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#IWD2017

Societal norms, the world over, since the dawn of time, have placed more undisputed power at the hands of men (and boys) than have been placed with women (and girls).

The narrative of the day reflecting this factual reality changes from context to context. In the UK, for example, we are currently questioning when it is we are going to feel able not to celebrate today’s International Women’s Day (#IWD2017) – when will UK society accept we don’t need a national day to keep reminding everybody about gender equality?

In contrast, here in Vietnam, the entrenchment of gender norms runs deeper. Educated, decent, working husbands and fathers in Vietnam may ‘feel’ a connection to the relatively new concept that women are equal to men (across any indicator) however there is still too strong a cultural leaning away from equality, which has been silently and often subconsciously drummed into that husband/father, for him to really feel 100% behind gender equality.

Another generation and yet one more still, and the softening of these values will happen.

External factors will help with this – for one, the rising number of young Vietnamese citizens connected as they now are in their millions to social media, are exposed to more “news” and information than the ruling party could have ever imagined possible 20 years back. This will help. But the “interventions” of INGOs such as CARE, and others, is vital in keeping change at a decent pace and guiding and showing the way.

So, yes, the statistics with which we are all becoming familiar (those 8 richest men in the world owning half the world’s wealth, for example) are an important aspect to grounding us, and giving us a baseline. The stats around women doing “2/3’s of the world’s work but earning just 10% of the world’s income” probably needs to be double checked – however, if we take them on face value, and assume their inference is accurate enough (I am clearly not a trustworthy analyst in this field) then this is a good starting point…

Women – according to these same facts (choose to believe them or not) – also own just 1% of the world’s land, and what is fact in many countries is that the issues related to ownership are a root cause for gender inequality and for driving up poverty for women. These are hard issues to understand and get under the skin of. We’d laugh in the UK if a woman had to have her husband’s signature on a form to enable her to open a bank account. In parts of South Asia, such practice is commonplace.

In summary, when addressing poverty and social injustice, the economic “cards” are all stacked against women having as many opportunities to earn money as men. They are stacked against them being the main decision makers in the household, and stacked against them making choices about finances. In the most extreme cases, in contexts where women aren’t allowed to leave their houses on their own (let alone drive a car, or attend a public meeting) what we are witnessing is a modern day form of slavery, hidden behind the veil of cultural norms, and generations of patriarchal dominance.

The vision many have around “empowerment” is just that – visionary, aspirational, and awfully difficult to achieve, to prove and to sustain.

In the global north we struggle, in 2017, with the simple enough challenge of guaranteeing equal pay for women. As global south countries edge towards more liberal and capitalist values (which have the combined potential to address market inequalities for women) over in Europe, far right political values are growing daily, and with that the potential to undo many generations of movement towards equality more generally.

Today’s reality is that world’s conflicted contexts are still governed by male figures. In South Asia, child marriage is yet to be suppressed by “modern” thinking. The world’s social, economic and political tectonic plates are shifting so randomly this century already that the window for gender trans-formative approaches (in business and commerce, as well as at the grass-roots level) risks being lost among all the changes and flux in the world.

And yet, CARE and many others over the years have proven the case for a focus around women and girls in our work, and we are now able to make the case today, not just couched in the language of NGOs and using “project indicators”, but we are making that case firmly in step with an increasing number of governments and businesses.

The financial service sector is more aware than ever before of the risk they face if they don’t find ways to reach the 2 billion people cut off from the financial services grid – the majority of whom are women. The world’s largest retail companies understand better than ever before that they will only commercially survive over the next 50 years if they address not just health and safety in the workplace, but also how to tap into the ‘bottom of the pyramid’ marketplace – and within this, how to engage female consumers. The agriculture industry cannot afford not to design better ways for subsistence farmers to earn a respectable living, and women’s equal inclusion in supply chains is at the forefront of supporting this industry. The list goes on.

For these examples, as with other industry ones, it is women who provide the most economically viable and long-term solution to whichever the issues are on which you choose to focus on.

Over the next 20 years, more women than men will make purchasing decisions and choices about healthcare, education and nutritional household items. More women than ever before will join political decision making circles. More women will head up multi-national corporations. More women will design technological solutions to societal problems. More women will graduate from higher education.

More women will make choices about their lives – and these choices will have a more positive global impact on the planet than we have ever seen before.

If there was ever a time to turn societal norms around, to channel opportunities for women, then it is surely now.

 

One born every two seconds

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Dawn in Patna

Her first four children each died of asphyxiation during delivery. The 30 year old’s fifth – a baby girl – was born safely at home, and against all odds. However, when the same expectant mother entered Bihar’s district hospital last Friday, to deliver her sixth baby, she was praying for a boy. She entered the hospital carrying the hopes and dreams of the many family members waiting outside for the news and, as I bore witness to, her prayers were answered.

Through CARE International’s influence within the health sector of Bihar (one of India’s most populated states with 110 million citizens) this mother had been encouraged to deliver her sixth baby in hospital, rather than at home. A decision which instantly improved her and her baby’s chance of survival.

I was visiting the hospital with the local CARE team at the time, to learn more about how CARE is helping transform the state’s healthcare system, and improve the quality of the services available.

This blog is to share a few quick highlights of that work, and pay tribute to the front line health workers who are saving lives each day in Bihar, helping families fulfill their dreams…

Bihar is home to millions of people living on or below the poverty line – estimates vary depending on the criteria used (some recent analysis is here) – however, in rural parts, it can be up to 60%.

Since 2010, various Government and international aid investments in Bihar have accelerated change in vital areas of healthcare. This includes furnishing Community Health Centres (which are facilities containing six beds) as well as smaller, local clinics with more up to date equipment, and providing healthcare workers with more structured training. This enables workers to offer up many of the skills they need to be able to have a real influence on lowering the rates of maternal and child mortality.

According to India’s 2013 census data, approximately 42 new births are registered every minute however, in Bihar, maternal and child mortality rates are higher than the average – 208 out of 100,000 and 42 out of 1,000 respectively. To bring this into context, that equates to approximately 2 mothers out of 1,000 dying in child birth every 23 minutes, and 4 child deaths out of 100 born every 2 and half minutes .

As the CARE Chief of Party, Dr Hemant Shah, explained to me from his office in Patna, the state capital, it is by focusing on three complimentary areas of the sector – the systems, the facilities, and the out-reach support – that CARE is working with the Government and with partner organisations to help bring about change in Bihar.

If more citizens, previously cut off from healthcare services, can be reached, and if the quality of healthcare facilities is improved, alongside changes being made ‘vertically’ in how the system itself functions, Dr Hemant is convinced that more positive advancements can be made in Bihar in the years to come.

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One of the many Auxiliary Nurse Midwives working in Bihar

CARE has already seen positive results over the past 5 years.

When the work started in 2011, a high percentage of premature babies were not surviving at birth. A “low birth weight” in Bihar is classified as weighing under 2kgs. Most of the state of Bihar is home to subsistence, agriculture based communities and, all too often, mothers from these often marginalised rural communities experience premature deliveries at home due to stress. Before CARE’s programme was launched, they simply had very limited support or erratic services on which to rely.

Through a combination of CARE’s engagement at a grass-roots level, as well as through an incentive scheme offered by the Government to encourage mothers to deliver at Community Health Clinics (each receives USD$23 per baby delivered) where CARE has trained front line workers, these statistics have quite rapidly started to change.

In some cases, mortality rates for low birth weight babies during their first 28 days (across the 8 districts in Bihar where the programme is being implemented) has now reduced to between 10-15% where previously in specific areas it had been recorded as high as 55%.

One of the most important frontline workers in CARE’s cadre is the village ASHA (Accredited Social Health Activist), a critical out-reach function that has helped reduce the gap between rural communities and the various healthcare services available to them.

“We instruct those who have no access to hospitals about delivery and child care at home” tells one ASHA we met, “I also tell them about tuberculosis and leprosy and other illnesses. I ask them to come to government hospital either with me or by themselves, because in government hospital they receive free treatment. If the disease is serious, they can get some money for the treatment, too.”

Two other ASHAs who spoke to us, Mamta Devi and Nazma Khatoon, from Rampur and Naraharpur villages, reinforced the importance of the newborn care services they offer in their roles: “We visit every house and advise people to come to hospital for vaccinations,” Mamta explains, “the first dose of BCG, OPV and Hepatitis injections are given within 24 hours of delivery, and then for other vaccines like measles, we spread awareness in the community and ask mothers to visit the healthcare centres,” Nazma continues.

In addition to vaccinations, front line workers also play a key role instructing the families of pregnant women on birth preparedness, sanitation and keeping properly washed and dried clothes for the newborn babies. Nazma stresses how important it is that they also “advise families to have extra money in hand for any emergencies…because of our efforts, fewer newborn deaths are happening. Even physical defects such as polio have reduced.”

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Ruby and baby Ruksiba

For some of the new mothers we visited last week, such as Ruby and her baby Ruksiba (both pictured, above) the out-reach services provided by the programme are a great source of support, information and advice.

Ruksiba weighed only 2kgs at birth, and the family thought she wouldn’t survive.

It was critical for Ruby, especially as a first time mother, to be able to seek basic guidance from CARE’s workers on breastfeeding, nutrition as well as information on vaccinations.

After one month, Ruksiba’s gained 1.2kgs and Ruby’s confidence in her own decisions around feeding and care had significantly increased, “the ASHA has advised me on how to hold my baby, and how to feed it regularly, and the importance of breast-milk” explained Ruby.

This advice is also made available through a twice weekly “Village Health Nutrition and Sanitation Day” event to which CARE gives operational support. These events bring new mothers together to learn about complimentary feeding, to receive vaccinations, and to learn about how to give their babies the healthy start in life they need.

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A complimentary feeding station at a Village Health Nutrition and Sanitation Day event

For the frontline workers engaged through CARE’s work, we heard from many of them last week not just about the positive effects on new mothers, but also about some of the things they as workers had been empowered to do, following CARE’s intervention and training. And, ultimately, how this has instilled in them a sense of pride and appreciation for the jobs they are carrying out and their own career paths.

“We have started focusing on sterilizing medical equipment. Earlier it was not a priority for us”, commented Suganthi, one of the programme’s Auxiliary Nurse Midwives based at Jalalpur Community Health Centre in Chapra, “we are now providing proper care to new born babies. We track the low birth weight babies in the community where earlier we were not able to do this or to diagnose complicated cases. Following the training, we have started diagnosing all complications and referring them to higher centres where appropriate”.

A thousand word blog cannot incorporate the myriad of complexities, cultural norms, and underlying causes of poverty which permeate in a country such as India. However, in the face of the many obstacles facing frontline workers and local communities, this work in Bihar highlights some of the significant and positive changes and shifts in norms which are taking place each day.

CARE is playing its role in this complex eco-system, and hopes to remain active in that for years to come – for it surely will take that to bring about the change that women and their families deserve.

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A new mother and her baby at Village Health Nutrition and Sanitation Day event

The short video compilation below also falls short of covering every nuance that is of importance in this narrative. However, it might offer more of a feel for the story – of life changing and life preserving interventions – that needs to keep being told.

Making change happen: Collaboration, and the power of Storytelling

I’ve been working in Dili, the capital of Timor-Leste (East Timor) this week, and it’s been a privilege as always to spend time in new surrounds. More so when stationed one hundred metres from the sea, with spectacular daily sunsets, and some of the tastiest coffee money can buy. 

Timor is an island, just a short hop north of Darwin, Australia, and up until quite recently, following 500 years of Portuguese occupation, was an Indonesian colony (between 1975 and 1999). The western side of the island is still governed by Indonesia. Timor-Leste claimed its independence in 2002.

Like so many other countries in 2016, Timor-Leste is experiencing the effects of the current El Nino droughts, disrupting the country’s wet season and ruining harvesting potential. A topic covered on this site back in March during my time in Ethiopia.

My assignment this week, however, has been to support CARE’s work to engage more with private sector companies in Timor-Leste (banks, retail, media and others) and examine ways in which, together, initiatives and relationships can be forged to tackle some of the social and economic challenges the country faces – poor infrastructure, lack of employment opportunities, issues around food security and nutrition, financial literacy, to name a few. Even without a more severe El Nino year, Timor-Leste is dealing with all of these mini crises combined.     Read more…

Resilient Markets in Ethiopia

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At home with Sindayo, a GRAD beneficiary in Tigray. Photo credit @ CARE Ethiopia.

Last month I visited Tigray, Northern Ethiopia, to interview farmers and livestock traders faced with the drought effects of one of the most devastating El Niños in 50 years, to learn about their coping strategies in the face of extreme weather patterns.

We wanted to find out how these coping strategies were linked to national and international market systems and how, through these systems, it might be possible to bring about a better deal for those in the supply chain typically made more vulnerable by drought: women.

CARE International, the global NGO and my employer for the last decade, has been operating in Ethiopia since 1984, and works alongside other international and national organisations to bring solutions to those whose livelihoods are invested in agriculture, and who by default are affected by regular market “shocks”.

After 70 years of operations around the world, CARE’s focus within any country programme is to bring about positive changes for women and girls. We do this because of the myriad of existing social and economic injustices faced by women and girls, all over the world, many of which have been described on this blog. At CARE, we talk a lot about “empowering” women and girls, and this encompasses many aspects, including improving access to economic resources for women and, crucially, increasing their control over those resources.       Read more…

What are we waiting for?

In case anyone needs ideas for New Year’s Resolutions.

Stunning, on every level…

Lend Me Your Ears

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Hoa Binh Province, rural Vietnam

Christmas is coming and there’s no stopping it. Even here in Saigon the Vietnamese have started to embrace what has become an indulgent festival of consumption, celebrating the birth of Jesus Christ.

And, at this time every year, people like me pen blogs like this one, instigated to push a perspective your way. People like me who (you’ll soon enough not be surprised to read) have just spent half my week up in rural Vietnam, meeting local communities.

So, what’s the perspective I’m peddling ? Well, no doubt by the end of this post I will have worked it out…    Read more…

“Scale, impact and partnerships” – seeing through the buzz factor

I’m back on the regional conference circuit at the moment, and it’s awash with talk about “scale” and “impact”.

Sound-bite central, indeed, with events I’ve attended recently also still obsessing with how to achieve scale and impact by working in “partnerships”. As suggested in my last post we need to look beyond semantics in the sustainability arena, and instead get real about what some of these terms actually mean as, all too often, our preoccupation with the vernacular distracts us from action.

The UN’s new Sustainable Development Goals (SDGs) have included “global partnerships” as their 17th Goal. The proof of authenticity around what the UN thinks can be achieved with this Goal will be revealed over time. However, right now, it seems to me that if you are not talking about “scaling your programmes”, or “measuring the impact” of your efforts (in terms of playing a positive role in society) then you are not “on message” – and that, for many, is a public relations cardinal sin.      Read more…

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