have recently called for a ban on filters and recommended the same for the rest of the European Union Member States.

For at least five decades, the tobacco industry has known that cigarette filters provide no health benefits; instead, they make cigarettes burn hotter, deliver more nicotine, and increase addiction.

Yet they have misled smokers into thinking filters make cigarettes “safer.” As awareness around smoking increased, the tobacco industry made advertisements for filtered cigarettes more appealing to pacify smokers’ concerns.

Advocates participating in the INC-2 reported a lot of misunderstandings related to cigarette filters that are yet to be addressed. In its blog on day 5 of the negotiations, ASH stated, “Many people, not just people who smoke, assume filters make cigarettes safer rather than more dangerous.”

Numerous countries already have a national policy banning single-use plastics such as plastic bags, straws, and cotton buds but have inadvertently not included cigarette filters. However, advocates speaking to government delegates found widespread support for a ban on cigarette filters.

As the possibility of a cigarette filter ban gathers momentum, the tobacco industry’s public relations (PR) machinery is already in motion implementing beach cleans-ups and cigarette butt collection activities through its corporate social responsibility (CSR) programs across the globe.

Before the third session of the Intergovernmental Negotiating Committee on plastic pollution (INC-3) resumes in Nairobi in November, governments must remember that the tobacco industry is not a stakeholder but a polluter that must be held liable for the myriad harms it has caused as well as continues to cause to human health and the environment.

Over 100 non-governmental health organizations of the STPA, along with other environmental groups such as Global Alliance for Incinerator Alternatives, Ecowaste Coalition, Break Free From Plastic (BFFP), Ban Toxics (Philippines), Our Sea of East Asia Network (OSEAN), Development Indian Ocean Network, Earthday.org (Earth Day Network), Green Africa Youth Organization, Vietnam Zero Waste Alliance, and Boomerang Alliance have called for the elimination of cigarette filters.

Mary Assunta is Senior Policy Advisor, Southeast Asia Tobacco Control Alliance (SEATCA)

IPS UN Bureau

Follow @IPSNewsUNBureau
  

"Remove corn and beans from NAFTA!" at a 2008 protest in Ciudad Juarez. It has been a longstanding demand the Mexican farmers' movement. Credit: Enrique Pérez S.

By Timothy A. Wise
CAMBRIDGE, MASS. , Jun 6 2023 (IPS)

On June 2, the U.S. government escalated its conflict with Mexico over that country’s restrictions on genetically modified corn, initiating the formal dispute-resolution process under the U.S.-Mexico-Canada Agreement (USMCA).

It is only the latest in a decades-long U.S. assault on Mexico’s food sovereignty using the blunt instrument of a trade agreement that has inundated Mexico with cheap corn, wheat, and other staples, undermining Mexico’s ability to produce its own food. With the government of Andrés Manuel López Obrador showing no signs of backing down, the conflict may well test the extent to which a major exporter can use a trade agreement to force a sovereign nation to abandon measures it deems necessary to protect public health and the environment.

The Science of Precaution

The measures in question are those contained in the Mexican president’s decree, announced in late 2020 and updated in February 2023, to ban the cultivation of genetically modified corn, phase out the use of the herbicide glyphosate by 2024, and prohibit the use of genetically modified corn in tortillas and corn flour. The stated goals were to protect public health and the environment, particularly the rich biodiversity of native corn that can be compromised by uncontrolled pollination from GM corn plants.

Where the original decree vowed to phase out all uses of GM corn, the updated decree withdrew restrictions on GM corn in animal feed and industrial products, pending further scientific study of impacts on human health and the environment. Some 96% of U.S. corn exports to Mexico, nearly all of it GM corn, fall in that category. It is unclear how much of the remaining exports, mostly white corn, are destined for Mexico’s tortilla/corn flour industries.

These were significant concessions. After all, there is no trade restriction on GM corn. Mexico is not even restricting GM white corn imports, just their use in tortillas.

Timothy A. Wise

No matter. In the U.S. government’s formal notification that it would initiate consultations preliminary to presenting the dispute to a USMCA arbitration panel, it cites a lack of scientific justification for the measures, denials of some authorizations for new GM products, and Mexico’s stated intention to gradually replace GM corn for all uses with non-GM varieties.

As Mexico’s Economy Ministry noted in its short response, Mexico will show that its current measures have little impact on U.S. exporters, because Mexico is self-sufficient in white and native corn. Any future substitution of non-GM corn will not involve trade restrictions but will come from Mexico’s investments in reducing import dependence by promoting increased domestic production of corn and other key staples. The statement also noted that USMCA’s environment chapter obligates countries to protect biodiversity, and for Mexico, where corn was first domesticated and the diet and culture are so defined by it, corn biodiversity is a top priority.

As for the assertion that Mexico’s concerns about GM corn and glyphosate are not based on science, the USTR action came on the heels of an unprecedented five weeks of public forums convened by Mexico’s national science agencies to assess the risks and dangers. More than fifty Mexican and international experts presented evidence that justifies the precautionary measures taken by the government. (I summarized some of the evidence in an earlier article.)

Three Decades of U.S. Agricultural Dumping

Those measures spring from deep concern about the deterioration of Mexicans’ diets and public health as the country has gradually adopted what some have called “the neoliberal diet.” Mexico has displaced the United States as the world leader in childhood obesity as diets rich in native corn and other traditional foods have been replaced by ultraprocessed foods and beverages high in sugar, salt, and fats. Researchers found that since the North American Free Trade Agreement (NAFTA) was enacted in 1994, the United States has been “exporting obesity.”

The López Obrador government recently stood up to the powerful food and beverage industry to mandate stark warning labels on foods high in those unhealthy ingredients. Its restrictions on GM corn and glyphosate flow from the same commitment to public health.

So does the government’s campaign to reduce import-dependence in key food crops – corn, wheat, rice, beans, and dairy. But as I document in a new IATP policy report, “Swimming Against the Tide,” cheap U.S. exports continue to undermine such efforts.

We documented that in 17 of the 28 years since NAFTA took effect, the United States has exported corn, wheat, rice, and other staple crops at prices below what it cost to produce them. That is an unfair trade practice known as agricultural dumping, and it springs from chronic overproduction of such products in that country’s heavily industrialized agriculture.

Just when NAFTA eliminated many of the policy measures Mexico could use to limit such imports, U.S. overproduction hit a crescendo, the result of its own deregulation of agricultural markets. Corn exports to Mexico jumped more than 400% by 2006, with those exports priced at 19% below what it cost to produce them. Again, from 2014 to 2020, corn prices were 10% below production costs, just as Mexico began seeking to stimulate domestic production.

We calculated that Mexico’s corn farmers lost $3.8 billion in those seven years from depressed prices for their crops. Wheat farmers lost $2.1 billion from U.S. exports priced 27% below production costs.

Thus far, the Mexican government has had little success increasing domestic production of its priority foods, though higher international prices in 2021 and 2022 provided a needed stimulus for farmers.

So too have creative government initiatives, including an innovative public procurement scheme just as the large white corn harvest comes in across northern Mexico. With corn and wheat prices falling some 20% in recent weeks, the government is buying up about 40% of the harvest from small and medium-scale farmers at higher prices with the goal of giving larger producers the bargaining power to then demand higher prices from the large grain-buyers that dominate the tortilla industry.

Swimming Against the Neoliberal Tide

With its commitment to public health, the environment, and increased domestic production of basic staples, the Mexican government is indeed swimming against strong neoliberal tides. Remarkably, it is doing so while still complying with its trade agreement with the United States and Canada.

Before U.S. trade officials further escalate the dispute over GM corn, they should look in the mirror and ask themselves if three decades of agricultural dumping are consistent with the rules of fair international trade. And why Mexico doesn’t have every right to ensure that its tortillas are not tainted with GM corn and glyphosate.

For more on the GM corn controversy, see IATP’s resource page, “Food Sovereignty, Trade, and Mexico’s GMO Corn Policies.”

IPS UN Bureau

Follow @IPSNewsUNBureau
  

Thembeni Mkingofa, a woman living with HIV, visits the PMTCT section of the Makhume District Hospital, Zimbabwe. She has three children - 14, 10 and 2 who are all HIV negative. This is her fourth pregnancy. Her husband is also on HIV treatment. Here she is pictured with her two-year-old daughter, Hilda Chakiryizira. 5 November 2019. Credit: UNAIDS/C. Matonhodze

By Winnie Byanyima and Sir Michael Marmot
BRASILIA, Brazil, Jun 5 2023 (IPS)

The COVID-19 crisis has shone a light on the danger of pandemics; social crises have shone a light on the danger of inequalities. And the reality is that outbreaks become the pandemics they do because of inequality. The good news is that both can be overcome – if they are confronted as one.

Scientific and medical breakthroughs in the treatment and prevention of HIV should have brought us to the point of ending AIDS. Tragically, however, although the number of new HIV infections is falling fast in many countries, it is still rising in dozens of countries and the goal of ending AIDS by 2030 is in danger.

The reason: economic and social inequalities within countries and between them increase people’s risk of acquiring disease and block access to life-saving services.

Letting inequality grow is driving pandemics and prolonging emergencies that drain economies and health systems. This makes all of us vulnerable to the next pandemic, while placing entire countries and communities of people in harm’s way.

In too much of the world we see policy approaches which leave inequalities to widen, and even, in some cases, deliberately exacerbate inequalities.

On a global level when wealthy countries quickly invest billions in their own medical and social response, while leaving other countries so burdened by debt they have no fiscal space to do so, that undermines the world’s capacity to fight AIDS and pandemics.

During COVID-19 while wealthy countries poured in billions to protect their economies, reduce economic and social hardship and fight the pandemic, almost half of all developing countries cut health spending and about 70% cut spending on education.

Shanenire Ndiweni, has a consultation to receive pre-exposure prophylaxis at the Centre for Sexual Health and HIV/AIDS Research Zimbabwe (CeSHHAR Zimbabwe) clinic, Mutare, Zimbabwe, 6 November 2019. Credit: UNAIDS/C. Matonhodze

Viruses do not respect borders, so when the vaccines, drugs, and tests intended to stop those viruses go to powerful countries in excess, while other countries have little or nothing and are held back from producing medicines themselves, that perpetuates pandemics everywhere.

Similarly, social and economic conditions that perpetuate pandemics in low- and middle-income countries present a global threat. Much as with COVID-19 the same has happened with the MPox virus.

In recent years twice as many people have died of MPox in the Democratic Republic of Congo as the entire rest of the world combined but, as of today, zero vaccines for MPox had been delivered to the DRC.

Social and legal determinants that make people vulnerable to pandemics must be tackled. Globally almost 5,000 young women and girls become infected with HIV every week. Dismantling barriers to sexual and reproductive health and rights services, investing in girls’ education, and combating gender-based violence to remove gender inequity is key to ending the AIDS pandemic and protecting women’s health.

Laws that criminalize and marginalize LGBT communities, sex workers and people who use drugs weaken public health approaches and prolong pandemics such as HIV. In sub-Saharan African countries where same sex relations are criminalized, HIV prevalence is five times higher among gay men and men who have sex with men than in countries where same sex relations are not criminalized.

Even within countries that are making substantial progress against HIV, advances may not be shared equally. Here in Brazil for example, HIV infections are falling dramatically among the white population as access to treatment is widened and new prevention tools such as PrEP are rolled out.

That shows what can be achieved; but HIV infections among the black population in Brazil are still on the rise. A similar story runs in the United States where gay white people are more likely to have access to good health care than gay black people.

We emphasize that it is not only access to health care that perpetuates these inequalities, but the social determinants that increase the risk of infection.

To overcome inequalities in accessing essential services, communities must be empowered to demand their rights. The AIDS movement is one of the best examples of how groups of people experiencing intersecting inequalities can unite to overcome them, leading to millions of lives being saved.

Successive Commissions on Social Determinants of Health have brought together evidence on how the conditions in which people are born, grow, live, work and age are powerful influences on health equity.

To bring together these two strands of knowledge over the coming months we will be convening global experts from academia, government, civil society, international development and the creative arts to build a Global Council to advance evidence-based solutions to the inequalities which drive AIDS and other pandemics.

The council will unite experts from disparate fields of economics, epidemiology, law, and politics and will include ministers, mayors, and former heads of state, researchers and clinicians, health security experts, community leaders and human rights activists.

The work of the Global Council will harness essential evidence for policymakers. It will elevate political attention to the need for action. Most crucially, it will help equip the advocacy of the frontline communities fighting for their lives, with what they need to shift policies and power.

Appropriately, the Global Council is launching in Brazil. Whilst Brazil has exemplified the challenges of intersecting inequalities, Brazil’s social movements have been pioneers in confronting them, and Brazil’s new government under President Lula has committed to tackle inequalities in Brazil and worldwide.

To fight tomorrow’s pandemics, we need inequality-busting approaches to today’s pandemics. The world’s leaders now face a clear choice: stand by whilst the dangers mount or come together to tackle inequalities for a world that is not only fairer, but safer too.

Winnie Byanyima is the Executive Director of UNAIDS and an Under-Secretary-General of the United Nations. Before joining UNAIDS, she served as Executive Director of Oxfam International, a confederation of 20 civil society organizations working in more than 90 countries worldwide, empowering people to create a future that is secure, just and free from poverty.

They will launch the Global Council on Inequalities, HIV and pandemics in Brazil on June 5. The authors are founder members of the Global Council on Inequality, AIDS and Pandemics and are in Brazil for its announcement.

IPS UN Bureau

Follow @IPSNewsUNBureau
  

Fake or substandard antimalarial medicines kill as many as 267,000 sub-Saharan Africans every year. Credit: Mercedes Sayagues/IPS

By Baher Kamal
MADRID, Jun 2 2023 (IPS)

There is a tangled trafficking web that has been woven across the Sahel, which spans almost 6.000 kilometres from the Atlantic Ocean to the Red Sea, and is home to more than 300 million people in 10 countries: Burkina Faso, Cameroon, Chad, The Gambia, Guinea, Mali, Mauritania, Niger, Nigeria, and Senegal.

This is how several international specialised bodies, mainly the United Nations, depict the aggravated situation in this already highly fragile African region, which the UN describes as a region in crisis, as those living there are prey to “chronic insecurity, climate shocks, conflict, coups, and the rise of criminal and terrorist networks.”

The Sahel criminal web deals with an unimaginable range of ‘commodities’, from chilli peppers and fake medicine, to fuel, gold, and guns, through humans and more which are being trafficked via millennia-old trade routes crisscrossing the Sahel, according to a 20 May 2023 report.

The US-led military intervention

Security has long been an issue in the region, “but the situation markedly degraded in 2011, following the NATO-led military intervention in Libya, which led to the ongoing destabilisation of the country,” explains the United Nations.

On 19 March 2011, a US-led North Atlantic Treaty Organization coalition (31 Western member-countries) launched a military intervention in Libya, with coordinated naval and air forces attacks mainly by the United States, the United Kingdom, France and Canada, among others.

Substandard or fake medicines, like contraband baby cough syrup, are killing almost half a million sub-Saharan Africans every year, according to a threat assessment report from the UN Office on Drugs and Crime (UNODC)

Since then the big oil producer Libya has been the stage of growing instability and chaos, let alone a hub of human trafficking, smuggling and slavery.

Humans, weapons, oil…

Such “ensuing chaos, and porous borders stymied efforts to stem illicit flows, and traffickers transporting looted Libyan firearms rode into the Sahel on the coattails of insurgency and the spread of terrorism,” reports the UN.

Fuel is another commodity trafficked by the main players – terrorist groups, criminal networks, and local militias.

“Armed groups now control swathes of Libya, which has become a trafficking hub.”

In fact, in addition to massive human trafficking and migrant smuggling, markets across the Sahel can be found openly selling a wide range of contraband goods, from fake medicines to AK-style assault rifles.

… And medicines that kill

A UN News series exploring the fight against trafficking in the Sahel, on 27 May 2023 focussed on the illegal trade in substandard and fake medicines.

“From ineffective hand sanitiser to fake antimalarial pills, an illicit trade that grew during the COVID-19 pandemic in 2020 is being meticulously dismantled by the UN and partner countries in Africa’s Sahel region.”

Substandard or fake medicines, like contraband baby cough syrup, are killing almost half a million sub-Saharan Africans every year, according to a threat assessment report from the UN Office on Drugs and Crime (UNODC).

Trafficking medication is often deadly; in just one case, 70 Gambian children died in 2022 after ingesting smuggled cough syrup.

Desperate demand

According to the UN, health care is scarce in the region, which has among the world’s highest incidences of malaria and where infectious diseases are one of the leading causes of death.

“This disparity between the supply of and demand for medical care is at least partly filled by medicines supplied from the illegal market to treat self-diagnosed diseases or symptoms,” the report says.

It further explains that street markets and unauthorised sellers, especially in rural or conflict-affected areas, are sometimes the only sources of medicines and pharmaceutical products.

Fatal results

The study shows that the cost of the illegal medicine trade is high, in terms of health care and human lives.

“Fake or substandard antimalarial medicines kill as many as 267,000 sub-Saharan Africans every year. Nearly 170,000 sub-Saharan African children die every year from unauthorised antibiotics used to treat severe pneumonia.”

In the summer of 2022, 70 Gambian babies and young children died from kidney failure after ingesting cough syrup spooned out by their caregivers.

The World Health Organization (WHO) issued a global alert that four tainted paediatric products had originated in India, as local health authorities continue to investigate how this tragedy unfolded.

Caring for people who have used falsified or substandard medical products for malaria treatment in sub-Saharan Africa costs up to 44.7 million US dollars every year, according to World Health Organization (WHO) estimates.

Corruption

Corruption is one of the main reasons the trade is allowed to flourish.

About 40% of substandard and falsified medical products reported in Sahelian countries between 2013 and 2021 land in the regulated supply chain, the report showed.

“Products diverted from the legal supply chain typically come from such exporting nations as Belgium, China, France, and India. Some end up on pharmacy shelves.”

The perpetrators

“The perpetrators are employees of pharmaceutical companies, public officials, law enforcement officers, health agency workers and street vendors, all motivated by potential financial gain,” the report found.

Traffickers are finding ever more sophisticated routes, from working with pharmacists to taking their crimes online, according to a UNODC research brief on the issue.

While terrorist groups and non-State armed groups are commonly associated with trafficking in medical products in the Sahel, this mainly revolves around consuming medicines or levying “taxes” on shipments in areas under their control.

Far beyond the Sahel and Africa

Fighting organised crime is a central pillar in the wider battle to deal with the security crisis in the region, which UN Secretary-General, António Guterres says, poses a global threat.

“If nothing is done, the effects of terrorism, violent extremism, and organised crime will be felt far beyond the [Sahel] region and the African continent,” Guterres already warned in 2022.

Apart from repeated proposals for action and solution, evidence shows that very little has been done, if anything, to halt those merchants of death. Who benefits from such a horrid destabilisation of 10 African countries which already rank among the poorest ones on Earth?

While poor maternal outcomes among Black women in the U.S. is not new, improving it is imperative. U.S. policymakers can look to sub-Saharan Africa for guidance on reversing this trend. Credit: Ernest Ankomah/IPS

By Ifeanyi Nsofor
ABUJA, Jun 2 2023 (IPS)

New research shows that Black mothers in the United States disproportionately live in counties with higher maternal vulnerability and face greater risk of preterm death for the fetus, greater risk of low birth weight for a baby, and a higher number of maternal deaths.

While poor maternal outcomes among Black women in the U.S. is not new, improving it is imperative. U.S. policymakers can look to sub-Saharan Africa for guidance on reversing this trend.

The problem of poor maternal health for Black women in the U.S. is dire. Too many Black women die during pregnancy and childbirth due to preventable causes. For instance, the 2020 maternal mortality data rates released by the U.S. Centers for Disease Control showed overwhelming maternal deaths among Black women compared to other women over a 3-year period (2018 – 2020).

The 2020 maternal mortality data rates released by the U.S. Centers for Disease Control showed overwhelming maternal deaths among Black women compared to other women over a 3-year period (2018 - 2020). To put it in context, maternal deaths among Black women in the U.S. is worse than African countries like Namibia, Botswana, South Africa, Libya, Tunisia and Egypt.

To put it in context, maternal deaths among Black women in the U.S. is worse than African countries like Namibia, Botswana, South Africa, Libya, Tunisia and Egypt.

Further, according to the Kaiser Family Foundation, maternal and infant health disparities are symptoms of broader underlying social and economic inequities that are rooted in racism and discrimination.

In a previous piece, I wrote about the way that institutionalized racism is keeping Black Americans sick. Therefore, healthcare providers and policymakers across the U.S. must ensure respectful maternity care for all women during pregnancy, childbirth and afterwards.

The United Nations Office of the High Commissioner for Human Rights says respectful maternity care“encompasses respect for women’s basic human rights, including recognition of and support for women’s autonomy, dignity, feelings, choices, and preferences, such as choice of companionship wherever possible”.

Unfortunately, there is overwhelming evidence that Black American women face disrespect and profound indignity during pregnancy and childbirth. Tennis player and businesswoman Serena Williams almost died due to blood clots after giving birth because her nurse refused to listen to her cry for help. That clot could have led to a stroke. Her doctor eventually listened to her, and this saved her. If one of the most influential and most powerful women can have such a near-death experience, what is the fate of other Black American women who are not as privileged? Respectful maternity care is a way to ensure equity irrespective of class and race.

These are three lessons American policymakers can learn from successful maternal health projects across countries in sub-Saharan Africa as they try to save Black American lives.

First, is the continuum of care – prevention of postpartum hemorrhage project, implemented by Pathfinder International in Nigeria. It was a novel project that deployed several evidence-based interventions to prevent excessive bleeding after childbirth across the country.

These included the use of misoprostol to ensure adequate uterine contraction after the delivery of the baby; use of a plastic sheet with a pouch for blood loss estimation and active management of the third stage of labor to ensure the placenta is properly separated after the baby is delivered. These interventions led to a reduction in women who bled excessively after childbirth and improved the overall survival of women in participating health facilities.

For example, a new study on the efficacy of the plastic sheet carried out in 80 hospitals across 4 African countries, showed a reduction in the number of women experiencing severe bleeding by 60%.

A second example is the maternal nutrition program, implemented by Garden Health International in Rwanda. Adequate nutrition during pregnancy is imperative for the wellbeing of the unborn child.

The first 1000 days of life are even more crucial. Through the Maternal Nutrition curriculum, pregnant women are encouraged to attend antenatal classes at least four times in health facilities where they are educated on how to address the factors that can contribute to malnutrition. Women are taught how to prepare a balanced meal, the importance of hygiene and food safety in preventing malnutrition, the importance of the timely introduction of breastfeeding and complementary feeding, and postnatal care.

For instance, through the “one pot, one hour” cooking initiative, families are taught to use readily available foods to prepare nutritious meals is a core component of this program. Its success led to its adoption by the Rwandan Ministry of Health and it was implemented by 44,000 community health workers across the country.

A last example is the Kangaroo Mother Care for very low birth weight infants in South Africa. Very low birth weight infants are prone to hypothermia – a significant and potentially dangerous drop in body temperature.

According to the WHO, Kangaroo Mother Care involves infants being carried, usually by the mother, with skin-to-skin contact. If the mother is unable to fulfill the role, the father or other members of the family can take on the responsibility of skin-to-skin contact and provide warmth for the infant. A study of Kangaroo mother care of 981 very low birth weight infants admitted at Charlotte Maxeke Johannesburg Academic Hospital over a six-year period showed increased weight gain, lower rates of complications of prematurity and low overall mortality.

A multi-country study by the World Health Organization showed that in Ethiopia, government leadership; an understanding by health workers that kangaroo mother care is the standard of care; and acceptance of the practice from women and families helped improve the implementation of kangaroo mother care.

Institutionalized racism over many decades has put Black Americans in the most vulnerable counties in the U.S. Health policymakers, healthcare providers, donors, non-profit organisations and all stakeholders involved in maternal healthcare in the U.S. must implement interventions that are shown to save lives. The African continent is a great place to look.

Dr. Ifeanyi M. Nsofor, MBBS, MCommH (Liverpool) is Senior New Voices Fellow at the Aspen Institute, Senior Atlantic Fellow for Health Equity at George Washington University, 2006 Ford Foundation International Fellow

Grow Food, not Tobacco. Credit: PAHO
 
On May 31, the World Health Organization (WHO) and public health institutions celebrated “World No Tobacco Day” (WNTD). This year’s theme was: “We need food, not tobacco”. WNTD was created by WHO Member States in 1987 to raise awareness about the harmful effects of tobacco use and exposure to tobacco smoke

By Thalif Deen
UNITED NATIONS, Jun 1 2023 (IPS)

The US has some of the strictest laws against smoking in public, including a 1997 executive order which bans smoking in all government federal buildings.

But still, the tobacco industry and its allies do not rest, says Dr. Jarbas Barbosa, Director of the Washington-based Pan American Health Organization (PAHO).

Currently, they “spread a lot of misleading information that promotes, especially among young people, the use of e-cigarettes and heated tobacco products”, he said, on the eve of World No Tobacco Day May 31.

According to PAHO, while the percentage of the population using tobacco in the Americas declined from 28% to 16.3% between 2000 and 2020, novel products and misleading information from the tobacco industry, especially targeting young people, threaten to undo those gains.

“Although eight countries in the region have banned the marketing of e-cigarettes and four of heated tobacco products, we are concerned that 14 countries have not yet taken any regulatory action in this regard,” he pointed out.

According to the latest statistics from PAHO, tobacco-use kills one million people per year in the Americas, one every 34 seconds.

In addition, 15% of cardiovascular disease deaths, 24% deaths from cancer and 45% of deaths from chronic respiratory diseases are attributable to tobacco use. In the region, 11% of young people use tobacco.

E-cigarettes are the most common form of electronic nicotine delivery. Their emissions contain nicotine and other toxic substances that are harmful to both users and those exposed to them.

To address the growing health threat posed by these products, the PAHO Director has called on countries to implement policies to prevent their use, especially among young people, as they can become the gateway to regular tobacco consumption.

Mary Assunta, Senior Policy Advisor, Southeast Asia Tobacco Control Alliance, told IPS about 40 countries in the world have banned e-cigarettes while 70 countries which allow them have instituted restrictions on sales. For example, 36 countries regulate the amount (concentration/volume) of nicotine in e-liquids.

She said New Zealand, the Philippines and England, where e-cigarettes are sold more as recreational products, are facing a big problem with teenage vapers.

The Australian government has just announced a slew of strong measures to strictly regulate e-cigarettes after misinformation on the health effects of vaping helped hook children and young people.

E-cigarettes are meant to be sold by prescription only in Australia, said Assunta.

Yolonda Richardson, Executive Vice President of the Washington-based, Global Programs of the Campaign for Tobacco-Free Kids, said this World No Tobacco Day, the WHO is calling for action against the tobacco industry’s human and environmental toll.

“Harming human and environmental health is pivotal to the business model of multinational tobacco companies like Philip Morris International and British American Tobacco. Millions of people die every year due to Big Tobacco’s profit-over-people model”.

She said low- and middle-income countries increasingly feel this burden, with 80 percent of tobacco-related deaths from diseases such as cancer, lung disease and heart disease projected to be in such countries by 2030. And the tobacco industry traps farmers with unsustainable crops and appropriates arable land to grow tobacco used for deadly products.

On this year’s World No Tobacco Day, the Campaign for Tobacco-Free Kids joins the WHO in calling on governments to stand up to the tobacco industry’s exploitative practices and the devastating impacts of its deadly products.

One in 10 adult deaths around the globe are due to tobacco use. By holding the industry accountable and through the implementation of proven tobacco control measures, we have the power to protect future generations from tobacco-related death and disease, she noted.

“It is critical that governments act with urgency to address tobacco’s burden by passing the proven tobacco control interventions contained in the WHO Framework Convention on Tobacco Control,” said Richardson.

Without urgent action, tobacco use will kill one billion people this century, lock tobacco farmers into a lifetime of poverty, and cause continued harm to the environment, she declared.

The United Nations which banned smoking in its 38-storyed Secretariat building in New York, back in 2016, says smoking is one of the biggest public health threats in the world today, killing millions of people from lung cancer, heart disease and other diseases.

All delegates, staffers and visitors to UN Headquarters are reminded of the strict no smoking policy mandated by the General Assembly in its resolution A/RES/63/8 and stipulated in ST/SGB/2003/9.　

A designated exterior smoking area is available in the South Garden and signs showing the shortest route from the Secretariat lobby and the General Assembly and Conference Building main areas have been posted.　

Since the entry into force of the WHO Framework Convention on Tobacco Control (FCTC) in 2005, says PAHO, the region has made great strides in tobacco prevention and control. Currently, 96% of the population in 35 countries in the region is protected by at least one of the six recommended tobacco control measures.

In 2020, South America became the first 100% smoke-free sub-region – where there is a total ban on smoking in enclosed public places and workplaces, and on public transport.

Mexico also adopted the 100% smoke-free environment policy by the end of 2021 and banned all forms of tobacco advertising, promotion and sponsorship. As a result, 63% of the population of the Americas – or more than 600 million people – are now protected from exposure to tobacco smoke.

In addition, in 2022, Paraguay ratified the Protocol to Eliminate the Illicit Trade in Tobacco Products, which will boost regional efforts in this area.

“These achievements allow us to be confident that the region of the Americas will reach the target of a 30% reduction in the prevalence of tobacco use in those over 15 years of age by 2025, established in the WHO’s Global Action Plan for the Prevention and Control of Noncommunicable Diseases,” Dr. Barbosa said.

But to expedite progress, the PAHO Director considered it “urgent to accelerate efforts to implement key measures that have fallen behind, including tax increases, a total ban on the advertising, promotion and sponsorship of tobacco-products, and the adoption of mechanisms to manage conflicts of interest.”

LINKS:
• World No Tobacco Day – May 31, 2023
• WHO urges governments to stop subsidizing life-threatening tobacco crops
• Tobacco Control – PAHO
• Tobacco: E-cigarettes
• WHO Framework Convention on Tobacco Control
• Report on Tobacco Control in the Region of the Americas 2022 (In Spanish)

IPS UN Bureau Report

Follow @IPSNewsUNBureau
  

Dr Paul Kinoti at the JKUAT snail farm, where he is researching the potential of snail slime cough syrup. Credit: Wilson Odhiambo/IPS

By Wilson Odhiambo
NAIROBI, May 29 2023 (IPS)

Snails and slime are usually followed by the thought ‘EEW!’ from most people … some might even scream at seeing a snail near them.

For Dr Paul Kinoti, however, these slimy creatures could earn him international recognition because his research on snails landed his institution, Jomo Kenyatta University of Agriculture and Technology (JKUAT), a Ksh. 127 million (USD 1 million) grant.

The grant, awarded by the Cherasco Institute of Snail Breeding, Italy, is expected to fund a two-phase research project to produce cough syrup meant for children under five.

As a lecturer at JKUAT’s Horticulture and Food Security department, Kinoti has specialized in non-conventional farming systems for over a decade.

Non-conventional farming is a system that employs modified/unique farming methods in crop and animal production. Kinoti has been researching insects and worms (vermiculture), concentrating on how they add value to supplement crop and livestock production.

According to Kinoti, snails are already associated with a wide variety of products, including animal feeds, skin care products, pharmaceuticals, and fertilizer.

“My research focuses on unique farming methods that farmers are not used to, including rearing insects and worms as a source of livestock feed and fertilizer for plants. I keep black soldier flies and worms which are a major source of proteins for livestock, especially for poultry and fish,” Kinoti explained to IPS.

And as a food security specialist, one of his goals is to encourage people to include snails in their diet, given that it is rich in proteins and iron.

“Lack of awareness is the main reason why Kenyans do not see snails as a source of food for themselves, and getting them to accept it will be a difficult task. This is why we are using a simpler approach by encouraging farmers to take up snail farming to get used to the idea of having snails around them,” he told IPS.

Across the globe, majorly in Asia, parts of Europe, and West Africa, snails are a known delicacy.

The snail products are currently being manufactured within JKUAT, where, through training, they have engaged local farmers to supply them with snail slime (mucin). The institution offers these farmers short, three-day courses on how to rear snails and extract their slime, which they later sell to the institution for profit.

“We are grateful to the institution for opening our minds to an opportunity that has become quite lucrative. Most of the people in Kiambu County are either full-time farmers or have a piece of land somewhere that they have put aside for farming activities, making this a good source of extra income. Snail farming is new to us. Most would never even have considered practicing it due to the culture that we have grown up with,” said Antony Njoroge, one of the local farmers who now farms snails.

During his PhD studies in Austria, Kinoti was introduced to snail farming by his host, a snail farmer.

“When I came back, I realized that snail farming was still alien to Kenya, and rather than just focus on rearing the snails, I decided to research their value addition for farming. It is from this that I was able to come up with different products such as fertilizer, animal feeds, and skin care products,” Kinoti told IPS. The products have been certified by the Kenya Bureau of Standards (KEBS) and are already in the market.

The idea for the cough syrup did not come about until 2019, when Kinoti conducted field research on snails in Kumasi, Ghana. His visit happened to be during the flu season, where he was surprised at the strange concoctions that parents were using as remedy for their children who were coughing.

“I noticed that rather than being given ginger or lemon tea that most of us are used to when someone gets the flu, their parents were collecting snail slime and mixing it with some bit of honey which they gave the children as a remedy,” Kinoti explained to IPS. This idea stuck in my mind, and when I came back, I decided to do more research on it.

The project’s first phase, which is meant to take two years, will involve identifying the best snail species for production and research on snail slime while encouraging farmers to breed them. The second phase will be manufacturing and producing the cough syrup once it has been approved by the Kenya Food and Drug Authority (KFDA).

The snail species commonly used for slime production is the African giant land snail (Achatina Fulica), which produces up to 4 milliliters of slime per snail. It takes about 250 of these giant snails to make a liter of slime, extracted once weekly.

The Achatina Fulica is native to East Africa, where its origin can be traced to Kenya and Tanzania. Across the globe, it is regarded as an invasive species due to its ability to produce colonies from a single female. It feeds in large quantities and is a carrier for plant pathogens, making it a pest to farmers when it invades their farms. It has spread across the globe through exportation to Europe and Asia as a delicacy, being bought into those areas as a pet or by accidental transportation when it latches on to something.

The project involves a number of experts (mainly within the university) from different departments to help oversee its success. These experts include animal scientists, food scientists, health scientists, and other technical staff who help run the snail farm.

It also works in conjunction with other major institutions such as the Kenya National Museum, whose work is to help them identify the best type of snails for slime production, and the Kenya Wildlife Service (KWS), which is the main stakeholder and body that provides them with the license they need to carry out snail farming in Kenya.

As a conservation measure, the snails are not supposed to be harmed during the slime extraction, which makes it a delicate process that involves using citric acid, and the extraction is only done once a week.

Once successful, the cough syrup is expected to help lower the cost of importation since everything will be manufactured locally, thus helping save a lot of money. The farmers are also excited that they no longer have to rely on expensive fertilizer and animal feeds from the government, which has always made their input expensive while giving them little returns.

As a delicacy, snails are primarily spotted in high-end hotels that are mostly visited by foreigners and tourists.

“Growing up, the one memory I had about snails from my biology lessons was that they caused bilharzia, which made me dislike them. Today, I am one of the suppliers of snail meat to some big hotels in Nairobi and Mombasa,” says Brian Wandera, a local businessman from Nairobi. “It is amazing what knowledge can do.”

“I buy the snails from the farmers in Kiambu and sell them to the hotels at a profit. Locally, Kenyans are yet to adopt snail meat as a source of food,” he added.

The grant is also expected to help empower women and the youth by providing them with employment opportunities through training on snail farming, according to Kinoti, an investment of Ksh. 20,000 (USD 190) can earn a snail farmer between Ksh. 50,000 (USD 450) and 100,000 (USD 950) monthly once the snails start to produce their slime, usually at four months. The slime is categorized into three grades which are sold at different prices.

“We buy the slime from the farmers at a fee of Ksh. 1200 (USD 11) per liter for grade A slime, Ksh. 850 (USD 8) per liter for grade B slime and Ksh. 650 (USD 6) for grade C slime,” Kinoti concluded.

IPS UN Bureau Report

Follow @IPSNewsUNBureau
  

Young women from the Brazilian state of Bahia attend an informational campaign which also hands out menstrual hygiene products. Poverty and the lack of adequate information on this subject affect millions of girls, adolescents and adult women. CREDIT: Government of Bahia

By Humberto Márquez
CARACAS, May 26 2023 (IPS)

Menstrual hygiene management is elusive for millions of poor women and girls in Latin America, who suffer because their living conditions make it difficult or impossible for them to access resources and services that could make menstruation a simple normal part of life.

“When my period comes, I miss class for three or four days. My family can’t afford to buy the sanitary napkins that my sister and I need. We use cloths for the blood, although they give me an uncomfortable rash,” says Omaira*, a 15-year-old high school student.

From her low-income neighborhood of Brisas del Sur, in Ciudad Guayana, 500 kilometers southeast of Caracas, she speaks to IPS by phone: “We can’t buy pills to relieve our pain either. And my period is irregular, it doesn’t come every month, but there are no medical services here for me to go and treat that.”

In Venezuela, “one in four women does not have menstrual hygiene products and they improvise unhygienic alternatives, such as old clothes, cloths, cardboard or toilet paper to make pads that function as sanitary napkins,” activist Natasha Saturno, with the Solidarity Action NGO, tells IPS.

“The big problem with these improvised products is that they can cause, at best, discomfort and embarrassment, and at worst, infections that compromise their health,” says Saturno, director of enforceability of rights at the NGO that conducts health assistance and documentation programs and surveys.

Campaigns that adult and young women have carried out in Mexico and Colombia demanding the right to menstrual health managed to get the authorities to eliminate the value added tax on essential feminine hygiene products. CREDIT: Nora Hinojo/UN Mexico

Universal problem, comprehensive approach

Is this a local, focalized problem? Not at all: “On any given day, more than 300 million women worldwide are menstruating.  In total, an estimated 500 million lack access to menstrual products and adequate facilities for menstrual hygiene management (MHM),” states a World Bank study.

“Today more than ever we need to bring visibility to the situation of women and girls who do not have access to and education about menstrual hygiene. Communication makes the difference,” said Hugo González, representative of the United Nations Population Fund (UNFPA) in Peru.

UNFPA says there is broad agreement on what girls and women need for good menstrual health, and argues that comprehensive approaches that combine education with infrastructure and with products and efforts to combat stigma are most successful in achieving good menstrual health and hygiene.

The essential elements are: safe, acceptable, and reliable supplies to manage menstruation; privacy for changing the materials; safe and private washing facilities; and information to make appropriate decisions.

UNFPA’s theme this year for international Menstrual Hygiene Day, which is celebrated every May 28, is “Making menstruation a normal fact of life by 2030”, the target date for compliance with the Sustainable Development Goals (SDGs) adopted by the international community at the United Nations.

United Nations Population Fund workers prepare packages of menstrual hygiene items for women from poor communities in Central America. The cost of some of these products makes them unaffordable for many families. CREDIT: UNFPA

The pink tax

Nine out of 31 countries in the region consider menstrual hygiene products essential, which makes them exempt from value added tax or reduced VAT, according to the study “Sexist Taxes in Latin America” ​​by Germany’s Friedrich Ebert Foundation.

After a “Tax-free Menstruation” campaign, in 2018 Colombia became the first country in the Americas to eliminate VAT – 16 percent – on menstrual hygiene products. Its neighbor Venezuela still charges 16 percent VAT, and Argentina, Chile, the Dominican Republic and Uruguay charge VAT between 18 and 22 percent on such products.

Colombia was joined by Ecuador, Guyana, Jamaica, Mexico – where street demonstrations were held against charging VAT on menstrual products – Suriname and Trinidad and Tobago. Other countries have reduced VAT, such as Costa Rica, Panama, Paraguay and Peru, while in Brazil VAT differs between states and averages 7 percent.

The so-called “pink tax” obviously affects the price of menstrual hygiene products such as disposable and reusable sanitary pads and menstrual cups, which becomes especially burdensome in countries with high inflation and depreciated currencies, such as Argentina and Venezuela.

According to the average price of the cheapest brands, ten disposable sanitary pads can cost just under a dollar in Mexico, 1.50 dollar in Argentina or Brazil, 1.60 dollar in Colombia, Peru or Venezuela, and almost two dollars in Costa Rica.

“It’s an important problem,” Saturno points out, “in a country like Venezuela, where the majority of the population lives in poverty and the minimum wage – although it has been increased with some stipends – is still just five dollars a month.”

Adult women, young women and girls participate in a session to share information and experiences organized by the Colombian association Menstruating Princesses, which emphasizes the importance of education to combat taboos and make menstruation a normal, stress-free experience. CREDIT: Menstruating Princesses

Hostile environment, scarce education

“If you often can’t buy sanitary pads, that’s the smallest problem. The worst thing is the shame you feel if you go to work and the cloth fails to keep your clothes free of blood, or if you catch an infection,” Nancy *, who at the age of 45 has been an informal sector worker in numerous occupations and trades in Caracas, told IPS.“Poverty causes women and adolescent girls to miss days of secondary school or work because they do not have the supplies they need when they menstruate. It becomes a vicious circle, because their academic or work performance is affected, hindering their chances of developing their full potential and earning a better income.” -- Natasha Saturno

The mother of four young people lives in Gramoven, a poor neighborhood in the northwest of the capital. Her two unmarried daughters, ages 18 and 22, have had experiences similar to Nancy’s on their way to school, in the neighborhood, on the bus, and on the subway.

“The thing is, the period is not seen as something natural, boys and men see it as something dirty, at work they sometimes do not understand that if you are in pain you have to stay at home,” said Nancy. “And when you work for yourself, you have to go out no matter what, because if you don’t go out, no money comes in.”

Saturno says that “poverty causes women and adolescent girls to miss days of secondary school or work because they do not have the supplies they need when they menstruate.”

“It becomes a vicious circle, because their academic or work performance is affected, hindering their chances of developing their full potential and earning a better income,” she adds.

But the problem “goes far beyond materials, it does not end just because someone obtains the products; it includes education and decent working conditions for women,” psychologist Carolina Ramírez, who runs the educational NGO Menstruating Princesses in the Colombian city of Medellín, tells IPS.

For this reason, “we do not use the term ‘menstrual poverty’ and speak instead of menstrual dignity, vindicating the need for society, schools, workplaces and States to promote education about menstruation and combat illiteracy in that area,” says Ramírez.

To illustrate, she mentions the widespread rejection of using tampons and cups “because of the old taboo that the vulva shouldn’t be touched, that the vagina shouldn’t be looked at,” in addition to the fact that many areas and communities in Latin American countries not only lack spaces or tools to sterilize products but often do not have clean water.

A concern raised by both Saturno and Ramírez is the great vulnerability of migrant women in the region – which has received a flood of six million people from Venezuela over the last 10 years, for example – in terms of menstrual and general health, as well as safety.

Another worrying issue is women in most Latin American prisons, which are unable to provide adequate menstrual hygiene, since they do not have access to disposable products or the possibility to sterilize reusable supplies.

Throughout the region, “greater efforts are required to break down taboos that violate fundamental rights to health, education, work, and freedom of movement, so that menstruation can be a stress-free human experience,” Ramírez says.

*Names have been changed to protect the privacy of the interviewees.

Excerpt:

Young children and infants are particularly sensitive to the harmful effects of lead. Current statistics suggest that approximately one in three children worldwide have elevated blood lead levels. Credit: Eva Bartlett/IPS

By Ahmed Rachid El-Khattabi and Aaron Salzburg
CHAPEL HILL, NC, US, May 23 2023 (IPS)

At the UN Water Conference in March 2023, the Water Institute at the University of North Carolina (UNC) along with several key partners, including UNICEF, Water Aid, the World Health Organization, and the governments of Ghana, Uganda, and South Africa, among others, organized a session centered around the elimination of lead in drinking water across the globe.

During the session, the various institutional partners articulated a vision of eliminating lead from all drinking water supplies by 2040. This vision, dubbed the “Global Pledge to Protect Drinking Water from Lead” (Lead-Free Water Pledge, for short), begins by outlining concrete steps for phasing out lead-leaching materials for new drinking water systems by 2030.

As long as lead is present in drinking water, we as a society are condemning millions (if not billions) of people to futures of health issues and reduced earning potentials in the decades to come. The vision articulated by the Lead-Free Water Pledge is one of many necessary steps that we as a global society must take to ensure access to safe drinking water to people around the world

The pledge’s two-pronged approach recognizes the complexity of eliminating lead from drinking water systems. On the one hand, lead is a problem in existing systems. On the other hand, many new drinking water systems are being constructed as much of the Global South develops and urbanizes; these new systems are being constructed with parts or components that contain and leach lead into the water.

As evidenced by efforts to address lead in drinking water in the United States, the first step of identifying areas affected by lead contamination is both financially and technically onerous. Because mitigation is more expensive than prevention, ensuring that new water systems are constructed in accordance to standards the prevent the leaching of lead is low-hanging fruit in the broader effort to eliminate lead from drinking water.

Lead in Drinking Water is a Global Concern

Globally, exposure to lead is responsible for a significant burden of disease, accounting for an estimated 0.9 million deaths per year and 30% of developmental disability from unknown origins. Young children and infants are particularly sensitive to the harmful effects of lead. Current statistics suggest that approximately one in three children worldwide have elevated blood lead levels.

Lead is seldom, if ever, found to be naturally occurring in bodies of water, such as rivers or lakes. Lead is also rarely present in water leaving water treatment plants. Yet, lead in drinking water is a global concern.

Lead in drinking water constitutes a significant portion of a person’s exposure to lead in countries around the world. In the US, lead in drinking water is a significant issue that affects households in almost every state. The Environmental Protection Agency (EPA) estimates that drinking water can account for at least 20% of a person’s total exposure to lead; this estimate can increase up to 60% for infants who mostly consume mixed formula. A 2021 study by researchers at the University of North Carolina at Chapel Hill examining water supplies in sub-Saharan found that nearly 80% of drinking water systems were contaminated with lead. Of these systems, approximately 9% of drinking water samples across several countries had lead concentrations that exceeded the World Health Organization (WHO) guideline value of 10 parts per billion (ppb).

Lead contamination of drinking water supplies is entirely preventable: lead finds its way into drinking water from lead-containing plumbing materials used throughout drinking water systems. Notably, lead can leach into water from lead-based solder used to join pipes, lead-containing brass or chrome-plated brass faucets and fixtures, and the wearing-away of old lead service lines.

Regulations around Lead in Drinking Water are Insufficient

There is no safe level of exposure to lead. Even low levels of exposure can be harmful to human health and can cause damage to the central and peripheral nervous system, cognitive impairments, stunt growth, and impair the formation and function of blood cells, among other harmful effects.

Many countries around the world have regulations in place to reduce or limit the amount of lead in drinking water. The European Union, China, and Japan, for instance, all have statutory limits of 10 ppb; Canada and Australia have published guidelines recommending limits of 5 and 10 ppb, respectively. In the US, the EPA set the maximum contaminant level for lead at 15 ppb.

Except for the US, however, none of the existing national-level regulations have goals place to eliminate lead from drinking water. In 2022, the EPA issued the Revised Lead and Copper Rule (LCR) setting the maximum contaminant level goal for lead in drinking water at zero. As part of the revised LCR, water systems have to create lead service line inventories to better identify areas where they may possible lead in drinking water. Creating this inventory, however, is proving to be financial and technologically onerous for many water systems because it requires both a significant financial investment and having access to staff with technical expertise in GIS or data modeling.

Delivering on the Pledge

The Lead-Free Water Pledge is not the first global initiative to reduce exposure to lead. Notably, one of the most successful public health initiatives over the previous century has been to remove the use of lead in gasoline. For context, lead was commonly used as an additive in gasoline since the 1920s when it was discovered that the addition of lead reduced engine knock allowing engines to run more smoothly.

Though the harmful health effects of lead were almost immediately apparent, it took close to a century for global action to gather any meaningful momentum to eliminate its use. As of 2021, all but one country has banned the use of lead as an additive in fuels because of concerted efforts by the Partnership for Clean Fuels and Vehicles and other like-minded organizations.

As illustrated by the effort to remove lead from gasoline, delivering on the pledge to remove lead from drinking water by 2040 will require non-trivial amounts of effort. First, countries must sign on to the pledge and take it on as a priority. So far, three African countries—Ghana, Uganda, and South Africa—have made firm commitments to eliminating lead from drinking water by 2040. Though the United States’ current policies are largely consistent with the Lead-Free Water Pledge, it has yet to commit.

Second, there must also be a commitment mechanism in place to ensure countries that sign on to the pledge take meaningful actions towards eliminating lead in drinking water. National governments will have to set up systems to ensure new treatment plants follow international standards, support the training and certification of professionals to oversee the construction of safe drinking water systems, ensure affordable access to fittings and other plumbing materials that meet standards for lead in drinking water, among other commitments.

The dual problem of both gathering momentum and implementing a commitment mechanism to ensure progress is not unique to the Lead-Free Water Pledge: the UN Water Conference in 2023 culminated in over 200 similar sorts of commitments, pledges, or agreements.

Given that the next UN Water Conference of the sort that took place in March 2023 wouldn’t take place until 2030 (at the earliest), the need for spaces that decision-makers and researchers from different parts of the world working on particular issues, such as the elimination of lead from drinking water, can use to come together to flesh out details, report on progress, and hold each other accountable is paramount.

A logical step in the right direction would be to take advantage of all the current meetings to create the space for meaningful discussions and actions around lead. To that end, the UNC Water & Health conference is ideally suited to serve as a space to follow-up on the Lead-Free Water Pledge and other commitments made at the UN Water Conference. The yearly conference hosted by the Water Institute each fall is already a gathering place for experts on water sanitation & hygiene in both developing and developed countries.

As long as lead is present in drinking water, we as a society are condemning millions (if not billions) of people to futures of health issues and reduced earning potentials in the decades to come. The vision articulated by the Lead-Free Water Pledge is one of many necessary steps that we as a global society must take to ensure access to safe drinking water to people around the world. We are grateful for the commitments made by Ghana, Uganda, and South Africa and are proud that Africa is taking the lead in tackling such a fundamental issue to ensure a more water secure future.

Dr. El-Khattabi is the Associate Director for Research and Data at the Environmental Finance Center at the University of North Carolina at Chapel Hill.

Dr. Salzberg serves as the Director of the Water Institute and the Don and Jennifer Holzworth Distinguished Professor in the Department of Environmental Science and Engineering in the Gillings School of Public Health at the University of North Carolina at Chapel Hill.

Adel Mansour takes his WFP food basket home on a cart in Abyan, Yemen. Credit: WFP/Ahmed Altaf

By Max Lawson
LONDON, May 22 2023 (IPS)

“G7 countries have failed the Global South here in Hiroshima. They failed to cancel debts, and they failed to find what is really required to end the huge increase in hunger worldwide. They can find untold billions to fight the war but can’t even provide half of what is needed by the UN for the most critical humanitarian crises.”

Hunger and debt

“If the G7 really want closer ties to the developing countries and greater backing for the war in Ukraine, then asking Global South leaders to fly across the world for a couple of hours is not going to cut it. They need to cancel debts and do what it takes to end hunger.

“Countries of the Global South are being crippled by a food and debt crisis of huge proportions. Hunger has increased faster than it has in decades, and all over the world. In East Africa two people are dying every minute from hunger. Countries are paying over $200 million a day to the G7 and their bankers, money they could spend feeding their people instead.

“The money they say they will provide for the world’s rapidly growing humanitarian crises is not even half of what the UN is asking for, and it is not clear what, if anything, is new or additional —and the G7 have a terrible track record on double counting and inflating figures each year.

“These food and debt crises are direct knock-on effects of the Ukraine war. If the G7 want support from the Global South, they need to be seen to take action on these issues —they must cancel debts and force private banks to participate in debt cancellation, and they must massively increase funding to end hunger and famine across the world.”

Adak Nyuol Bol stands outside her farm which has been submerged by floodwaters. South Sudan is on the frontlines of the climate crisis and currently experiencing a fourth consecutive year of flooding. Credit: World Food Programme (WFP)

Climate Change

“The G7 owes the Global South $8.7 trillion for the devastating losses and damages their excessive carbon emissions have caused. In the G7 Hiroshima communique they said they recognized that there is a new Loss and Damage fund, but they failed to commit a single cent.

“It is good they continue to recognize the need to meet 1.5 degrees, and stay committed to this despite the energy crisis driven by the war in Ukraine, but they try to blame everyone else —they are far off track themselves to contribute their fair share of what is needed to meet this target and they should have been on track years ago.

“They confirm their commitment to end public funding for fossil energy, they maintain their loophole on new fossil gas, using the war as an excuse. This means they have continued to wriggle out of their commitment to not publicly fund new fossil fuels, making a mockery of their fine statements. The G7 must stop using fossil fuels immediately —the planet is on fire.”

Health

“The G7 had hundreds of fine words on preparing for the next pandemic, but yet failed to make the critical commitment —that never again would the G7 let Big Pharma profiteering and intellectual property rights lead to millions dying unnecessarily, unable to access vaccines. Given a 27 percent chance of a new pandemic within in a decade, this omission is chilling.”

More on debt, food and hunger

“Over half of all debt payments from the Global South are going to the G7 or to private banks based in G7 countries, notably New York and London. Over $230 million dollars a day is flowing into the G7.

Countries are bankrupt, spending far more on debt than on healthcare or food for their people. Debt payments have increased sharply as countries in the Global South borrow in dollars, so rising interest rates are supersizing the payments they must make.

“The G7 saying they support clauses to temporarily suspend debt payments for those countries hit by climate disasters is a positive step and a tribute to Barbados and Prime Minister Mia Mottley for fighting for this. They need to go further and cancel debts for all the nations that need it, a growing number daily.

Money is flooding from the Global South into the G7 economies —that is the wrong direction.”

Max Lawson is Oxfam International’s Head of Inequality Policy.

Footnote: The UNOCHA’s current total requirement for humanitarian crises is nearly $56 billion. The G7 communique says they will commit to providing over $21 billion to address the worsening humanitarian crises this year (paragraph 16).

IPS UN Bureau

Follow @IPSNewsUNBureau
  

Freshly slaughtered bush meat is being consumed even though it may have health risks.

By Busani Bafana
BULAWAYO, May 18 2023 (IPS)

Meat from wild animals is relished across Africa and widely traded, but scientists are warning that eating bush meat is a potential health risk, especially in the wake of pandemics like COVID-19.

A study at the border settlements of Kenya and Tanzania has found that while people have been aware of the risks associated with eating bushmeat, especially after the COVID-19 outbreak, they don’t worry about hunting and eating wild animals that could transmit diseases.

On the contrary, the demand for bushmeat has increased, the 2023 study by the International Livestock Research Institute (ILRI) and TRAFFIC and other partners found.

No Beef With Bushmeat

Bushmeat is a collective term for meat derived from wild mammals, reptiles, amphibians, and birds that live in the jungle, savannah, or wetlands. Bushmeat comes from a variety of wild animals, including monkeys, pangolins, snakes, porcupines, antelopes, elephants, and giraffes.

The study — the first ever to look at disease risk perceptions of wild meat activities in rural communities in East Africa — was conducted in December 2021, and 299 people were interviewed in communities on the Kenya-Tanzania border.

Key findings of the study revealed that levels of education played a critical role in understanding zoonotic disease transmission; a majority of the people interviewed who had higher levels of education were more aware of the risks of disease transmission.

Nearly 80 percent of the respondents had learned about COVID-19 from mass media sources, but this did not impact their levels of wild meat consumption. Some even reported increased consumption. Hoofed animals, such as antelopes, gazelles and deer, were found to be the most consumed species, followed by birds, rodents and shrews.

Scientist and lead study author at ILRI, Ekta Patel, commented that it was important to commence the study in Kenya given the limited information on both rural and urban demand for wild meat and the potential risks associated with zoonotic diseases. The Kenya-Tanzania border is a known hotspot for wild meat consumption.

Zoonotic diseases are those that originate in animals — be they tamed or wild — that then mutate and ‘spill over’ into human populations.  Two-thirds of infectious diseases, from HIV/AIDS, which are believed to have originated in chimpanzee populations in early 20th century Central Africa, to COVID-19, believed to have originated from an as-yet undetermined animal in 2019, come from animals.

Confirming that there is no COVID health risk of consuming wild meat, Patel said that given the COVID-19 pandemic, which is thought to originate from wildlife, the study was investigating if the general public was aware of health risks associated with frequent interactions with wildlife.

Patel said some of these risks of eating bush meat include coming into contact with zoonotic pathogens, which can make the handler unwell. Other concerns are linked to not cooking meats well, resulting in foodborne illnesses.

“The big worry is in zoonotic disease risks associated with wild meat activities such as hunting, skinning and consuming,” Patel told IPS.

Africa is facing a growing risk of outbreaks caused by zoonotic pathogens, according to the World Health Organisation (WHO). The global health body reported a 63% increase in zoonotic outbreaks in the region from 2012-2022 compared to 2001-2011.

Control or Ban?

Scientists estimate that 70 percent of emerging infectious diseases originated from animals, and 60 percent of the existing infectious disease are zoonotic. For example, Ebola outbreaks in the Congo basin have been traced back to hunters exposed to ape carcasses.  She called for governments to implement policies to control zoonotic disease transmission risks through community engagements to change behaviour.

The study, while representative of the small sample, offered valuable insights about bushmeat consumption trends happening across Africa, where bushmeat is many times on the menu, says Martin Andimile, co-author of the study and Research Manager at the global wildlife trade monitoring network TRAFFIC.

Pointing to the need to improve hygiene and standards of informal markets while at the same time providing communities with alternative protein sources, Andimile believes bushmeat consumption should be paused, citing the difficulty of regulating this source of meat.

“I think people in Africa have other options to get meat besides wild meat although some advocate that they get meat from the wild because of cultural reasons and that it is a delicacy, government systems cannot control the legal exploitation of wildlife,” Andimile told IPS. “I think bushmeat consumption should be stopped until there is a proper way of regulating it.”

Andimile said while some regulation could be enforced where the population of species are healthy enough for commercial culling to give communities bushmeat, growing human populations will impact the offtake of species from the wild.

“Bushmeat consumption is impacting species as some households consume bushmeat on a daily basis, and it is broadly obtained illegally (and is) cheaper than domestic meat,” Andimile told IPS.

Maybe regulation could keep bushmeat on the menu for communities instead of banning it, independent experts argue.

“Wild meat harvesting and consumption should not be banned as this goes against the role of sustainable use in area-based conservation as made clear by recent CBD COP15 decisions,” Francis Vorhies, a member of the International Union for Conservation of Nature (IUCN) Sustainable Use and Livelihoods Specialist Group (SULi), says.  He called for an enabling environment for sustainable and inclusive wild meat harvesting, which means better regulations and voluntary standards such as developing a FairWild-like standard for harvesting wild animals.

Another expert, Rogers Lubilo, also a member of the IUCN SULi, concurs that bushmeat consumption should not be banned because it is a major source of protein. He argued that local communities who live side-by-side with wildlife would like to access bushmeat like they used to before, but the current policies across many sites incriminate bushmeat when acquired from illegal sources.

“There is a need to invest in opportunities that will encourage access to legal bushmeat,” Lubilo said. “The trade is big and lucrative, and if harnessed properly with good policies and the ability to monitor, would be part of the broadened wildlife economy.”

Eating Species to Extinction

There is some evidence that the consumption of bushmeat is impacting the species’ population, raising fears that without corrective action, people will eat wildlife to extinction.

The IUCN has warned that bushmeat consumption and trade have driven many species closer to extinction, calling for its regulation. Hunting and trapping are listed as a threat to 4,658 terrestrial species on the IUCN Red List of Threatened Species, including 1,194 species in Africa.

At least 5 million tons of bushmeat are trafficked every year in Central Africa. Africa is expected to lose 50 percent of its bird and mammal species by the turn of the century, says  Eric Nana, a member of the IUCN SULi.

Nana notes that bushmeat trafficking from Africa into European countries like France, Switzerland, Belgium and the UK remains a largely understudied channel. He said estimates show that more than 1,000 tons are trafficked yearly.

“Much of the reptile-based bushmeat trade in Africa is technically illegal, poorly regulated, and little understood,” Patrick Aust, also a member of IUCN SULi, said, adding that reptiles form an important part of the bushmeat trade in Africa and further research is urgently needed to better understand conservation impacts and socioeconomic importance.

IPS UN Bureau Report

Follow @IPSNewsUNBureau
  

By Yasmine Sherif
NEW YORK, May 17 2023 (IPS-Partners)

At this year’s G7 Hiroshima Summit in Japan, world leaders will have a chance to “uphold the international order based on the rule of law and extend outreach to the Global South.” Education, as a binding force that unites us all in our global efforts to protect human rights and ensure sustainable development, should be front and centre on the G7 Agenda.

Through the ground-breaking leadership of Japan, the G7 Summit promises to address a number of interconnected global crises – including nuclear disarmament and non-proliferation, economic resilience and security, climate and energy, food, health and development. By investing in education in emergencies and protracted crises through multilateral organizations such as Education Cannot Wait – the UN global fund for education in emergencies and protracted crises – the G7 has an opportunity to make targeted and responsive investments to these interconnected crises.

During my recent high-level mission to Japan, I was impressed and inspired by the Government of Japan’s growing interest in supporting ECW and our partners in delivering on our four-year strategic plan. In lead up to the G7 Summit, we call on Japan and all G7 global leaders to ensure that funding for education in emergencies is prioritized. There is no greater investment in our shared future.

Education is a key driver in building economic resilience, social cohesion and human security. By investing in an educated, skilled workforce, we are investing in greater economic growth, peace and security today and well into the future. Education for girls is especially critical. Every US$1 spent on girls’ rights and education generates US$2.80 in return. This is equivalent to billions of dollars in additional GDP.

By 2050, as many as 140 million people across South Asia, sub-Saharan Africa and Latin America could be displaced by climate change. By connecting climate action with education action, we have the opportunity to reduce risk, build resilience, and protect our planet from the life-threatening impacts of massive flooding, temperature rises, rising seas and other climate catastrophes.

The war in Ukraine has made the food crisis even more dangerous and painful, especially in places like Africa where recurrent droughts and other climate-related crises are triggering spikes in hunger and displacement. School feeding is essential in responding to famine and achieving our goals for a world without hunger, and good health and well-being for every girl and every boy on the planet. These are their inherent human rights, and this is our international obligation.

In taking a human-centred approach to sustainable development, we must ensure children receive holistic education opportunities, including mental health and psychosocial services, safe and protective learning environments, access to health and hygiene, and other whole-of-child solutions that will nurture the leaders of tomorrow.

By investing in education – especially for the 222 million crisis-affected girls and boys who are left furthest behind in armed conflicts, forced displacement and climate-disasters – the leaders of the G7 have an opportunity to make a mark on history and build a new world order based on universal values and human rights.

Follow @IPSNewsUNBureau
  

Excerpt:

Joy of Marketing - Ethiopia. Credit: International Seed Federation

By Michael Keller
VAUD, Switzerland, May 16 2023 (IPS)

At long last, momentum is growing for an overdue rethink of climate finance and development assistance to support countries on the frontlines of the climate crisis.

But while investment, aid and compensation are all much needed, another form of currency is equally valuable for climate-vulnerable countries that are also highly dependent on small-scale agriculture: quality seeds.

The latest generation of seeds offers varieties adapted to specific climatic circumstances to provide more reliable food production, as well as improved incomes and livelihoods for farmers, having boosted productivity by 20 per cent for nine key crops in the European Union over 15 years.

Yet improved varieties of many of the world’s staple cereals, vegetables and pulses are too often inaccessible for farmers in Africa, despite having some of the greatest exposure to climate extremes.

For instance, in East Africa, certified quality seed potatoes – which produce higher yields and greater resilience to climatic changes, pests, and diseases – account for just one per cent of all those planted by farmers.

By leveraging the advances and resources of the commercial seed sector – supported and scaled by public and NGO partners – the global community can ensure African farmers receive the tangible, long-term support they need to cope with the impacts of climate change.

Michael Keller

For example, non-profit Fair Planet coached more than 2,300 lead farmers in 65 Ethiopian villages and trained their regional extension agents in improved farming practices. With this training, farmers were able to quickly adopt and maximize their crop yields using locally tested and improved varieties of vegetables.

In total, some 75,000 smallholder farmers in the project’s regions subsequently tripled their vegetable production at a time when the Horn of Africa faced pressing food security challenges. As a result of an historic, ongoing drought, an estimated 22 million people are currently facing acute food insecurity across Ethiopia, Kenya, and Somalia.

According to an external evaluation, more than 95 per cent of households involved in Fair Planet’s work in Ethiopia – or roughly 485,000 people – benefitted from improved nutrition after the increased yields raised household incomes in just one production season by more than 25 per cent. This extra income provided farmers with a greater buffer against climate shocks, and more money to spend on health services and education for their families.

Opening up access to improved varieties of staple crops plays an important role in safeguarding food and nutrition security in the face of climate change, which could reduce levels of protein, iron and zinc in cereals by up to 10 per cent.

This is why the International Seed Federation (ISF), together with Fair Planet, is embarking on a five-year project to increase farmer choice of and access to quality seeds in Rwanda.

The aim is to benefit 84,000 Rwandan farmers by offering increased access to improved, high-quality vegetable, pulses, cereal, and potato varieties alongside downstream value chain projects training to support higher yields and incomes, and climate adaptation.

The final piece of the puzzle is to establish the policies and regulations needed to develop resilient and sustainable seed systems that benefit farmers. This requires policymakers to build an efficient and effective regulatory framework that provides reassurance to farmers that they are receiving the highest quality seed year after year, while also providing the long-term certainty likely to incentivize additional private sector investment.

Quality seeds are clearly the bedrock upon which productive and resilient farming systems are built, yet these technologies up to now remain out of reach for many of Africa’s farmers – one of the many significant challenges they face today.

By investing and collaborating to build resilient seed systems, the private sector can share more broadly the fruits of progress in global crop science through partnerships that ensure farmers receive seeds that are not only fit for purpose but fit for the future.

Improved seeds can then pay dividends by unlocking better productivity, incomes, and climate resilience for those on the frontlines who have for too long been underserved.

IPS UN Bureau

Follow @IPSNewsUNBureau
  

Excerpt:

Nosintu Mcimeli and Bonelwa Nogemane of the Abanebhongo People with Disability (APD) started with an agroecological project to improve food security in South Africa’s Eastern Cape (left). A soup kitchen feeds the village children (right). Credit: ADP

By Fawzia Moodley
JOHANNESBURG, May 11 2023 (IPS)

In the deep rural village of Jekezi in South Africa’s Eastern Cape, most young and able-bodied people have fled the area, leaving behind people with disabilities, the elderly, and children.

It’s in villages like this one that the stark statistics of one in five South Africans being so food insecure they beg to feed themselves and their families could be a reality.

The village instead supports its fragile community through an agroecological project, Abanebhongo People with Disability (APD), co-founded in 2020 by Nosintu Mcimeli as an example of food sovereignty in action.

Food security in South Africa, the second wealthiest country by GDP, is low. According to 2019 data, Statistics SA says at least 10 million people didn’t have enough food or money to buy food.

Impacts on Physical Development, Mental Health

The impacts of this are devastating; hunger not only impacts physical development but also people’s mental health. Siphiwe Dlamini, writing in The Conversation, recently reported on a study that found that those who could not afford proper nutrition resorted to eating less, borrowing, using credit, and begging for food on the streets, which was the most harmful coping strategy for mental health.

“We found that over 20% (1 in 5) of the South African households were food insecure. But the prevalence varied widely across the provinces. The Eastern Cape province was the most affected (32% of households there were food insecure). We also confirmed that food access in South Africa largely depends on socioeconomic status. People who are uneducated, the unemployed, and those receiving a low monthly income are the most severely affected by inadequate food access,” wrote Dlamini, a lecturer School of Physiology, University of the Witwatersrand.

The situation in the region is also dire, with a UN World Food Programme (WFP) report in 2020 revealing that 45 million people were severely food insecure in the Southern African Development Community (SADC).

South Africa has long been afflicted with widespread hunger, but the onset of Covid, an ailing economy, climate change, fuel and food price increases, interest hikes, and the impact of the Russia-Ukraine war has deepened the food crisis.

However, Vishwas Satgar of the SA Food Sovereignty Campaign (SAFSC) says even before Covid, the number of hungry people was close to 14 million – and “women shoulder the burden of the high food prices, sharing limited food, skipping meals, and holding families together.”

The irony, Satgar says, is that the country can feed all its people.

“We produce enough food, but it’s essentially for export. The stark paradox in the commercial food system is that it is just another commodity; most people can’t feed themselves. The poor eat unhealthy (cheaper) food, and we have an obesity problem.”

Satgar says a change of strategies is needed to feed the poor.

“Despite overwhelming research proving that small-scale farmers feed the world, many people have the perception that large-scale industrial farms are the ultimate source of food. South Africa, with an expanded unemployment rate of 46.46 percent (start of 2022), cannot afford to lose more farm workers. Agroecological farming can transform the rural and urban economy with localised farming practices that absorb many unskilled and semi-skilled people,” he says.

The SAFSC, the Climate Justice Charter Movement, and the Cooperative and Policy Alternative Centre (COPAC) are building a new food system to avert a catastrophe.

Food Sovereignty 

“We call this the food sovereignty system, which is democratically organised and controlled by small-scale farmers, gardeners, informal traders, small-scale fishers, communities, and consumers.

That’s where Mcimeli comes in. She tells IPS her activism journey began after she left a company that worked with people with disabilities in Cape Town. She contracted polio as a baby because her domestic worker mother could not take her for immunisation. “I have a disability in my right thigh and leg.”

She was working as an informal trader when she was given the opportunity from SADC, “which was releasing millions of rand to train SA women for activism in any kind of project.”

Mcimeli was one of 80 women trained in 2012 and 2013.

“In 2014, I was transferred to Copac for activist schooling. That’s when I met Vish (Satgar). I then decided to come to the Eastern Cape to plough back my activism skills.”

It was here that she co-founded the APD, and it has become an example of food sovereignty in action in Jekezi in the Eastern Cape.

Mcimeli says the ADP started an agriculture project.

“Because in rural areas there is communal land, it’s free, so we formed groups to start communal gardens. Then I realised that there are people who are bedridden, so I started enviro gardens in nearby villages. At the moment, we have 24 of these, and they are working.”

She works with four young women but wants to include more young people in the projects.

A donation of a water tank and a borehole brought a promise of fresh ‘forever’ water to the village of Jekezi. Credit: ADP

Forever Water—Free and Healthy

During the hard lockdown, the ADP got a big water tank from the local municipality and started a soup kitchen.

“We got donations of masks and sanitisers and food from Shoprite. Then a colleague of mine organised radio interviews for me, and a company that provides boreholes heard me asking for more water tanks. They said they had a lifetime solution and sponsored a community borehole. It was installed free of charge in a local schoolyard. It’s forever water—free and healthy and available for everyone, not just our projects”.

One of ADP’s beneficiaries, Bonelwa Nogemane, says: “I have a family of seven including a disabled four-year-old; we are often hungry because the food is too expensive. I joined the ADP to help my family and community to grow our own food.”

While the ADP is making a small dent, the problem is much bigger, and activists warn that unless a solution is found to the hunger crisis, South Africa is in danger of producing a lost generation of intellectually and physically stunted future leaders.

A study published in BMC Public Health on the link between food insecurity and mental health in the US during Covid found that: “Food insecurity is associated with a 257% higher risk of anxiety and a 253% higher risk of depression. Losing a job during the pandemic is associated with a 32% increase in risk for anxiety and a 27% increase in risk for depression.”

Campaign to Save Children from ‘Slow Violence of Malnutrition’

Marcus Solomon of the Children’s Resource Centre, which has launched a campaign to save SA’s children from the “slow violence of malnutrition”, says: “The consequences of this are dire for the affected children, with an estimated four million children in SA having stunted growth because of malnutrition and another 10 million going hungry every day.”

Activist Shanaaz Viljoen from Cape Town says: “My personal experience on a grassroots level is rather heartbreaking. The children we work with are always hungry due to the situation in their homes.”

In addition to an alternate food system, Trade Union Federation Cosatu, the SASFC, Copac, and others believe introducing a Basic Income Grant will go a long way towards addressing the hunger crisis in the country.

IPS UN Bureau Report

Follow @IPSNewsUNBureau
  

According to the United Nations, the world’s population is more than three times larger than it was in the mid-twentieth century. The global human population reached 8.0 billion in mid-November 2022 from an estimated 2.5 billion people in 1950, adding 1 billion people since 2010 and 2 billion since 1998. The world’s population is expected to increase by nearly 2 billion persons in the next 30 years, from the current 8 billion to 9.7 billion in 2050 and could peak at nearly 10.4 billion in the mid-2080s.

By Nandita Bajaj
ST PAUL, Minnesota USA, May 10 2023 (IPS)

India’s population has just reached 1.4 billion people, surpassing China as the world’s most populous nation four years earlier than projected. Spurring this growth is a traditional patriarchal culture in which women’s identity is constrained by the social expectation they bear children.

Across the globe, pronatalist forces undermine women’s autonomy and self-determination. Pronatalism is an underlying driver of the global population growing to 8 billion and counting, with 80 million added each year.

The new UNFPA State of World Population Report is wrong to dismiss “population anxiety” as groundless and assert that “population sizes are neither good nor bad.” Population growth is not good for people or the planet, and anxiety is not an unwarranted response to how it affects us.

Population growth deepens social and economic inequality and has negative impacts on unemployment, housing costs, inflation, infrastructure, resource scarcity, pollution, and well-being. It even fuels resource conflicts and wars.

It’s also one of the key variables determining overall consumption and pollution levels, which are jeopardizing planetary life support systems on which we and Earth’s remaining biodiversity depend.

Population growth is a significant factor in climate change according to the Intergovernmental Panel on Climate Change. Over the past three decades, it has cancelled out most climate gains from renewables and efficiency.

Going forward, population growth will be concentrated in the developing world. Dismissing its environmental impacts betrays an assumption that low-income populations in the Global South will stay that way.

This is false as well as unjust. Across the globe, the middle class is the fastest-growing segment of the population, projected to grow another billion to reach 5 billion by 2030. This will bring better living standards for a billion of today’s poor. But we must recognize that it will also bring more peril to an already overburdened planet.

Beyond its impacts on GHG emissions and the climate, population growth also drives broader “overshoot,” meaning that human demands are exceeding Earth’s regenerative capacity.

Currently, we consume 75 percent more than the Earth can provide sustainably, resulting in unprecedented biodiversity loss and an extinction crisis, dwindling freshwater supplies, ocean acidification, expanding desertification, and resource scarcity.

Much of this damage comes from our global food systems, which are directly tied to population growth, and which have already transformed at least 40 percent of the planet’s ice-free land area. They are the primary threat to 86 percent of endangered species.

Much of agriculture’s negative impact is due to the Green Revolution, which is often invoked to inspire confidence that human ingenuity can solve the problems associated with population growth.

But the Green Revolution has posed wicked problems of its own, including deforestation, damaging soil health and the nutritional content of food, and agrochemical pollution. In the Global South, where these problems are especially acute, it has failed to improve health and well-being.

Similarly, faith in green technology, including the unfounded belief renewable energy will somehow decouple growth from environmental damage, ignores real-world negative impacts which disproportionately affect poor people and frontline communities.

Scaling up massive clean energy infrastructure without working to downsize demand wreaks environmental devastation. So does mining toxic rare earth metals, dirty and dangerous work which is done in slave-like conditions by people in the Global South.

The UNFPA report displays this kind of misplaced faith in technology and human ingenuity. Such faith is rooted in a bias toward endless economic growth, propagated by those who have most benefited from the current economic system and who are already wealthy. It ignores the ecological unraveling of continued human expansionism, and the massive toll it takes on human well-being.

According to the IPCC, the climate crisis will lead to increased death and illness from extreme weather and heat waves, growing agricultural losses, destruction of small island states, debilitating drought, declining freshwater supplies, and escalating losses of marine and terrestrial biodiversity.

Over a billion people are expected to be climate refugees by 2050.

From climate change, violence, and conflict to decreased economic opportunity, population growth’s impacts are felt most acutely by women, whose status in developing countries is already low, and by children, including those yet to be born. UNICEF calls the outlook for a billion children in climate-vulnerable countries “unimaginably dire.”

In a time when no government climate plans are on track to limit warming to 1.5 degrees Celsius, and we are witnessing a human-driven mass extinction event, dismissing the profound impacts of population growth is shockingly irresponsible.

The UNFPA makes this mistake. It seeks to champion reproductive rights, yet dismisses the importance of population growth, which is driven by patriarchal pronatalist forces that pressure women into obsolete gender roles and abrogate their rights.

Failure to make this connection between rights and growth is the report’s most disappointing aspect.

Population deceleration and human rights go together; we need to advocate both. They are both achievable by the same set of human rights-based policies: universal education, women’s empowerment, children’s rights, and free, state-of-the-art family planning for all.

Truly advancing the causes of human rights and ecological sustainability requires humanity to shrink our population and our economies. It’s our only chance to achieve a high standard of living for all while staying within planetary boundaries.

Nandita Bajaj is the executive director of Population Balance and co-host of The Overpopulation Podcast. She also teaches the first graduate course of its kind: Pronatalism, Overpopulation, and the Planet, through the Institute for Humane Education at Antioch University.

IPS UN Bureau

Follow @IPSNewsUNBureau
  

Nearly every maternal death is preventable, and the clinical expertise and technology necessary to avert these losses have existed for decades. Credit: Patrick Burnett/IPS

By Marty Logan
KATHMANDU, May 10 2023 (IPS)

A new report reveals that from 2000 to 2015, the global maternal mortality ratio (MMR) fell by 33%, and by more than 50% in 58 countries that had the highest rates of women dying during pregnancy or up to 42 days after delivery. But from 2016 to 2020, maternal mortality barely changed. In 2020, roughly 287,000 women globally died from a maternal cause, which is almost 800 maternal deaths daily, and about one every two minutes.

The report, Trends in maternal mortality 2000 to 2020: estimates, by United Nations (UN) agencies and the World Bank Group, predicted that if current trends continue more than one million extra maternal deaths will occur by 2030, the end of the global Sustainable Development Goals (SDGs).

What are the SDGs?

Health systems must be held accountable for providing quality, respectful and equitable care through a well-trained and supported workforce and well-stocked shelves, At the same time, the persistent gender norms that deprioritize the health of women and girls must be addressed, to afford women respect and care during pregnancy and childbirth, along with protecting their right to access high-quality sexual and reproductive health services

WHO Director-General Dr Tedros Adhanom Ghebreyesus in the foreword to the UN /World Bank report Trends in maternal mortality 2000 to 2020: estimates

The 17 SDGs were adopted by all UN member states In 2015 after the Millennium Development Goals (2000-2015) ended. Each SDG deals with a specific development issue, such as poverty, education and health. And every goal includes specific targets, all of which are supposed to be met by 2030.

What is the SDGs target for maternal mortality?

The SDG target (3.1) for maternal mortality is a global MMR of less than 70 for every 100,000 live births. A supplementary target is that by 2030, no country should have an MMR greater than 140.

Is the world on track to meet the target?

The global MMR in 2020 was estimated at 223, down from 227 in 2015 and from 339 in 2000 – a drop of one-third (34.3%) from 2000 to 2020 but far from the target of 70. If the pace of progress seen in 2016–2020 continues, the MMR will be 222 by 2030 – over three times the target.

Why is the world so far off-track?

The vast majority of maternal deaths are preventable: the clinical knowledge and technology needed to prevent them have long existed. But, such solutions are often not available, not accessible or not put in place, says the report. This is especially true in locations lacking resources and/or among populations that are at greater risk because of so-called ‘social determinants’ — for instance, their economic and education levels and distance from health services.

Where are the biggest challenges?

In 2020, sub-Saharan Africa was the only region with an MMR that the report labels ‘very high’ (500-999) — 545 maternal deaths per 100 000 live births. A 15-year-old girl in the region had a 1 in 40 lifetime risk of dying from a maternal cause. Sub-Saharan Africa alone accounted for roughly 70% of global maternal deaths in 2020, followed by Central and Southern Asia (17%).

Are any countries or regions doing well?

Between 2000 and 2020, Central and Southern Asia achieved the greatest percentage drop in MMR, with a decline of 67.5%, falling from 397 to 129 maternal deaths per 100 000 live births. In 2020, MMR was lowest in Australia and New Zealand. A 15-year-old girl there had a 1 in 16,000 lifetime risk of dying from a maternal cause.

Are there any outliers?

In the United States the MMR soared between 2018 and 2021, from 17.4 per 100,000 live births to 32.9, according to the US Centers for Disease Control and Prevention. During the same period, the MMR for the Black population went from 37.3 to 69.9. For the White population it started at 14.9 in 2018 and rose to 26.6 in 2021.

Many experts point to impacts of COVID-19 as a main cause of the spike, and an article by CNN also notes that the MMR has been steadily rising in the US for three decades.

In 2021 the US Government introduced policies to address the negative trend, including the Black Maternal “Momnibus” Act of 2021. That package of bills aims to provide pre- and post-natal support for Black mothers, including extending eligibility for certain benefits postpartum, adds the CNN article.

Did the COVID-19 pandemic have an impact?

“It is plausible” that the pandemic had an impact on maternal mortality, says the UN/World Bank report, while noting that stagnation in progress started before 2020, when COVID-19 spread globally. Studies in four countries have found excess maternal mortality due to the pandemic but research is scarce.

What needs to change to meet the 2030 target?

The report says multisectoral action is needed to meet various challenges to reducing maternal mortality, including:

• Strengthen health systems by: increasing numbers of well-trained and supervised staff; tackling shortages of essential supplies and making them accountable to ensuring the rights of women and girls;
• Focus on improving access to women and girls marginalized by social determinants, including: ethnicity, age, disability and socioeconomic inequalities, which impede women’s access to and use of sexual and reproductive health services;
• Achieve universal health coverage so that services are affordable;
• A perspective that embraces women’s equality and human rights must animate action;
• Health systems must be made more resilient to climate and humanitarian crises.

What are other benefits of cutting maternal mortality

“A woman’s health lays the foundation for her children’s health, her family, her community and for generations to come,” says the World Economic Forum. Gender equality globally would raise the world’s gross domestic product as much as US$28 billion, it adds.

By Yasmine Sherif
NEW YORK, May 8 2023 (IPS)

A civilian student named Saber was caught in the crossfire in Khartoum. He had two choices: either flee and lose everything; or die. But within a moment his option to choose was violently denied: he died.

As a result of the brutal internal armed conflict in Sudan right now, UNHCR projects that 860,000 people will flee across the borders as refugees and returnees into the Central African Republic, Chad, Egypt, Ethiopia, Eritrea and South Sudan. About 50% will be children and adolescents below 18.

Will they arrive alive? They can’t choose. They can only hope.

Making it worse, none of the neighboring countries has the financial and structural capacity to manage such influx, and yet they too, have no choice.

Indeed, an enormous international response will be required to support the Refugee Response Plan developed by 134 partners, including UN agencies, national and international NGOs and civil society groups, and launched on 4 May 2023.

Fleeing children and adolescents will need immediate psycho-social support and mental health care to cope with the stress and trauma of the conflict and perilous escape. They will need school meals. They will need water and sanitation. They will need protection. In the deep despair of their young lives, they will need a sense of normalcy and hope for their future. They need it now and a rapid response to establishing education can meet these needs.

Or to paraphrase ECW’s new Global Champion, the world-renowned journalist, Folly Bah Thibault – who reaffirms the need for speed and quality: the humanitarian-development nexus in action – in her high-level interview in this month’s ECW Newsletter, “We need to deliver with humanitarian speed and development depth.”

The choice is ours.

ECW is now traveling to the region to support host-governments, UN and civil society colleagues who jointly produced the Refugee Response Plan and who are on the ground working day and night in difficult circumstances. ECW will provide support both through an initial First Emergency Response investment and through our global advocacy.

We all have a choice to act now. Our choice is not between losing everything or die. Our choice is between action or inaction. Between humanity and indifference.

Prior to the breakout of the internal armed conflict in Sudan, Samiya*, a 17-year-old refugee student, wrote in her recent Postcard From the Edge: “Education is our future dream. Education is one of the most important factors to progress in life. Through education, people can thrive in their lives; they can also develop their skills and improve their life quality.”

We can help make Samya’s dream come true at the hardest, darkest moment of her life. Samiya does not have that choice. Only, we have that choice. Let us recognize it for what it is: as a privilege or blessing of choosing responsibility and humanity.

Yasmine Sherif is Director of Education Cannot Wait.

IPS UN Bureau

Follow @IPSNewsUNBureau
  

Dr. Daisaku Ikeda. Credit: Seikyo Shimbun

By Daisaku Ikeda
TOKYO, Japan, May 8 2023 (IPS)

The Ukraine crisis, which in addition to bringing devastation to the people of that country has had severe impacts on a global scale—even giving rise to the specter of nuclear weapons use—has entered its second year. Against this backdrop and amid urgent calls for its resolution, the G7 Summit of leading industrial nations will be held in Hiroshima, Japan, from May 19 to 21.

In February of this year, an emergency special session of the UN General Assembly was held, where a resolution calling for the early realization of peace in Ukraine was adopted. Among the operative paragraphs of the resolution was one that urged the “immediate cessation of the attacks on the critical infrastructure of Ukraine and any deliberate attacks on civilian objects, including those that are residences, schools and hospitals.”

With that as a first essential step, all concerned parties must come together to create a space for deliberations toward a complete cessation of hostilities. Here I would like to propose that, as negotiations advance through the cooperative efforts of the concerned countries, they be joined by representatives of civil society, such as the physicians and educators who work in schools and hospitals to protect and nurture people’s lives and futures, participating as observers.

In March, the leaders of Russia and China issued a joint statement following their summit meeting which reads in part: “The two sides call for stopping all moves that lead to tensions and the protraction of fighting to prevent the crisis from getting worse or even out of control.” This is aligned with the resolution adopted by the emergency special session of the UN General Assembly.

The G7 Hiroshima Summit should develop concrete plans for negotiations that will lead to a cessation of hostilities.

I also urge the G7 to commit at the Hiroshima Summit to taking the lead in discussions on pledges of No First Use of nuclear weapons. The current crisis is without parallel in the length of time that the threat of use and the fear of actual use of nuclear weapons have persisted without cease.

Since the bombings of Hiroshima and Nagasaki, the hibakusha of those cities, in coordination with the larger civil society movement, have stressed the inhumane nature of nuclear weapons; non-nuclear-weapon states have engaged in continuous diplomatic efforts; and the states possessing nuclear weapons have exercised self-restraint. As a result, the world has somehow managed to maintain a seventy-seven-year record of non-use of nuclear weapons.

If international public opinion and the taboo against the use of nuclear weapons were to fail to provide their braking function, nuclear deterrence policy will compel humankind to stand on a precipitous ledge, never knowing when it might give way.

Since the start of the Ukraine crisis, I have written two public statements. In both, I referenced the joint statement by the five nuclear-weapon states (United States, Russia, United Kingdom, France and China) made in January 2022, which reiterated the principle that “a nuclear war cannot be won and must never be fought,” and called for it to serve as the basis for reducing the risk of nuclear weapons use.

Also of important note is the declaration issued by the G20 group in Indonesia last November, which stated: “The use or threat of use of nuclear weapons is inadmissible.”

The G20 member countries include nuclear-weapon states as well as nuclear-dependent states. It is deeply significant that these countries have officially expressed their shared recognition that the use or threat of use of nuclear weapons is “inadmissible”—the animating spirit of the Treaty on the Prohibition of Nuclear Weapons (TPNW).

It is vital that this message be communicated powerfully to the world from Hiroshima.

As the G7 leaders revisit the actual consequences of a nuclear weapon detonation and the bitter lessons of the nuclear era, I urge that they initiate earnest deliberations on making pledges of No First Use so that their shared recognition of the inadmissible nature of nuclear weapons can find expression in changed policies.

If agreement could be reached on the principle of No First Use, which was at one point included in drafts of the final statement for last year’s NPT Review Conference, this would establish the basis on which states could together transform the challenging security environments in which they find themselves. I believe it is vital to make the shift to a “common security” paradigm.

Commitment to policies of No First Use is indeed a “prescription for hope.” It can serve as the axle connecting the twin wheels of the NPT and TPNW, speeding realization of a world free from nuclear weapons.

For our part, the SGI has continued to work with the world’s hibakusha, the International Campaign to Abolish Nuclear Weapons (ICAN)—which arose from its parent body IPPNW—and other organizations first for the adoption and now the universalization of the TPNW. As members of civil society, we are committed to promoting the prompt adoption of policies of No First Use of nuclear weapons, generating momentum to transform our age.

The author is Peace builder and Buddhist leader Daisaku Ikeda, who is President of the Soka Gakkai International (SGI). https://www.daisakuikeda.org/ Read full statement here full statement.

IPS UN Bureau

Follow @IPSNewsUNBureau
  

Stagnant water in one of Nairobi’s residential areas. Credit: Wilson Odhiambo/IPS

By Wilson Odhiambo
NAIROBI, May 8 2023 (IPS)

‘Urban’ Kenya has been alerted because new mosquito species, Anopheles stephensi, threatens to derail decades of effort made in the fight against malaria.

According to a report by experts from the Kenya Medical Research Institute (KEMRI), the species was first noted during routine mosquito surveillance in Saku and Laisamis villages in Marsabit County. The report states that, unlike the traditional mosquito vector, the Anopheles stephensi can adapt to man-made habitats that include plastic containers, discarded car tyres and open sewer lines—this makes urban centres a hot spot for their prevalence.

Anopheles stephensi is endemic to South Asia and Arabian Peninsula, where it is a known carrier for two malaria variants Plasmodium falciparum and P. vivax. It was first noted at the Horn of Africa ten years ago in Djibouti, after which it was later tracked down in Ethiopia, Somalia, and Sudan in 2019.

The species is also known to survive through different climatic conditions, which can enable it to cause problems all year round if left uncontrolled.

‘’This mosquito most likely spreads through ships coming in from Asia since genetic analysis of many of the samples collected in Africa shows they are closely related to those found in Asia. Once they got to Africa, it is highly likely they have been transported southwards on the road,’’ said Dr Eric Ochomo, the project’s lead researcher and an entomologist at the KEMRI, Kisumu.

‘’It breeds in a wide range of habitats, mostly water storage containers that are not covered, manholes, overhead tanks, poorly dumped plastic containers etc.’’

Malaria has been a perennial problem in Kenya and Africa, given the vast tropical conditions that favour mosquitos and unreliable health facilities that make its control and treatment an almost impossible hurdle.

While being a nuisance in Africa, most malaria cases and mortalities have been recorded in rural areas, characterized by a lack of adequate medical amenities, unreliable infrastructure, and a lack of knowledge among residents.

Urban areas have usually been spared the malaria burden due to access to proper medical facilities and a good understanding of the disease and how to control and prevent it.

This notion may, however, change for the worse as this new mosquito species threatens the demographics and steps made in the fight against malaria in Africa.

‘’This species is different from the traditional mosquito for two main reasons; A) its diversity of breeding habitats means it can breed in rural and urban settings alike, which means that it is not restricted to rural habitats like the Anopheles gambiae, Anopheles arabiensis and Anopheles funestus which are the most common vectors in Kenya at the moment. B) It can transmit both Plasmodium falciparum and Plasmodium vivax parasites. We currently have very low levels of P. vivax transmission in Kenya, and this could be increased by this vector,’’ Ochomo explained to IPS.

Despite the 2020 world malaria report showing a significant decrease in malaria deaths over the past two decades (from 84 percent in 2000 to 67 percent in 2019), it remains one of Africa’s leading causes of death, especially among pregnant women and children under the age of five.

The report stated that 51 percent of the global malaria deaths were in Africa, with Burkina Faso (4%), the Democratic Republic of the Congo (11 percent), Nigeria (23 percent), Mozambique (4 percent), Niger (4 percent) and Tanzania (5 percent).

In Kenya, most malaria cases are centred around the malaria endemic areas, including the coastal and lake regions, which form prime breeding spots for female anopheles mosquitos. For the cases reported in towns such as Nairobi, a follow-up on the patient’s movements often reveals that they recently visited or through one of these malaria-endemic places and got infected.

A researcher from KEMRI’s Entomology Department tests stagnant water for the new species of mosquito. Credit: KEMRI’s Entomology Department

According to the Centers for Disease Control (CDC), about 3.5 million malaria cases are reported in Kenya annually, with about 10,700 mortalities. Out of this, western Kenya (lake region) usually records the highest number of cases at 45 percent.

The lake and coastal regions are categorized as malaria-endemic due to the favourable temperature and humid conditions they provide for mosquito breeding.

With most people in central Kenya and the highland areas having little exposure to malaria infections, this new vector could prove problematic given their immune system’s primitiveness to the disease.

The 2020 Kenya malaria indicator report says that low-risk malaria areas include Nairobi, Nyandarua, Nyeri, Kirinyaga, Murang’a, Kiambu, Machakos, Makueni, Laikipia, Nakuru, and Meru. Most of these areas are considered urbanized compared to most parts of Kenya.

Seasonally, areas that experience malaria outbreaks include Tana River, Marsabit, Isiolo, Meru, Garissa, Wajir, Mandera, Turkana, Samburu, Baringo, Elgeyo Marakwet, Kajiado. This is mainly due to the arid and semi-arid conditions experienced throughout the year that do not favour mosquito breeding.

‘’What this means is that we are going to have more incidences of malaria because this vector can thrive in both rural and urban settings and many other geographical regions,’’ says Dr Alex Owino, Medical Superintendent, Katulani Sub-County Hospital, Kitui.

‘’Kitui county falls under the low-risk malaria areas, with the few cases recorded being mainly from patients who had recently travelled outside the county,’’ he told IPS.

Owino explained that controlling malaria was easy when there were specific places where the host mosquito was known to favour. However, with this new vector being able to spread widely, it becomes a threat to the efforts made in the fight against malaria.

Being a developing country, parts of urban Kenya are characterized by poorly planned housing facilities, inadequate drainage systems and poor waste disposal management. Nairobi, for instance, is also known for hosting the largest slum in the country, Kibera, coupled with the Nairobi dam, which has, for years, made the headlines for having all manner of pollution destroying it.

All these conditions have been a recipe for various diseases, such as cholera and typhoid, causing health problems, especially in the slum areas. Now, malaria may have just added to the burden that these town dwellers have to deal with.

Ochomo said that, unlike the traditional malaria-causing mosquitoes, Anopheles gambiae and Anopheles funfests, the Anopheles stephensi is an invasive species that could bring malaria transmission to these areas where there is a large number of naive (have never had malaria) individuals.

‘’These individuals could get far more severe symptoms than people who have been exposed since birth,’’ he told IPS.

Wilson Opudo, a public health and infectious diseases specialist, also believes that the ongoing changes in climate conditions are likely to increase the malaria burden by creating mosquito breeding zones in areas where they were not a concern.

‘’Despite malaria being known to favour certain parts of Kenya, the recent changes in climate which have resulted in temperature increase and hydrological changes may help form new areas for the malaria vector breeding thus bringing malaria to places where it initially did not exist,’’ Opudo told IPS.

‘’This will put a lot of pressure on the malaria control commodities currently available for the endemic areas of Africa and could result in increased disease burden,’’ he added.

Ochomo concluded that its presence in urban settings means controlling this new vector will rely on properly managing waste disposal, covering water containers, and draining stagnant water.

‘’There is very little information available on the behaviour of the adult mosquitoes and an urgent need to invest in the research on this to inform what control methods would be applicable for the adult mosquitoes,’’ said Ochomo.

IPS UN Bureau Report

Follow @IPSNewsUNBureau
  

In India, a doctor checks a patient’s x-ray for lung damage, which may indicate tuberculosis. Credit: ILO/Vijay Kuty
 
On May 8, there will be an interactive multistakeholder hearing at the UN as part of the preparatory process toward High-level meeting on the fight against tuberculosis. The event will be broadcast live on UN Web TV.
 
Meanwhile, the head of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, has unveiled plans to speed up the licensing and use of effective novel vaccines against tuberculosis (TB), the second leading infectious killer after COVID-19 and the 13th leading cause of death worldwide. January 2023

By Morounfolu Olugbosi
PRETORIA, South Africa, May 8 2023 (IPS)

This week, the United Nations will host two days (May 8-9) of preliminary talks to plan a larger conference on tuberculosis (TB) in September. These preliminary talks will be held in New York City, the epicenter of the last significant surge of TB cases in the United States (U.S.) thirty years ago.

TB is a disease that strikes hardest in impoverished places, and the last U.S. outbreak was no different. Disadvantaged urban communities hit hard by the HIV/AIDS pandemic bore the brunt of the outbreak.

Yet, at the outbreak’s peak in 1992, less than 27,000 people in the U.S. were infected with TB. Today, an estimated 304,000 people are infected with TB in South Africa every year, while just under 3,000,000 people are infected with TB in India. The scope of the disease today far exceeds what the U.S. saw three decades ago, much less what it sees now.

TB deaths have risen across the world for two consecutive years; at this point it kills more people than COVID-19. Globally, an estimated 10.6 million people were infected with TB, but only 6.4 million people were diagnosed. The other 4.2 million people infected with this potentially lethal and debilitating disease slipped through the cracks.

In 2018, the UN held the first high-level meeting on TB. More than half of the UN member states sent delegations and 15 heads of state spoke at the event.

In a resolution endorsed by the entire UN General Assembly, every nation pledged to invest, by 2022, a total of US$2 billion annually for TB research and US$13 billion annually for TB diagnostics, treatment and care. Other commitments—to treat more people and prevent more active disease—were also made.

The world got off to a slow start on meeting these pledges and then the pandemic hit. Many of the goals were not reached. We were delighted, for example, that the annual research budget for TB research finally reached US$1 billion in 2021, because it was a critically important achievement—but the actual goal was twice that amount.

And less than half of what was pledged annually on diagnostics, treatment and prevention—US$5.4 billion—was actually provided in 2021.

There are bright spots in the fight against TB, of course. Sub-Saharan Africa is the only region that did not suffer a significant slump in TB detection during the COVID-19 pandemic. But with just under 40% of active TB infections unidentified, it still lags behind much of the world in diagnosing active cases.

Another recent highlight is the approval of new drug-resistant TB treatments that can reduce treatment time from as much as a year and a half (or sometimes even longer) to six months—including one developed by my organization, TB Alliance. African nations like Nigeria and South Africa are taking steps to rolling out this new regimen so that the spread of drug resistant infections can be curbed.

The goal pledged at the 2018 UN meeting was that, between 2018 and 2022, 1.5 million people with drug-resistant TB (DR-TB) would be treated—this is a critical slice of the TB caseload. Yet only 649,000 DR-TB patients were treated between 2018 and 2021.

There is optimism that the number of DR-TB patients who can be treated will escalate, given the new treatments, but funding and resources must increase.

The bottom line is this: TB was the most lethal infectious disease before the COVID-19 pandemic, and as COVID recedes, it is once again the worst. As leaders prepare to meet in New York City and start drafting a new set of promises in the form of the next Political Declaration on TB, we need the world to commit to ending this disease, which has killed too many people for far too long.

But this time around, we also need the world to follow through on its commitments.

Morounfolu (Folu) Olugbosi, M.D. is the Senior Director, Clinical Development at TB Alliance. He works with the clinical development of products in the TB Alliance portfolio and helps to oversee clinical trials in TB endemic countries and heads the South Africa office.

IPS UN Bureau

Follow @IPSNewsUNBureau
  

Fish farmers harvest genetically improved farmed tilapia. Credit: Shandy Santos

By Jharendu Pant
PENANG, Malaysia, May 3 2023 (IPS)

For Timor-Leste, as with most other islands in the Pacific, fortunes are to be found in fish – an equity food available to all regardless of status.

Nevertheless, the island is highly exposed to the impacts of climate change, hampering domestic food production and contributing to Timor-Leste’s ranking of 110th out of 121 countries for malnutrition. Meanwhile, the country is highly dependent on imported foods – including aquatic foods.

But a national strategy to prioritise the sustainable growth of fish production, particularly through farming of Genetically Improved Farmed Tilapia (GIFT), is helping not only to reverse these trends, but also to provide new economic and livelihood opportunities throughout the entire aquaculture value chain.

And its successes offer economies of scale for development agencies and donors looking to maximise impact by replicating the strategy across other Pacific states with similar environments and challenges.

Jharendu Pant

Timor-Leste is on track to double fish consumption between 2010 and 2030, with all the benefits for improving nutrition this holds, having already generated returns by tripling productivity while reducing culture period by half. Timor-Leste’s farmers are now able to produce more nutritious aquatic food in less time.

The ripple effects of these successes are already spreading in the region: representatives from the Solomon Islands travelled to Timor-Leste for training in 2018 and 2019 to learn from the model, which offers a blueprint for addressing similar challenges faced by other island nations.

Small island developing states (SIDS) are collectively among the countries most affected by malnutrition, with 75 per cent of adult deaths in the Pacific caused by non-communicable disease – many of them diet-related. At the same time, small island states are among the most exposed to climate risk, which impacts the production of nutritious, indigenous foods.

But based on Timor-Leste’s learnings, other small island nations can also boost nutrition security and livelihoods through a similar dedicated strategy for aquaculture.

The approach starts with prioritising and deploying locally adapted solutions and technologies. WorldFish, working together with the Government of Timor-Leste, helped to introduce a public-private partnership (PPP) model for Genetically Improved Farmed Tilapia (GIFT) hatcheries across the country, ensuring that farmers have access to high quality fish fingerlings in their local area.

Senor Robiay, cluster coordinator of Laubonu. Credit: Silvino Gomes

This improved breed of tilapia is ideal for addressing nutrition gaps for protein, essential fatty acids and micronutrients, while also minimising the burden on the environment, due to its relatively lower carbon footprint. The hatcheries were also established following rigorous environmental standards, which limits the release of effluence and observes biosecurity measures.

However, one of the challenges remaining for Timor-Leste and other resource-poor countries is the development of effective regulations and compliance monitoring. Alongside greater capacity for upholding environmental standards, subsequent phases of the strategy would also look to ensuring the benefits of increased production are shared equitably. This includes addressing issues of gender equality as well as youth employment opportunities.

Secondly, other countries with similar contexts can learn from Timor-Leste’s example of prioritising growth in production to drive increased consumption. Timor-Leste’s new fish hatcheries have helped increase production threefold between its first and second phase, paving the way for the successful scaling of aquaculture across the country.

And by prioritizing the production of monosex (all male) tilapia – which grow faster than female tilapia – Timor-Leste’s approach allowed the country’s farmers to maximize growth and the rate at which domestic production could meet the nutrition needs of the population. This resulted in increased availability and accessibility of nutritious fish to support higher levels of consumption.

Finally, Timor-Leste’s commitment to an ongoing aquaculture strategy over a decade and counting has also allowed the initiative to evolve over time. Such a long-term approach has also enabled the testing and validation of technologies and practices, making the scaling and replication elsewhere comparatively straightforward.

But ongoing funding is critical, both to develop the long-term capacity needed to maintain economic and nutritional gains in Timor-Leste, and to jumpstart similar initiatives elsewhere. The Partnership for Aquaculture Development in Timor-Leste (PADTL2) has been funded by the Ministry of Foreign Affairs and Trade (MFAT) New Zealand since 2014, with complementary financing from USAID in recent years, offering more solid and lasting gains than ad hoc interventions that last just a couple of years.

The sustainable growth of aquaculture production offers many benefits for small island nations. Over the last decade, Timor-Leste’s aquaculture strategy has become a model for developing more inclusive and secure food systems for all, helping to combat the challenges of malnutrition and exposure to climate change that impact Pacific Islands.

Partners including WorldFish are standing by to replicate this success and support other island governments to sustainably increase fish production and consumption to unlock blue fortunes for all.

IPS UN Bureau

Follow @IPSNewsUNBureau
  

Excerpt:

A doctor talks to a TB survivor at a clinic in Manilla, Philippines. Credit: Getty Images for TB Alliance

By Ed Holt
BRATISLAVA, May 2 2023 (IPS)

While there is no established causal relationship between climate change and tuberculosis (TB), studies have begun to highlight the potential impact its effects could have on the spread of the disease.

Undernutrition, HIV/AIDS, overcrowding, poverty, and diabetes have all been identified as TB risk factors that are worsened by climate change. Worryingly, many countries with high burdens of TB, including, for instance, drought-hit Ethiopia, Indonesia, Kenya, and Peru, have suffered from the kind of extreme weather associated with a heating planet.

But despite vying with COVID-19 for the grim distinction of the world’s deadliest infectious disease, claiming 1.6 million lives in 2021, TB is not often talked about in connection with climate change, with the link often overlooked by policymakers.

TB experts say this must change as the climate crisis accelerates.

“The effects of climate change, such as its impact on migration, for instance, are getting attention. What we want to see is for that attention to also get drawn to its effects on TB,” Maria Beumont, Chief Medical Officer at TB Alliance, a global nonprofit organisation developing TB drugs, told IPS.

In recent years, disease experts and climatologists have sounded increasingly dire warnings about the potential impact of the climate crisis on the spread of lethal diseases.

The latest report from the Intergovernmental Panel on Climate Change (IPCC) warned of the health impacts of global heating, including an increase in the incidence of infectious diseases. Meanwhile, other research has shown how changes in climate have aggravated the risks of hundreds of infectious diseases worldwide.

But much of the discussion around that has focused on how higher temperatures and increased incidence of flooding and drought could drive more vector, food and water-borne diseases with diseases.

What has often been overlooked in these conversations, say Beumont and others, is how the effects of the climate crisis could worsen what is de facto a global TB pandemic.

Part of this is because of the nature of those effects in relation to TB.

“The potential impact of climate change [on TB] is more indirect than with some other infectious diseases,” Dr Mohammed Yassin, Senior Disease Advisor, TB, at the Global Fund to Fight AIDS, Tuberculosis and Malaria, told IPS.

TB experts point to how more frequent and more devastating natural disasters linked to climate change, or simply places on the planet becoming too hot to be habitable, are leading to mass displacement, which can create ideal conditions for TB to spread.

“Mass displacement can lead to overcrowding and poor living conditions of those displaced. If some of those people already have symptoms of TB, there is a higher chance of it spreading. There would also be people living under stress, and facing malnutrition, which are factors adding to the potential for TB to spread,” said Yassin.

Displacement also raises issues with access to healthcare for the displaced, which can negatively affect the management of treatment for those with TB because patients need to take treatment daily. Interruption of treatment can leave them infectious for longer and at risk of developing drug-resistant TB, which in turn is much more difficult and expensive to treat.

But displacement would also impact the treatment of those with other conditions, such as HIV and AIDS and diabetes, which weaken immune systems and leave people more susceptible to TB.

Meanwhile, displaced people are likely to find themselves living in crowded areas where, in the absence of adequate screening and diagnostic procedures, TB could spread.

But displacement is far from the only problem. Both extreme droughts and flooding can impact food security, devastating crops and killing livestock and leading to malnutrition and undernutrition—known risk factors for TB.

The impact of extreme weather on health, particularly TB, is already being seen in some parts of the world.

Somalia is in the grip of severe drought following five consecutive failed rainy seasons—something which the UN has said has not been seen for four decades—with five million people facing acute food shortages and nearly two million children at risk of malnutrition, according to the UN.

TB is a major cause of death in Somalia, and late last year, with TB services largely non-existent in settlements for displaced persons, the Global Fund committed USD 1.9 million for food support for thousands of TB patients and outreach activities in settlements. Officials at the time emphasised the importance of such action to help reach the most vulnerable and stop TB from spreading.

Meanwhile, the devastating floods in Pakistan last year, which affected an estimated 33 million people, not only brought an immediate threat of diseases such as malaria and dengue but interrupted vital vaccination programmes, including TB.

“The impact of flooding on TB is usually seen sometime later, but it, of course, has an immediate impact in disrupting treatment which can lead to problems such as drug-resistant TB,” said Yassin.

TB experts are calling for governments and leaders within the TB community itself to begin paying more attention to the issue and start thinking about current TB programs and where changes need to be made to deal with these potential impacts.

Some groups, like TB Alliance, are looking to mitigate some of these impacts through treatment developments. The group recently developed a new TB treatment regimen, BPaL, with a much shorter treatment length and fewer of the sometimes very toxic side effects of previous regimens.

An oral-only regimen involving only a few pills a day, it has been widely praised by patients and experts for the relative ease with which it can be taken, notably in Ukraine, where it has recently been rolled out programmatically and used among the many millions displaced there because of the Russian invasion.

“What we are focusing on is trying to find solutions to make treatment safer and shorter, which would overcome some of the negative effects of climate change related to TB, for instance, displacement, as there would be less chance of treatment interruption with shorter treatment,” said Beumont.

A doctor studies x-rays of a TB survivor at a clinic in Kyiv, Ukraine. Credit: Getty Images for TB Alliance

Yassin said that investment in health systems, especially in low-income countries which have some of the world’s highest TB burdens and where healthcare is already under-resourced, is also crucial.

“We learnt from Covid that health systems can’t cope with a pandemic, and TB is actually a pandemic. It is very important for countries to think about strengthening their health systems and making them more resilient. There needs to be investment now to prepare the systems for a pandemic, including climate change-driven TB,” said Yassin.

“There was a collapse of some healthcare systems during Covid, and because of that, all resources in some countries went to dealing with that, and TB was forgotten, and the TB burden of those countries rose. We need to invest now, not wait for another pandemic. We need more resources,” he added.

Meanwhile, others say that alongside these measures, individual, non-climate-specific interventions could help.

Dr Krishnan Rajendran of the ICMR-National Institute for Research in Tuberculosis (NIRT) in India, which has the highest burden of TB in the world according to the World Health Organisation, told IPS that lessons learnt from the Covid pandemic could be used to reduce TB spread.

“National and local authorities could take preventive measures, such as at least encouraging people to wear masks in seasons where TB incidence is high,” he said.

Whatever efforts are made to deal with the impact of climate change on the disease, they need to be made soon, said Yassin.

“We shouldn’t wait for climate change impacts [to fuel the spread of TB] before we act—we should do something now and deal with TB to prevent more deaths and disabilities,” he said.

IPS UN Bureau Report

Follow @IPSNewsUNBureau
  

An aerial photograph of a busy roundabout in Lusaka Zambia. Credit: UNRSF.

By Nneka Henry
GENEVA, Apr 27 2023 (IPS)

Crises may be a centuries-old phenomenon, but so too is human resilience.

The high number of road deaths and life-changing injuries in the global south is a crisis that affects millions of people every year. In 2018 alone – the year that the UN Road Safety Fund was established – 1.3 million people died on the world’s roads, and another 50 million were injured or disabled.

Recognizing the world’s state of increasing complexities, the Fund has been meeting the global road safety challenge head-on. It has done this through a coordinated and multi-faceted approach that addresses the underlying cause of unsafe roads whilst also addressing interconnections with other global development crises

These numbers are even more sobering against the backdrop of multiple global crises that range from the coronavirus pandemic to the climate emergency, the cost of living crisis to geopolitical conflicts. As daunting as the mounting crises facing the world may be, the millions of lives and livelihoods lost to road crashes has made the Fund as resolute as ever to continue to mobilize and coordinate effective responses to very real road safety needs.

Recognizing the world’s state of increasing complexities, the Fund has been meeting the global road safety challenge head-on. It has done this through a coordinated and multi-faceted approach that addresses the underlying cause of unsafe roads whilst also addressing interconnections with other global development crises.

As the only United Nations body solely dedicated to channelling resources and expertise to tackling the root cause of the crisis, preventing further loss of life is, and will always be, our ultimate goal.

How could it not be – considering that road traffic crashes take the lives of around 3,700 people each day; the equivalent of losing a large cruise ship of passengers at maximum capacity. Through annual Calls for Proposals, the Fund coordinates and finances projects that help ensure road safety is treated as the significant public health issue that it is.

In Brazil, our project partner, the UN Economic Commission for Latin America and the Caribbean, worked with the Department of Transport to correct and improve speed control operations including with the use of portable equipment on all of the Pará State highways. The project resulted in a doubling breathalyzer tests to over 78,000 carried out in 2022 and contributed to decreasing the rate of traffic deaths by a third, down from 6.13 per 10,000 vehicles in 2021 to 4.13 in 2022.

Underpinning the Fund’s ability to effectively address the road safety crisis is our comparative advantage of encouraging international collaboration and cooperation through pooled financial resources and technical knowledge. The more financial and technical partners that participate in the Fund the more comprehensive our response has been, spanning road safety-related legislation, enforcement, education, use of technology and implementation of international regulations and standards.

In the case of West Africa – led by our project partners the UN Environment Programme and UN Economic Commission for Europe – the Fund collaborated on an initiative with the UN Economic Commission for Africa, FIA, and the International Motor Vehicles Inspection Committee.

This has supported the 15 ECOWAS members states to adopt and roll out a regionally-harmonized vehicle directive and technical inspection system, which sets a common standard to safeguard the safety and environmental-friendliness of used vehicles on West African roads. It is now helping to decrease the number of vehicles involved in fatal crashes due to technical defects by 50%, saving thousands of lives.

Nneka Henry, Head of UN Road Safety Fund

Key to strengthening the Fund’s global outreach and engagement is our commitment to communicate clearly and effectively with the public, stakeholders, and decision-makers to ensure that everyone is up-to-date and engaged in the response efforts.

In addition to project planning information sessions which encourage knowledge exchange, and building synergies and complementary financing opportunities before projects are finalized; the Fund also delivers three main flagship events. These include the virtual Open Day for project partners to share project results, the launch of the Annual Impact Report, which takes place on the margins of the International Transport Forum Summit, and the Highlights Country Visit for stakeholders to deep dive into projects that the Fund is supporting.

As global citizens we are all facing a crossroads of crises. The Fund’s response has been to invest in supporting interconnections with other development priorities as a way to build resilience and preparedness for future crises.

Mindful of economic crises, the Fund’s investment in safe transport and road infrastructure is vital. This is what we have been doing in support of the Tanzanian government – with project partners the International Road Assessment Programme, International Road Federation and the UN Economic Commission for Africa.

This initiative has been helping to reduce traffic crashes that place a heavy additional economic burden on families, governments and employers – spanning medical expenses, lost income, and reduced productivity – all of which costs the global economy US$ 1.85 trillion each year.

Low- and middle-income countries devote considerable public personnel and other resources to the treatment and rehabilitation of people injured in road crashes. There is, therefore, a compelling need to reduce the road crash burden on national healthcare systems freeing up critical resources to address other pressing health issues.

Considering ongoing health crises, the Fund is investing in effective post-crash responses – a focus area for the 2023 Call for Proposals and an issue we address in countries like Bangladesh and Azerbaijan, which suffer high rates of road casualties.

Mitigating the effects of climate change, the Fund also invests in cleaner ways of moving safely, including through the Reclaiming the Streets project across Africa to prioritize safe walking and cycling lanes for pedestrians and cyclists who also happen to be our most vulnerable road users.

During these years of polycrises, the Fund has relied on the global solutions approach to rise to the global road safety challenge. And, this month, as the Fund celebrates five years, I challenge more nations, companies and individuals to invest in the only global response comprehensively addressing the root causes of poor national road safety systems across the world. Join us in our sustained effort and rise to meet the serious and interconnected challenges that is the global road safety crisis today.

Excerpt:

The World Alliance for Mercury-Free Dentistry delegates at Minamata COP-4, on 23 March, 2022, Bali, Indonesia. Credit: Kiara Worth, IISD/ENB (Earth Negotiation Bulletin)

By Charlie Brown
LOME, Togo, Apr 26 2023 (IPS)

The Minamata Convention on Mercury, a stellar success story to date, has been favorably compared to the prototype success story for a treaty on toxins: the Montreal Protocol. Both had a single focused mission; both gained universal support across the globe; both matched technological innovation with environmental science to discard old polluting methods.

But emerging after hidden negotiations with the mercury lobby is a GEF project with UNEP endorsement which ignores, if not outright defies, the will of the Parties. As COP5 approaches, here is the test case on whether Minamata continues to move our small planet toward an end to anthropogenic mercury—or become mired in corporate capture.

For the past decade, the Parties repeatedly rejected the agenda of the dental mercury lobby—the dentists who still cling to the 19th century tooth-unfriendly pollutant amalgam, despite it being 50% mercury and a health risk to their own dental nurses; and the waste industry, whose obvious self-interest is to keep amalgam going into perpetuity to sell their equipment.

Charlie Brown

So, the dental mercury lobby met repeatedly with GEF and UNEP staff in sessions closed to the Parties . . . closed to the Minamata Secretariat . . . closed to the Minamata Bureau . . . closed to the dozens of CSOs who have actively pushed for a treaty to phase out anthropogenic mercury.

Violating their own standards, GEF and UNEP constructed (or allowed without objection) a project that bypasses the Children’s Amendment entirely in favor of trying to redirect the mission of the treaty from use to waste—the very position repeatedly rejected by the Parties since 2013.

Separators do not sell well because they do not and cannot eliminate mercury waste; they only catch the mercury in the dentist office—not the mercury implanted in people—and they require a massive infrastructure to ensure that even that partial waste, from dental offices, is properly disposed of. Only one solution ends mercury waste from amalgam: the switch to mercury-free dentistry.

The #1 beneficiary of this Greenwashing is the world’s only major publicly traded dental products maker expanding sales of amalgam: Southern Dental Industries (SDI) of Melbourne. While its competitors exited or scaled back amalgam—or never made it in the first place—SDI seized their exits as its opportunity to corner the amalgam market.

Just six weeks ago, in a call to its shareholders, SDI’s CEO boasted about its huge increases in amalgam sales, detailed its entry into new markets to sell amalgam, and affirmed her personal goal of ‘maximizing’ amalgam sales! Wriggling into a GEF-UNEP amalgam “reduction” project while increasing amalgam sales, SDI is the sole dental products company in a project partnership role—hence given market access denied to their mercury-free competitors in nations on three continents. Here is a classic case of Corporate Capture!

GEF’s requirement of stakeholder participation at the earliest stage was papered over via a legerdemain: a false claim that the NGOs are participating. Falsely listed as participants are the World Alliance for Mercury-Free Dentistry, Bangladesh-based Environment and Social Development Organization, Germany-based European Network for Environmental Medicine, Philippines-based BAN Toxics, Nepal-based Center for Public Health and Environmental Development, Cameroun-based Centre de Recherche et d’Education pour le Développement, and U.S.-based Consumers for Dental Choice.

Equally troubling, RAP-AL Uruguay, who leads the campaign for mercury-free dentistry for Latin America, is preliminarily assigned to promote separator sales—a goal anathema to its very mission.

UNEP top brass in Nairobi and GEF top brass in Washington need to act:

• First, to determine who on their staffs submitted the plethora of false claims of CSO participation;
• Second, to kill this project, so that the Minamata Convention on Mercury does not become the treaty about corporate capture and greenwashing;
• Third, to use GEF funding to enact the will of the Parties as stated unequivocally in its 2022 Amendment: stop placing mercury fillings, for all time and all regions, in children and women who are pregnant or breastfeeding.

IPS UN Bureau

Follow @IPSNewsUNBureau
  

Excerpt:

Young girls chat while sitting under a mosquito net in Bienythiang, South Sudan. Credit: UNICEF/Mark Naftalin
 
World Malaria Day, April 25, is an occasion to highlight the need for continued investment and sustained political commitment for malaria prevention and control. It was instituted by WHO Member States during the World Health Assembly of 2007.

By Arthur Ng'etich Kipkemoi Saitabau
KUALA LUMPUR, Malaysia, Apr 24 2023 (IPS)

For centuries, malaria has remained one of the deadliest diseases, inflicting great suffering on families and perpetuating the cycle of poverty in many communities and nations. The African region currently accounts for 95% of malaria cases and 96% of malaria deaths globally, with women and girls disproportionately affected by the disease.

Women are at higher risk of malaria due to biological, social, economic, and gender factors. They have limited access to healthcare, less decision-making power and control over household resources, which increases their susceptibility.

Gender-based economic disparities further worsen the situation by limiting women’s access to malaria prevention and treatment.

While significant progress has been made in the past decades in combatting malaria through the development of life-saving treatment regimens and the implementation of cutting-edge technologies to accelerate the discovery and development of new malaria vaccines, deaths due to malaria remain high.

In 2021 alone, an estimated 619,000 deaths were caused by malaria, highlighting the need for continued efforts to combat this disease.

In addition, COVID-related disruptions in the delivery of malaria curative and preventive services during the two peak years of the pandemic (2020-2021), led to approximately 13 million more cases of malaria and an additional 63,000 deaths caused by the disease compared to the pre-COVID-19 year of 2019.

To date, malaria cases and deaths have primarily been reduced through disease-focused approaches that tend to be reactive rather than proactive often initiated in response to malaria outbreaks.

This narrow focus on treating individual cases of malaria overlooks broader social, economic, environmental risk factors including gender-based inequalities.

As Member States work towards ambitious goals set during the 2015 World Health Assembly of reducing the global malaria burden by 90% by 2030, efforts need to prioritise the underlying factors that drive transmission through a multifaceted approach, particularly recognising the social determinants like gender inequalities.

The concept of people-centred health care is based on fundamental principles that prioritize human rights, dignity, participation, equity, and partnerships.

This approach aims to create a health care system where individuals, families, and communities receive humane and holistic care, while also having the opportunity to actively engage with the health care system.

As we work towards leaving no one behind and achieving the last mile, developing and adopting more people-centred approaches, that address gender and intersectionality concerns through an analysis of power dynamics, will be critical to make significant strides towards eradicating malaria for good.

This can involve engaging with communities and stakeholders to identify their needs and develop evidence-based malaria control strategies that promote equity and inclusion.

Additionally, promoting participation of marginalized groups in decision-making and ensuring malaria interventions respect human rights and promote social justice.

Not only will this help advance Sustainable Development Goals towards gender equality but importantly will also contribute to decolonising global health and empowering communities that remain most impacted by the disease.

Unpacking the Gendered Dimensions

A people-centred approach to malaria prevention aims to prioritize the well-being of individuals and communities by establishing reliable health systems. However, power dynamics must be taken into account to prevent the perpetuation of power imbalances, hierarchies, and inequalities.

This means engaging with communities and other stakeholders to identify their needs and priorities and working together to develop evidence-based malaria control strategies.

The Community Directed Intervention (CDI) approach exemplifies the importance of extensive community engagement to identify local needs and priorities for malaria control. This includes community meetings, involving leaders and women groups, and conducting surveys on malaria burden and risk factors.

Developing evidence-based strategies through community engagement results in increased community ownership and participation, leading to higher uptake of interventions and reducing malaria transmission.

Addressing the power dynamics associated with malaria prevention requires acknowledging and tackling gendered dimensions linked with malaria prevention.

Women in some communities may lack access to education, employment, and decision-making power, which can limit their ability to protect themselves from malaria.

Additionally, cultural beliefs and practices may contribute to the unequal distribution of resources for malaria prevention and control, with men accessing more resources than women.

This underscores the importance of addressing gender roles in malaria control initiatives and empowering women to take an active role in protecting themselves and their families.

Intersectionality also has important implications for malaria control as gender intersects with other social categories to create specific vulnerabilities and challenges. For instance, women from lowest income groups are least likely to get access to healthcare.

To address these challenges, it is important for more malaria control programs to conduct systematic social and gender analysis, hearing from those affected, to better understand the subtle nuances of gendered and intersectional dimensions of power both within households and communities.

This approach can then help to identify the specific barriers and opportunities for women’s participation in malaria control initiatives. By unpacking the gendered dimensions in communities, public health officials can design targeted interventions that promote women’s empowerment, address gender inequalities, and increase women’s involvement in malaria control programs.

Confronting not Reinforcing Power Dynamics

A people-centred approach to malaria control can empower individuals by providing education and training on malaria prevention and control. It can emphasize inclusivity and centre the experiences and knowledge of those who have been historically excluded or marginalized due to factors such as racism, sexism, classism, and other systems of power.

To avoid reinforcing power dynamics in malaria control, it is crucial to involve and empower marginalized groups in decision-making. This involves consulting communities to identify their needs and priorities, promoting participation of women and marginalized groups, and designing interventions that promote equity and inclusion.

The foundation for improving community dialogue and community-led actions towards malaria elimination has been established over the years.

A case in point is the successful elimination of malaria in Cambodia’s last mile, which relied on communities in high-risk areas agreeing to increased testing, regular fever screening, and in some cases, taking preventive antimalarial medication.

A people-centred approach recognizes the significance of communities in designing and implementing malaria control programs, considering their unique social, cultural, and environmental contexts that can impact malaria transmission and control.

One illustration is the use of local languages and cultural practices to build trust and improve communication on malaria prevention and control measures through empowerment of community health workers who understand and can tailor interventions to their specific contexts.

On the other hand, a people-centred approach, which does not consider power dynamics, can unintentionally reinforce social hierarchies and exclude vulnerable populations from accessing preventative and curative treatment for malaria.

For instance, a malaria control program that only involves male community leaders and village chiefs in decision-making when distributing bed nets reinforces patriarchal power and favour wealthier households, while excluding marginalized groups such as women and those from lower socio-economic backgrounds.

In conclusion, achieving malaria elimination through people-centred approaches requires a holistic approach that actively considers issues of gender, intersectionality, and balance of power. It is crucial to ensure that these approaches do not perpetuate existing inequalities, but instead centre the experiences and knowledge of marginalized groups.

By acknowledging and addressing the ways in which different forms of oppression intersect and compound to create experiences of marginalization and exclusion, we can make meaningful strides towards malaria elimination.

To achieve this, sustaining a commitment to inclusivity, equity, and social justice is imperative in all efforts aimed at eradicating malaria and improving the health and well-being of communities affected by this disease.

This includes actively involving marginalized groups in decision-making processes, addressing social determinants of health, tailoring interventions to specific cultural and contextual factors, and promoting gender equality and women’s empowerment.

By taking a proactive and inclusive approach, we can ensure that malaria control efforts are effective, equitable, and sustainable, leading to more just and healthier communities.

Arthur Ng’etich Kipkemoi Saitabau is Post-Doctoral Fellow of the United Nations University – International Institute for Global Health.

IPS UN Bureau

Follow @IPSNewsUNBureau
  

The removal of Mughal history from textbooks is seen as a political move which downplays the rich diversity of the Indian subcontinent. This artwork stems from this period. Credit: Govardhan. Jahangir Visiting the Ascetic Jadrup. ca. 1616-20, Musee Guimet, Paris

By Ranjit Devraj
NEW DELHI, Apr 20 2023 (IPS)

The removal from school textbooks of chapters covering the Mughal period of Indian history spanning three centuries has raised a storm of protests from academics.

The Mughals, who ruled much of the Indian sub-continent between the 16^th and 19^th centuries, left behind an indelible stamp on science, art, culture, and overall development. Their legacy is visible today mainly in a number of monuments recognised as UNESCO World Heritage Sites, including the Agra Fort, Fatehpur Sikri, Red Fort, Humayun’s Tomb, Lahore Fort, Shalamar Gardens, and the Taj Mahal.

UNESCO’s India representative, Hezekiel Damani, said the organisation advises that the curriculum represents a conscious and systematic selection of knowledge, skills and values that shape the way teaching, learning and assessment processes are organised by addressing questions such as what, why, when and how students should learn.

“Therefore, a quality curriculum must pave the way to the effective implementation of inclusive and equitable quality education,” Damani says. “Subject-specific curriculum development, reform and revision are entirely the decision of member states; they must be conscious of today’s curriculum, and future needs while making any intervention.”

“The issue here is that Mughal rule does not align well with present-day politics — it is no surprise that chapters that refer to that period are being deleted by the National Council for Education Research and Training (NCERT),” says Ruchika Sharma, who teaches history at the Delhi University.

Sharma says that from an academic point of view, the Mughal period presents a well-researched part of Indian history because of the rich documentation they left behind. “Removing an entire chapter dealing with such an important period of history from class XII textbooks would certainly affect students’ career choices — they will see a mismatch between visible legacy and the curriculum.”

Sharma referred in particular to the chapter titled ‘Kings and Chronicles, the Mughal Courts,’ from the NCERT history book Themes of Indian History-Part II, which describes how the Mughals encouraged peasants to cultivate cash crops such as cotton grown over a “great swathe of territory that spread over central India and the Deccan plateau.”

The Mughal period saw India becoming the world’s biggest exporter of cotton as well as cotton manufactures such as calico and fine muslins that were shipped to the European markets by the Dutch and English East India Companies that were allowed to set up ‘factories’ or fortified trading posts along the Indian coasts.

Other revenue-generating crops included sugarcane and oilseeds such as mustard and lentil that were grown alongside staples like rice, wheat and millets, the deleted chapter said. The section on ‘Irrigation and Technology’ noted that under the Mughals, cultivation rapidly expanded with the help of artificial irrigation systems and the introduction of crops from the new world, such as tomatoes, potatoes and chilli.

Swapna Liddle, historian and author, says that much of India’s built heritage, language, arts, agriculture and land tenure systems are a legacy of the Mughal period. “It is important to study how India was also progressing in the scientific fields during that period,” says Liddle.

The Mughal period saw a flowering of the sciences, especially astronomy, mathematics, medicine, architecture and engineering, that had an impact long after the dynasty ended in 1857. Akbar’s reign (1556—1605), for example, saw the establishment of medical schools and dispensaries, while his successor, Jehangir, patronised the study of mathematics and astronomy.

On April 7, a group of ‘Concerned Historians’ issued a statement saying: “We are appalled by the decision of the NCERT to remove chapters and statements from history textbooks and demand that the deletions from the textbooks be immediately withdrawn.”

“The decision of the NCERT is guided by divisive motives. It is a decision that goes against the constitutional ethos and composite culture of the Indian subcontinent. As such, it must be rescinded at the earliest,” said the statement, which has been endorsed by hundreds of academics.

According to the statement, the textbooks were designed to be inclusive and provide a sense of the rich diversity of the human past both within the subcontinent as well as the wider world. “As such, removing chapters/sections of chapters is highly problematic not only in terms of depriving learners of valuable content but also in terms of the pedagogical values required to equip them to meet present and future challenges.”

The director of the NCERT, Dinesh Kumar Saklani, has stated that the chapters were removed as part of “rationalisation aimed at reducing the burden on schoolchildren following the COVID-19 pandemic.” He claimed that the rationalisation was vetted by experts and denied that there was any political agenda behind the move.

Says Ajay K. Mehra, a political scientist currently attached to the independent think tank, the Observer Research Foundation: “It would have been far better to modify the chapters on the Mughal and Islamic periods than delete them altogether — this way a very large and important period of mediaeval Indian history is going to be lost to impressionable young students and to future generations.”

The changes to the textbooks, says Mehra, are deliberate and part of a larger, declared political agenda to restore the past glory of Hindu dynasties that existed before the arrival of Islam in India. This can be seen in the renaming of roads and cities, he said, citing the renaming of Allahabad city in 2018 to Prayagraj to reflect its importance as a Hindu pilgrimage site at the confluence of the sacred Yamuna and Ganges rivers.

“What is lost here is the fact that Mughal rule saw enormous economic advancement that lasted three centuries because of a compact with Hindu Rajput (princely) feudatories. “Rajput princes not only led Mughal armies but also entered into marital alliances — two of the important Mughal emperors, Jehangir and Shah Jahan, were born of Rajput princesses, for example,” Mehra said.

Makkhan Lal, distinguished fellow at the Vivekananda International Foundation, a think tank considered close to the government, says that there is a case for the Mughal period getting “disproportionate description and allotment of space” in history textbooks and this needed to be rectified.

Lal, who has taught history at the Banaras Hindu University and worked with the NCERT, said the “correction being made now is a step in the right direction and should have been taken earlier.”

Apart from academics, leaders of opposition parties have also denounced the changes to the textbooks. Sitaram Yechury, general secretary of the Communist Party of India, said the changes made to class textbooks were regrettable because of India’s diversity.

“The lands of India have always been the churning crucible of civilisational advances through cultural confluences,” Yechury says.

Pinarayi Vijayan, who leads a communist party government in the southern Kerala state, Tweeted: “They resort to rewriting history and masking it with lies. So, we must strongly protest the decision of the BJP government to delete certain sections from NCERT textbooks. Let the truth prevail.”

IPS UN Bureau Report

Follow @IPSNewsUNBureau
  

"If people do not change the way antibiotics are used now, these new antibiotics will suffer the same fate as the current ones and become ineffective” . Credit: Adil Siddiqi/IPS

By Baher Kamal
MADRID, Apr 11 2023 (IPS)

Research after research, world’s scientists renew their loud alerts against the high dangers of human-driven ‘superbugs’ – bacterias and pathogens that no longer respond to antimicrobials, making infections harder to treat and increasing the risk of disease spread, severe illness and death.

No way.

The pressure of giant industrial sectors appear to be heavier than the needed political well to reduce the dangerous impacts of the excessive use of those drugs which are widely employed to prevent and treat infections in humans, aquaculture, livestock, and crop production.

Antibiotics are perhaps the most familiar ones, but there are many others, including numerous antivirals, antifungals and antiparasitic agents that have been largely used and misused to treat diseases but that end up spreading them.

They are known as ‘superbugs’ resulting from their increasing resistance to those medicines. And they are antimicrobial resistant germs which are found in people, animals, food, plants and the environment (in water, soil and air).

“They can spread from person to person or between people and animals, including from food of animal origin,” as further explained by the UN Food and Agriculture Organization (FAO).

Such an increasing abuse of antimicrobials and other microbial stressors (e.g. the presence of heavy metals and other pollutants) creates favourable conditions for microorganisms to develop resistance.

The big threat

They represent one of the most complex threats to global health, and food safety and security. Much so that the World Health Organization (WHO) lists Antimicrobial Resistance (AMR) among the top 10 threats for global health.

The emergence and spread of drug-resistant pathogens that have acquired new resistance mechanisms, leading to antimicrobial resistance, continues to threaten the ability to treat common infections, WHO explains.

Alarming advance of multi-resistant bacterias

“Especially alarming” is the rapid global spread of multi- and pan-resistant bacterias that cause infections that are not treatable with existing antimicrobial medicines such as antibiotics.

“The clinical pipeline of new antimicrobials is dry.” In 2019 WHO identified 32 antibiotics in clinical development that address its list of priority pathogens, of which only six were classified as innovative.

Moreover, estimates suggest that by 2050 up to 10 million additional direct deaths could occur annually. That is on par with the 2020 rate of global deaths from cancer.

Additionally, in the next decade, AMR could result in a Gross Domestic Product (GDP) shortfall of at least 3.4 trillion US dollars annually and push 24 million more people into extreme poverty.

Antibiotics, increasingly ineffective

According to the World Health Organization, the lack of access to quality antimicrobials remains a major issue. Antibiotic shortages are affecting countries of all levels of development and especially in health-care systems.

“Antibiotics are becoming increasingly ineffective as drug-resistance spreads globally leading to more difficult to treat infections and death.”

New antibiotics urgently needed

New antibacterials are urgently needed – for example, to treat carbapenem-resistant gram-negative bacterial infections as identified in the WHO priority pathogen list.

“However, if people do not change the way antibiotics are used now, these new antibiotics will suffer the same fate as the current ones and become ineffective.”

Meanwhile, FAO reports, “the situation is expected to worsen as global demand for food increases,” adding that it is therefore paramount that the agrifood systems are progressively transformed to reduce the need for antimicrobials.

What drives antimicrobials?

As mentioned above, such a threat is primarily driven by the excessive application of antimicrobials, the international body adds. In fact, currently, more than 70% of antimicrobials sold worldwide are used in animals for human consumption.

While AMR occurs naturally over time, usually through genetic changes, FAO reports that their main drivers include:

– misuse and overuse of antimicrobials in human health and agriculture;

– lack of access to clean water, sanitation and hygiene for both humans and animals;

– poor infection and disease prevention and control in healthcare facilities and farms;

– poor access to quality, affordable medicines, vaccines and diagnostics; and

– weak enforcement of legislation.

Who influences the spread of superbugs?

According to UN reports, three economic sector value chains profoundly influence AMR’s development and spread:

• Pharmaceuticals and other chemicals manufacturing
• Agriculture and food including terrestrial animal production, aquaculture, food crops or those providing inputs such as feed, textiles, ornamental plants, biofuels, and other agricultural commodities.

• Healthcare delivery in hospitals, medical facilities, community healthcare facilities and in pharmacies where a range of chemicals and disinfectants are used.

Other major consequences

Another leading specialised body, the UN Environment Programme (UNEP) warned in its February 2023 report: Bracing for Superbugs about the need to curtail pollution created by the pharmaceuticals, agricultural and healthcare sectors.

The study focuses on the environmental dimensions of AMR, reporting that the pharmaceutical, agricultural and healthcare sectors are key drivers of AMR development and spread in the environment, together with pollutants from poor sanitation, sewage and municipal waste systems.

Inger Andersen, the UNEP Executive Director, explained that the triple planetary crisis – climate change, pollution and biodiversity loss – has contributed to this.

“Pollution of air, soil, and waterways undermines the human right to a clean and healthy environment. The same drivers that cause environmental degradation are worsening the antimicrobial resistance problem. The impacts of antimicrobial resistance could destroy our health and food systems,” she warned.

Climate, biodiversity, pollution, nature loss…

According to UNEP, global attention to AMR has mainly focused on human health and agriculture sectors, but there is growing evidence that the environment plays a key role in the development, transmission and spread of AMR and is a key part of the solution to tackle AMR.

In fact, AMR is closely linked to the triple planetary crisis of climate change, biodiversity and nature loss, and pollution and waste, driven by human activity, unsustainable consumption and production patterns.

The world leading environmental body explains the following:

— Climate crisis and AMR are two of the greatest and most complex threats the world currently faces. Both have been worsened by, and can be mitigated by, human action.

— Higher temperatures can be associated with increases in AMR infections, and extreme weather patterns can contribute to the emergence and spread of AMR.

— Antimicrobial impacts on microbial biodiversity may affect the cycles of carbon and methane, which are directly involved in regulating Earth’s climate.

— Biodiversity loss: Land-use changes and climate change alter soils’ microbial diversity in recent decades, and microbes inhabiting natural environments are sources of pharmaceutical discovery.

— Municipal solid waste landfills and open dumps are prone to wildlife and feral animal interaction and can contribute to the spread of AMR.

— Pollution: Biological and chemical pollution sources contribute to AMR development, transmission, and spread.

Patients outside the Mycetoma Research Center in Sudan. Credit: DNDi

By Geoffrey Kamadi
NAIROBI, Apr 7 2023 (IPS)

The disease burden and distribution of mycetoma—a neglected tropical disease—are not very well understood. However, it is known to affect people in Sudan, Senegal, Mauritania, Kenya, and Niger, as well as people in Nigeria, Ethiopia, India, and Cameroon. Cases have also been reported in Djibouti, Somalia, and Yemen.

“It is currently unknown what the incidence, prevalence and the number of reported cases per year per country is,” observes Dr Borna Nyaoke, head of the Mycetoma Program at the Drugs for Neglected Diseases initiative (DNDi) – Africa Regional office. DNDi is a not-for-profit international R&D organisation operating in Kenya, Ethiopia, Uganda and Sudan.

Mycetoma is one of a group of 20 diseases referred to as neglected tropical diseases or NTDs in short. These diseases usually affect marginalized and poor communities.

NTDs are caused by viruses, bacteria, fungi and toxins from snake bites. They affect 1.7 billion people globally.

According to the Centres for Disease Control and Prevention, mycetoma is caused by certain types of bacteria and fungi found in soil and water. Mycetoma can be caused by bacteria (actinomycetoma) or fungi (eumycetoma).

For years now, little attention has been directed towards NTDs in terms of research and the development of new treatments, hence their neglected categorization status.

Between 2000 and 2014, only 66 novel products entered phase I clinical trials intended to prevent or treat NTDs, according to Dr Maurice Odiere, head of the Neglected Tropical Diseases Unit, Centre for Global Health Research at the Kenya Medical Research Institute (KEMRI). This represented just 1.65 percent of all 4,006 phase I trials in the world.

However, this has changed over the last couple of years, with concerted efforts producing new drugs and research initiatives.

For example, the world’s first randomized double-blind clinical trial on eumycetoma (fungal mycetoma) was completed last year in Sudan, according to Nyoke.

“We were comparing the investigational drug Fosravuconazole against a treatment against Itraconazole, which is the standard treatment of eumycetoma in Sudan,” she explains.

This clinical trial started in 2017 in Khartoum, Sudan, with phase II clinical trials completed in March 2022, and the top-line results were presented in September 2022. The clinical report is under review and is expected to be finalized later in 2023.

The study was conducted in Sudan because it is one of the countries where mycetoma is endemic.

Expensive Toxic Treatment

The existing treatments for eumycetoma, such as the antifungals Ketoconazole and Itraconazole, are expensive, ineffective, and have serious side effects. Patients oftentimes undergo multiple amputations, which may prove fatal.

However, scientists think that Fosravuconazole, a drug developed for onychomycosis (a fungal nail infection), could offer an effective and affordable treatment for eumycetoma, hence the study. The drug’s interaction with body tissues is said to be favourable, and its toxicity levels are low. Lab tests show its activity against agents causing eumycetoma to be effective.

Mohamed Safi Ahmed El-Safi, who hails from the Kordofan region of Sudan, is a survivor of mycetoma. Initially, he did not think much of what appeared to be a pimple on his toe.

However, he would soon seek medical attention when he began experiencing excruciating pain emanating from the toe.

“The infection and pain increased, giving me a fever. My body felt like I was on fire,” recounts El-Safi.

Medical tests later revealed that the infection had spread to the bone. His lower right leg had to be amputated as a result. He now urges people to immediately seek medical attention once they notice a boil or pimple on the leg.

Mycetoma Research Centre (MRC)

Sudan boasts of the Mycetoma Research Centre (MRC) in Khartoum, which was established in 1991 under the auspices of the University of Khartoum, which is based at Soba University Hospital.

“It is the only referral hospital in the country, providing integrated medical care for mycetoma patients as well as training for medical and health professionals,” says Nyaoke.

Not only does the centre receive patients from within Sudan, patients from across Africa and the Middle East are referred to the Centre as well.

Nyaoke maintains that plans are underway to conduct epidemiological studies in Sudan, Senegal and India, among other endemic countries, to gather information on the burden and distribution of disease.

IPS UN Bureau Report

Follow @IPSNewsUNBureau
  

A nurse walks into a hospital ward in Janakpur in Dhanusha District in southern Nepal. Credit: UNICEF/Rupadhayay

By Roopa Dhatt and Susannah Schaefer
WASHINGTON DC / NEW YORK, Apr 7 2023 (IPS)

As World Health Worker Week draws to a close on April 7, health organizations from around the world have been celebrating women’s vital role in the health workforce and sharing stories about the enormous value they bring to all areas of health and care.

But platitudes are not enough. It’s time for global health leaders to step up and turn these words into action.

Globally, women make up almost 70% of the global health workforce and 90% of the frontline health workforce, contributing over $3 trillion to global health each year. The health systems in which they work play a significant role in remote and marginalized groups’ access to health, especially in times of crisis. Despite this, the challenges faced by community health workers (CHWs) are frequently overlooked.

CHWs play a critical role in providing care to vulnerable populations, but they are undervalued and accorded lower status in the “informal” workforce. Upwards of six million women are estimated to be either unpaid or grossly underpaid despite working in core health systems roles and just 14% of CHWs in Africa are salaried.

It is unjust that global health systems rely on the labor of unpaid women who are creating social and economic value that is uncounted and unrewarded. Unpaid work reduces women’s economic security and increases their lifetime poverty.

It also weakens health systems. The pandemic has demonstrated the need for strong and resilient health systems, but there can be no global health security while health systems are subsidized by some of the world’s poorest women.

Women health workers continue to make huge sacrifices to work on the frontlines. They went door-to-door educating households on the COVID-19 virus, tracing contacts, and delivering vaccines.

At last year’s World Health Assembly, India’s one million women community health workers known as accredited social health activists (ASHAs) were honored for successfully protecting the health of millions of people during the pandemic.

At the start of the pandemic, however, reports were coming out of India about the unacceptable risk faced by ASHA workers who were being sent into communities without lack of infection controls and facing stigma and abuse as perceived vectors of the virus.

In 2020, they launched widespread street protests and strikes to demand better pay, protection, and working conditions. ASHA workers may have been acknowledged as global health leaders, but they continue to be underpaid with small performance-based honorariums. They are still fighting for a fair and regular salary and the benefits that come with formal sector roles.

Pre-pandemic the World Health Organization (WHO) projected a global shortage of 10 million health workers by 2030, which COVID-19 now has deepened. Health workers lost their lives to the virus and significant numbers are unable to work, affected by ‘long-COVID’. There have been increased reports of violence towards women health workers during the pandemic–from colleagues as well as patients and their families.

In a 2018 report on health policy and system support to optimize CHW programs, one of the primary WHO recommendations included fair remuneration for CHWs, but this is still far from the norm. When CHWs are compensated, it often fails to align with WHO recommendations, which call for financial packages that are commensurate with the demands of the job, the level of complexity, the training required, and the hours worked.

This World Health Workers Week, we come together with our partners to call on global health leaders, governments and policy makers to disrupt the status quo. We believe that every person, regardless of gender, should have access to quality health and care and opportunities to thrive.

We know a fairly-compensated health workforce–alongside training, supervision, and safe working environments–leads to improved productivity, wider access to healthcare, and better patient outcomes.

The gender pay gap in health of 24% is one of the largest of any sector. We are calling on leaders to take measures to close that gap. We stand with our partners in calling for and focusing on transformative change, including gender-equal leadership in global health and a new social contract for women health workers centered on the need for fair and equal pay and safe and decent work.

There is increasing urgency in both high-income and low- and-middle income countries to prioritize changes in guidelines, funding, and policies. After three years of COVID-19, women health workers, who have been the majority in patient-facing roles, are burned out and traumatized.

Understandably, women are leaving the health sector at all levels in a ‘Great Resignation,’ which threatens to deepen the global health worker shortage crisis.

Addressing these injustices is a moral obligation and an economic necessity. Investing in health workers is a win-win proposition and will send a message that we recognize and value them as professionals.

Not only can we restore justice to neglected global health systems, but we can improve the working conditions and pay of health workers, unleashing broader economic benefits.

We would like to send a clear message that as heads of global health organizations we are committed to building stronger health systems and a more equitable world. Achieving true health equity includes quality care for all–including health workers.

Dr Roopa Dhatt is Executive Director and Co-Founder Women in Global Health, a fast- growing women-led movement with 47 chapters worldwide.

Susannah (“Susie”) Schaefer is Executive Vice Chair, President, and Chief Executive Officer (CEO) of Smile Train, the world’s largest cleft-focused organization with a sustainable and local model of supporting surgery and other forms of comprehensive cleft care.

IPS UN Bureau

Follow @IPSNewsUNBureau
  

By External Source
Apr 1 2023 (IPS-Partners)

 
This is David.

He is becoming an exceptional chess player.

This is Mai.

She loves beaches and the ocean.

This is Kwame.

He is a passionate architect.

The only thing these people have in common…

…is that they all identify as Autistic.

Autistic people have a wide range of talents and challenges that are often not recognized by the world they are born into.

They continue to face discrimination and other challenges.

Levels of awareness and acceptance vary dramatically from country to country.

In recent years, however, major progress has been made in increasing awareness and acceptance.

Thankfully, we are moving away from the narrative of curing or converting autistic people.

We now focus much more on education, support and inclusivity.

This is a major transformation for all autistic people, their allies, and neurodiversity.

It enables autistic people to claim their dignity and self-esteem.

And to become fully integrated as valued members of societies.

Without stigma.

This year, we celebrate World Autism Awareness Day with a pivotal theme:

Transforming the narrative: Contributions at home, at work, in the arts and in policymaking

Together, we must transform the narrative around neurodiversity to overcome barriers and improve the lives of autistic people.

IPS UN Bureau

Follow @IPSNewsUNBureau
  

By Saima Wazed and Zain Bari Rizvi
DHAKA, Bangladesh, Mar 31 2023 (IPS)

When is too much Autism awareness still not enough? This thought recurs every April as we near World Autism Day on April 2, and parents reach out to me after reading enthusiastic and well-meaning news and journal articles – which are actually harmful and hurtful.

Saima W. Hossain

Today, we feel our work in Bangladesh, through effective national and international partnerships with equally dedicated parents and professionals, has impacted the country. Professional training, extensive awareness activities, and inclusion in social situations are demonstrable. The best part is that parents no longer view themselves as victims punished by fate for having a child with a disability.

Despite all the efforts in educating people in the many sectors of our country, including the formulation of a detailed National Strategic Plan, it is shocking to still find blatant disregard for the truth. I have, therefore, requested a parent, a former Shuchona Foundation head of operations and now a member of our executive board, to share her thoughts. Nothing speaks the truth louder and stronger than the person who has been on the receiving end of the discriminatory, hurtful, and unethical behaviour than the parent who hears it over and over again.

Here below excerpts of what I learned from Zain Bari Rizvi

If I had a Taka (Bangladesh currency) for each time someone said: ‘But he looks so normal,’ when I share that my son is on the Autism Spectrum, I would have been able to take early retirement at a villa in the Maldives!

Zain Bari Rizvi

As I watch my feisty, opinionated and uber affectionate ASD child thrive in a typical school and social setting thanks to early childhood interventions and therapy, I shudder at the thought of what could have been our reality if I had paid heed to the photos of what Autism looks like in Bangladesh media.

I hope those reading this will take heed. Autism is a complex state of being, and no two autistics are alike. Every time I meet and spend time with someone with Autism, I am amazed at how unique, creative, and what a gift they are to the world. I want to change how we treat those we deem to be different, not change who they are.

For centuries all we have done is find creative ways to separate the majority from the minority. I hope the two years of the global pandemic will finally make us realize that when one group of people mistreat another, be it through military, financial or social power, we all suffer, not just the ones we discriminate against.

Saima Wazed Hossain is Advisor to the Director-General, World Health Organization (WHO), on Mental Health and Autism. She is Chairperson, National Advisory Committee for Autism and NDDs, Bangladesh and Chairperson, Shuchona Foundation. She is a specialist in Clinical Psychology and an expert on Neurodevelopment disorders and mental health. Her efforts have led to international awareness, policy and program changes, and the adoption of three international resolutions at the United Nations and WHO.

Zain Bari Rizvi is a Board Member of Shuchona Foundation, an Operations and Finance professional who is a passionate advocate for people with Autism and a mother of two children.

IPS UN Bureau

Follow @IPSNewsUNBureau
  

Excerpt:

LGBTIQ+ activists in Caracas protest outside the National Electoral Council, in charge of the civil registry, demanding enforcement of the legal statute that authorizes a change of name for trans, intersex or non-binary people. The agency has delayed compliance with the law for years. CREDIT: Observatory of Violence

By Humberto Márquez
CARACAS, Mar 30 2023 (IPS)

The vulnerability and struggles of the LGBTIQ+ community in Venezuela were once again highlighted when the Supreme Court finally annulled the military code statute that punished, with one to three years in prison, members of the military who committed ” acts against nature.”

The Constitutional Chamber of the Supreme Court ruled that the statute, in force since the last century, “is contrary to the fundamental postulate of progressivity in terms of guaranteeing human rights,” and also “lacks sufficient legal clarity and precision with regard to the conduct it was intended to punish.”

The statute, in the Code of Military Justice, was the only one that still punished homosexuality with jail in Venezuela, and it was overturned on Feb. 16."In Venezuela LGBTIQ+ people (lesbians, gays, bisexuals, transsexuals, intersex, queers and others) must still fight for the right to identity, to equal marriage, to non-discrimination in education, health and housing.” -- Tamara Adrián

However, “in Venezuela LGBTIQ+ people (lesbians, gays, bisexuals, transsexuals, intersex, queers and others) must still fight for the right to identity, to equal marriage, to non-discrimination in education, healthcare and housing,” transgender activist Tamara Adrián told IPS.

Even the procedure followed to overturn the statute, the second paragraph of article 565 of the Military Code, was an illustration of the continued disdain towards the LGBTIQ+ minority.

Activist Richelle Briceño reminded IPS that civil society organizations had been demanding the annulment of the statute for seven years, receiving no response from the Supreme Court.

“All of a sudden, the Ombudsman’s Office (in Venezuela all branches of power are in the hands of the ruling party) asked the court to overturn that part of the article and in less than 24 hours the decision was made, on Feb. 16,” Briceño observed.

In addition, the Ombudsman’s Office argued that the statute was not used in the last 20 years, but Briceño said that around the year 2016 there were several documented cases.

Different NGOs see the legal ruling as linked with the presentation, the following day, of reports to the United Nations Human Rights Council of serious violations on this question in Venezuela, including the non-recognition of the rights of the LGBTIQ+ community.

In the Venezuelan armed forces, homosexual conduct or acts “against nature” were still punishable by prison sentences of one to three years, until the statute was finally overturned by the Supreme Court in February. CREDIT: Mippci

Many pending issues

In Venezuela, “according to current medical protocols, blood donations by people who have sexual relations with people of the same sex are not even accepted,” Natasha Saturno, with the Acción Solidaria NGO, which specializes in health assistance and supplies, told IPS.

“Forty days ago they operated on my son. I brought a dozen blood donors, they were all asked this question, and several were turned away,” she said.

If these restrictions still exist, even further away are the hopes of the LGBTIQ+ community to obtain identity documents that reflect their gender option, to same-sex unions or equal marriage, or to outlaw all forms of discrimination, Saturno said.

Adrián said that “recognizing gender identity or equal marriage with both spouses enjoying the right to exercise maternity or paternity are achievements that are advancing or expanding throughout Latin America, and Venezuela, which has moved forward in civil rights since the 19th century, is now among the laggards.”

The activist, founder in 2022 of the political party United for Dignity, highlighted the progress made on this issue in Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Peru and Uruguay, “with only Guyana, Paraguay, Suriname and Venezuela lagging behind in South America.”

With regard to identity, since 2009 the Civil Registry Law states that “everyone may change their own name, only once, when they are subjected to public ridicule (…) or it does not correspond to their gender, thus affecting the free development of their personality.”

But the rule is not enforced in the case of trans, intersex and non-binary people, with countless procedural obstacles in the way, which is why, frustrated by meaningless paperwork, LGBTIQ+ groups have protested before the Supreme Court, the Ombudsman’s Office and the National Electoral Council, which the civil registry falls under.

Adrián maintained that “we are guided by the opinion of the Inter-American Court of Human Rights, which in 2017 recognized the right to identity as essential for the development of personality and non-discrimination in areas such as labor, health and education.”

A demonstration by the LGBTIQ+ community outside the Supreme Court in Caracas demanded the right to same-sex marriage, which is legal in many parts of Latin America but remains a distant dream in Venezuela. CREDIT: Acvi

Victims of violence

LGBTIQ+ people in Venezuela “suffer numerous forms of discrimination and violence, from the family sphere to public spaces,” said Yendri Velásquez, of the recently created Venezuelan Observatory of Violence against this community.

It manifests itself “in psychological violence, very present in the family sphere, beatings, denial of identity, access and use of public spaces – from restaurants to parks -, extortion, bullying based on gender expression, employment discrimination and even murder,” Velásquez said.

He pointed out that in 2021 there were 21 murders of people “just for being gay or lesbian,” and that in the second half of 2022 the Observatory recorded 10 “murders or cases of very serious injuries” with a total of 11 gay, lesbian or transgender victims.

The activists are advocating for norms and policies that help eradicate hate crimes and hate speech, as well as online violence, because through social networks they receive messages as serious as “die”, “kill yourself”, “I hope they kill you” or “you shouldn’t be alive.”

The organizations share these fears and are protesting that the legislature, in the hands of the ruling party, is drafting a law that would curtail and severely restrict the independence and work of non-governmental organizations.

Marches for the rights of the LGBTIQ+ community and against discrimination are growing in size in Venezuela, and groups of European residents and diplomats have even joined in on some occasions. CREDIT: EU

Healthcare as well

For the LGBTIQ+ community, healthcare is a critical issue, in the context of a complex humanitarian emergency that, among other effects, has led to the collapse of health services, with most hospitals suffering from infrastructure and maintenance failures, lack of equipment and supplies, and the migration of health professionals.

Adrián said “there are barriers to entry into health centers, both public and private, for people who are trans or intersex, for their stay in hospitals – sometimes they are treated in the corridors – and for adherence to the treatments.”

An additional problem is that hormones have not been available in Venezuela for 10 years, and users who resort to uncontrolled imports are exposing themselves to significant health risks.

The community was greatly affected by the AIDS epidemic, although in 2001 civil society organizations managed to get the Supreme Court to make it obligatory for the government to provide antiretroviral drugs free of charge.

They were available for years, although Saturno points out that the supply became intermittent starting in 2012.

That year marked the start of the current economic and migration crisis suffered by this oil-producing country of 28 million people, with the loss of four-fifths of GDP and the migration of seven million Venezuelans.

Currently, deliveries are made regularly, according to the NGOs dedicated to monitoring the question, although usually with only one of the treatment schemes prescribed by the Pan American Health Organization, “and not everyone can take the same treatment,” Saturno said.

Some 88,000 HIV/AIDS patients are registered in Venezuela’s master plan on HIV/AIDS that the government and United Nations agencies support. But according to NGO projections, there could be as many as 200,000 HIV-positive people in the country.

The activists also note that the climate marked by the denial of identity and rights for individuals and couples, discrimination, harassment, violence and work handicap, plus health issues, push LGBTIQ+ people to form part of the flow of migrants that has spread across the hemisphere.

The cumulative needs of injured patients from the war have created a medical crisis. Credit: James Jeffrey/IPS

By Abdo Husen
ADDIS ABABA, Mar 30 2023 (IPS)

There are about 5 billion people globally who cannot access surgery. In Ethiopia, for every 5,000 needed surgeries per 100,000 people, the country’s health system can only provide 192. Yet, this is Africa’s second largest population, with over 120 million people.

The statistics are worrying. This is further exacerbated by a recently ended two-year war in the northern part of the country that devastated among others, the health sector. There is however an opportunity to build back better as the government institutes post-war reconstruction. This is possible through prioritizing access to surgical care as part of restoring the country’s health system in post-war reconstruction efforts.

Armed conflict increases the demand for health services yet hampers the system’s ability to deliver these services as it disrupts the supply chain, results in direct damage to health facilities, and forces health workers to flee their duty stations. In Ethiopia, unofficial estimates put the proportion of health workers who fled their duty stations at over 90% of the pre-conflict numbers.

Armed conflict increases the demand for health services yet hampers the system’s ability to deliver these services as it disrupts the supply chain, results in direct damage to health facilities, and forces health workers to flee their duty stations

The cumulative needs of injured patients from the war have created a medical crisis. It is a vicious cycle whose victims are innocent civilians. Take for instance patients with open fractures and bullet wounds who require some form of reconstructive surgery. This service is largely unavailable in affected regions, particularly in Tigray. If left untreated, these injuries can result in infections, amputation, permanent disability, or even death.

This was the case for 17-year-old Hakeem* (not his real name). He suffered bone and nerve damages as a casualty of the war. Hakeem was facing the threat of disability from abnormal bone healing and wrist-drop, which is paralysis of the muscles that enable hand function.

Fortunately, he received surgical care that allowed him to return to his daily activities with reduced physical challenges. Not many people have been as lucky. Reports show that over 100,000 people died from lack of access to medical care in war time. This includes lack of access to surgical care.

Additionally, the influx of surgical patients owing to the war has slowed down the already strained health system’s ability to provide non-emergency surgical care. Although not life threatening, these surgical needs have a major impact on improving the quality of life of those in need.

These include cleft lip and cleft palate, which are birth defects that occur when a baby’s lip or mouth do not form properly during pregnancy. Failure to correct this, often results in social and economic exclusion of patients who are often ostracized by their communities for allegations based on false and harmful cultural and religious beliefs including their participation in witchcraft.

Arguably, the Federal Government of Ethiopia has indeed made efforts toward the rehabilitation of health infrastructure in conflict areas. For example, the government’s effort to restore 36 hospitals in Afar and Amhara. There is however much more to be done. Rebuilding the health system will cost the country an estimated 74.1 billion ETB (Approx. US$1.4 billion).

To restore all social service infrastructure- including health facilities damaged by conflicts in the country, the government has allocated 20 billion ETB into the capital budget for the current fiscal year. This is way below the requisite threshold to rebuild the health services alone.

There is indeed urgent need to prioritize surgical care at the forefront of rehabilitation efforts. The Ministry of Health must provide health workers – including specialist surgical and anesthesia workforce with monetary and non-monetary incentives to return to their pre-war duty stations to fill the gaping vacuum in human resourcing.

The federal government must allocate resources towards the rehabilitation and equipping of all health facilities including surgical theatres in northern Ethiopia. This budgetary allocation must be included in the 2023/2024 budget cycle (2016 Ethiopian fiscal year). Critics could argue that there is simply not enough money to this end.

While the government could be cash-strapped to rebuild different sectors of the economy; it is its ultimate responsibility to ensure the life and health of its citizens. It must therefore seek innovative ways to fund reconstruction efforts. One such way could be through leveraging public private partnerships.

Not only will this provide the necessary funds but has the prospect of being an accountability mechanism to ensure lasting peace as a condition of the disbursement of funds or gifts in kind. These would be tangible steps towards reconstruction, alleviating the suffering of Ethiopians who without these services, continue to suffer preventable medical conditions and deaths.

Abdo Husen is a public health specialist by training, Program Lead at Operation Smile Ethiopia, and a 2023 Global Surgery Advocacy Fellow

Dr. Ameenah Gurib-Fakim

By Ameenah Gurib-Fakim
PORT LOUIS, Mauritius, Mar 30 2023 (IPS)

On 12th March 2023, The Republic of Mauritius celebrates 55 years of post-independence history. It would be an understatement to just say that there has been a lot of water under the bridge on our journey to self-determination!.. Indeed, we have made massive progress since we lowered the Union Jack and unfurled our own flag. It was and remains a moment of great pride whenever I see our flag in any international event, I participate in.

We are a small vulnerable island, deprived of natural resources and at the time of independence, we were flanked with a monoculture economy, high unemployment, low education and low income were amongst the major challenges. We had been relegated to being a basket case. Even by Nobel prize winners concluded that because of our isolation from the then major capitals; climate challenges etc. we were doomed at a time when our per capita income hovered around 200USD.

We were more a recipe for disaster than that of a success story. Still over time, with leadership and vision, we proved to the world that another outcome was feasible, but more importantly, that profound transformation was possible, and we succeeded within one single generation.

We became the shining star especially South of the Sahara and our experience brings useful insights into the dynamics and pitfalls of an economic transformation journey. Nonetheless, this transformation has been conducted in such a manner that the economic landscape, society and institutions were modernised simultaneously, albeit at various speeds, taking into consideration the political, human, institutional and economic realities and constraints of the time. The approach was largely inclusive because the major asset then and now remains our diverse, talented population.

Our story had been based on the following foundational stones: political leadership, strong institutions, ethnic diversity, a class of versatile indigenous entrepreneur and a well-structured private sector engaged in dialogues on policy matters. Coupled with this, the balance has been between economic and social objectives, with a strong focus on the human capital, through free education since 1976, free health care, and a minimum basic social safety net for the most vulnerable.

Still the strength of our institutions were a key guarantee for investment, entrepreneurship and innovation. While acknowledging that significant progress has been achieved in the last 50+ years, the global dynamics call for more and more reforms if our country wants to avoid the middle-income trap and join the club of high-income countries within the realm of a changing climate. There are already indications of worrying signals: the average growth rate has been stabilizing at less than 5%, necessary to enable incremental changes, but insufficient to steam up the engine to the next level. Beyond the redesigning and re-engineering of the economic landscape, some implementable reforms will have to be addressed.

The main weaknesses are found in our education system. While we have a 99% enrolment rate at the primary level, but what comes next is disappointing. Let’s take the hypothetical 100 children entering our primary school, 80 will manage to pass their primary school exam to enter secondary school; only 60 will manage to succeed after the first 3 years, 40 will pass the Grade 5 (O-level) exams and with only 20-30 will reach the end of the secondary school cycle. This is in total contradiction to the requirements of a high-income country; one that ambitions to attract High Tech investment. The curriculum needs to move away from being too academic and with little openings for technical and vocational training.

Also, labour market reforms need to ensure flexibility. A diversified economic base only makes sense if it is possible for people to move across sectors. Currently, the stiffness of labour market and employment schemes that go with it, makes it difficult for people to move around. The basic principle must remain the protection of the people as opposed to jobs.

Finally, Mauritius must step up efforts to plug into regional and global value chains. We must continue to build on the regional market and must upgrade our participation in the global value chains, by capturing activities with higher value addition. Our regional market penetration remains weak. In the last decade it has been estimated that Mauritius export to the SADC region amounted to only 1.3% while its imports from the SADC region amounted to 2.5%. Similarly, we still have too big a bias towards our traditional markets to export low value added products.

Competition over concepts rather than over processes will be increasingly necessary to have a meaningful role. To achieve this, increased investment in quality education, innovation, research and development and technology, the appropriate ecosystem for start-ups, is crucial. We are at a crossroad in our economic transformation. The latter can remain a continuous process as we have had a good track record so far. The challenge for our country now lies in combining sustained domestic reforms with efforts required to keep up with international trends to become a global player. This demands that we align all our talents, competence and resources.

Next door to us, a giant is waking up – The African continent and the AfCFTA presents a huge opportunity, for, inter alia, our manufacturing sector, provided we engage with her, like in any relationship, seriously, and not just pay lip service. We have to keep reminding ourselves that the world we embraced in 1968, is now fast mutating. We were born in a bipolar world and now living in an increasingly multipolar world. Our foreign policy must remain agile as it is going to be a rocky road especially as we will have to count the presence of new emerging African middle-income countries that are increasingly catching up with their economic trajectory.

We will only succeed if we manage to navigate through competition, build trust and strengthen our institutions, acknowledge our diversity as strength, ensure meritocracy and by turning challenges into potential opportunities as ONE people and ONE Nation, in Peace, Justice and Liberty.

IPS UN Bureau

Follow @IPSNewsUNBureau
  

Excerpt:

On Mar. 22, 2023, dozens of people watched a live broadcast from San José, Costa Rica, on a large screen at the University of El Salvador, in San Salvador, of the open hearing of the Inter-American Court of Human Rights, listening to the testimony of witnesses in the Beatriz v. El Salvador case. The screenshot shows Beatriz's mother giving her testimony. CREDIT: Edgardo Ayala/IPS

By Edgardo Ayala
SAN SALVADOR , Mar 24 2023 (IPS)

An open hearing in the Inter-American Court of Human Rights in the Beatriz v. El Salvador case is raising hopes that this country and other Latin American nations might overturn or at least mitigate the severe laws that criminalize abortion.

That will happen if the Inter-American Court rules that El Salvador violated the right to health of Beatriz, as the plaintiff is known. In 2013 she sought to have her pregnancy terminated because it was high risk and her life was in danger."I hope that in the end my daughter's name will be vindicated, and that what happened to her will not happen again to any other woman.” -- Beatriz´s mother

But she was not given an abortion, only a tardy cesarean section, which affected her already deteriorated health and, according to the plaintiffs, eventually led to her death in October 2017.

The hearing on the emblematic case was held Mar. 22-23 at the Inter-American Court in San José, Costa Rica. Beatriz’s case builds on similar ones: the cases of Manuela, also from El Salvador, Esperanza from the Dominican Republic, and Amelia from Nicaragua.

The seven judges heard the arguments of the plaintiffs, the representatives of the Salvadoran State and the witnesses on both sides.

After the hearing, the parties have 30 days to deliver their written arguments and the magistrates will then take several months to debate and reach a resolution.

The open hearing held by the Inter-American Court of Human Rights on the Beatriz v. El Salvador case is the first time that the complete ban on abortion has been tried, and the verdict will have implications for Latin America, a region that is especially restrictive in terms of women’s sexual and reproductive rights. CREDIT: Inter-American Court of Human Rights

A historic case

“I hope that in the end my daughter’s name will be vindicated, and that what happened to her will not happen again to any other woman,” Beatriz’s mother said when testifying on the stand. Her name was not revealed in court.

The hearing has drawn international attention because it is considered historic for the sexual and reproductive rights of women in a region that is especially restrictive with regard to the practice of abortion.

“This will be the first case where the Court will rule on the absolute prohibition of the voluntary interruption of pregnancy, particularly regarding the risk to health and when the fetus is nonviable,” Julissa Mantilla Falcón, from the Inter-American Commission on Human Rights (IACHR), told the Inter-American Court.

Beatriz turned to the IACHR when the Constitutional Court of El Salvador denied, on Apr. 11, 2013, her request for an abortion.

On Apr. 19, the IACHR issued a precautionary measure in favor of Beatriz, and on May 27, 2013, it asked the Inter-American Court to adopt provisional measures which would be binding on the State.

In its November 2020 Merits Report, the IACHR established that the Salvadoran State was responsible for the disproportionate impact on various rights of Beatriz, by failing to provide her with timely medical treatment due to the laws that criminalize abortion.

The IACHR identified the disproportionate impact of this legislation on Salvadoran women and girls, especially the poor.

The Commission stated that it did not expect full compliance by the State with the recommendations of the report, and therefore referred the case to the Inter-American Court, which now, ten years later, is a few months away from handing down a resolution.

Anabel Recinos, from the Citizen Association for the Decriminalization of Abortion, one of the Salvadoran organizations that are co-plaintiffs in the Beatriz v. El Salvador case, hopes that the Inter-American Court sentence will set a legal precedent and pave the way for the modification of the 1998 law criminalizing abortion under any circumstances in El Salvador. CREDIT: Edgardo Ayala/IPS

For her part, Anabel Recinos, from the Citizen Association for the Decriminalization of Abortion, one of the Salvadoran organizations that are co-plaintiffs in the case, told IPS that she hopes that the Inter-American Court ruling will set a new precedent.

She said her hope is that the court will rule that laws in El Salvador and the region banning abortion under all circumstances must be modified.

In addition to El Salvador, Honduras, Nicaragua and the Dominican Republic are the countries in the region where abortion is completely prohibited in their penal codes. It is only legal in five countries in Latin America, while it is allowed only in strict circumstances in the rest.

“Or at least it should be allowed for specific reasons or exceptions, such as safeguarding health and life, or the incompatibility of the fetus’s life outside the womb,” Recinos said.

Twenty Latin American and Caribbean countries recognize the jurisdiction of the Inter-American Court: Argentina, Barbados, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname and Uruguay.

The IACHR and the Court make up the inter-American human rights system. They are independent bodies and in the case of the Court the sentences are final and binding, although they are not always enforced.

Recinos spoke to IPS at the University of El Salvador, in the country’s capital, where dozens of people gathered to watch the hearing, broadcast live from San José, on a large screen.

The activist added that it is likely that the Court will rule against the Salvadoran State, backing the IACHR’s conclusions.

The Court is made up of judges Ricardo Pérez Manrique (Uruguay), Humberto Sierra Porto (Colombia), Eduardo Ferrer Mac-Gregor (Mexico), Rodrigo Mudrovitsch (Brazil), Nancy Hernández López (Colombia) and Verónica Gómez (Argentina).

In March 2003, Beatriz requested an abortion during her second pregnancy, because she suffered from lupus, an autoimmune disease in which the body’s immune system mistakenly attacks healthy organs, and preeclampsia, a dangerous increase in blood pressure during pregnancy, as well as other health problems.

In other words, her life was at risk. In addition, the fetus had malformations and would not live long at birth.

However, the medical personnel, although they were aware that an abortion was indicated to save Beatriz’s life, did not carry it out due to the fear of prosecution.

Beatriz was forced to continue with a pregnancy that continued to harm her health as the days went by.

But after the Inter-American Court granted provisional measures, Beatriz underwent a cesarean section on Jun. 3, 2013, almost three months after requesting an abortion.

The child, who was born with anencephaly, missing parts of the brain and skull, died just five hours later.

Activists for the sexual and reproductive rights of women in El Salvador demonstrate on Mar. 22 outside the Inter-American Court of Human Rights in San José, Costa Rica, during the hearing for the emblematic case of Beatriz v. El Salvador. Many carried green balloons, whose color is a symbol of the fight for the right to abortion in Latin America. CREDIT: Collaborating Organizations

Misogyny on the part of the State

Since 1998 El Salvador, this Central American country of 6.7 million inhabitants, has been the most drastic in the region in the persecution of abortion, punishing women who terminate their pregnancies with sentences of up to 30 years, in all cases, even when the life and health of the pregnant woman is at risk or in cases of rape.

The legislation mainly affects poor women in rural areas. According to data from women’s rights organizations, 181 such cases have been prosecuted since 2019.

Guillermo Ortiz, a gynecologist and obstetrician who specializes in high-risk pregnancies, testified before the Inter-American Court: “Yes, I saw many women die because they did not have access to a safe abortion, despite my having requested it.”

In her testimony, Beatriz’s mother said that the many doctors who treated her daughter had recommended that the pregnancy be terminated, but did not dare to perform an abortion or c-section to remove the fetus, for fear of going to prison.

“They told my daughter that they couldn’t, because in El Salvador it’s a crime, and if they did, they could go to jail,” said the mother.

“The State failed Beatriz twice,” said the mother, before breaking down in tears.

She was referring to the failure to carry out an abortion promptly, despite her daughter’s serious health conditions. She also was talking about a motorcycle accident that the 22-year-old suffered later.

“She had an accident that shouldn’t have been fatal, she was in stable condition” when she was admitted to the hospital in Jiquilisco, a municipality in the eastern department of Usulután.

But a storm caused a flood in some parts of the hospital, so they transferred her to the hospital in Usulután, the capital of the department.

“The doctor who treated her there didn’t even know what lupus was,” she said. In the hospital, Beatriz caught pneumonia.

The mother’s testimony and that of the other witnesses at the hearing has been closely followed in El Salvador and other nations by feminist and human rights organizations that have been monitoring and criticizing the country’s strict anti-abortion law.