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Outlawing violence against women
International news
International Day of the Midwife, 5 May 1998 The theme for this year's International Day of the Midwife is 'The midwife as the key health provider for Safer Motherhood'. Midwives throughout the world will be using the day to raise awareness of the contribution which they can make to making motherhood safer in their countries. Member Associations of the International Confederation of Midwives (ICM) have held special events on this designated day since 1991. The events take differing formats and examples of activities over the years include: processions through streets; market stalls promoting the role of the midwife and, in some cases offering free or reduced maternity care for those women who come to the marketplace that day, as well as demonstrating to the men the type of care available for their wives; street performances of poems and plays which have a reproductive-health message; professional lectures/symposia and workshops; and church services. Initially, monies were not raised on the day, but more recently the day has also been used as a fund raising event. All monies raised are used to further the goals of the Safe Motherhood Initiative, with Member Associations of the Confederation forwarding at least 10% of monies raised to Headquarters for the global addressing of safer motherhood. The International Day of the Midwife is not the only opportunity in 1998 to bring the need for safer motherhood to the attention of communities, professionals and policy makers as World Health Day, 7 April, has been designated by the World Health Organization along the same theme. Member Associations of the ICM are also being encouraged to use this occasion as an awareness raising one. Ten years after the launch of the WHO Safe Motherhood Initiative it is known that the 500000 maternal deaths estimated each year as due to causes relating to pregnancy and childbirth are actually nearer to 600000. During the 10 years a lot has been achieved in many countries as can be shown by improvements in maternal and neonatal mortality and morbidity, but there is still much to be achieved. The role and position of midMidwifery(1997) 13,6[-63
© 1997 Harcourt Brace & Co. Ltd
wives in bringing about improvements in reproductive health care are recognised by the World Health Organization, some governments and other international organisations. The ICM has established itself in Safe Motherhood and recognises that where there have been combined efforts by committed agencies and midwives that the greatest changes for the better have been brought about. It is hoped that once again the midwives can not only raise awareness, but that they can demonstrate their abilities to be leaders in setting policy through delivery of care in communities.
International Confederation of Midwives
Women's Health in Tanzania Culture and society devalue women, thus denying them the right of access to information, adequate nutrition, and health and family planning services. Risk factors for women's health include abortion, particularly of the girl fetus and among adolescents; discrimination in the allocation of food leading to malnutrition and chronic disability; female genital mutilation with its associated health hazards; illiteracy; early marriage and early childbearing; hazards of inappropriate employment for women; and violence at the hands of men. The death of a woman in Tanzania is not only a family tragedy, but affects the whole community as the woman is likely to be a worker in the rural area and likely to have assumed the role of a primary health-care worker. Family health invariably deteriorates following the death of a mother, and it is not unusual for young children to die very shortly after their mother. Sexually transmitted diseases show an increase in prevalence with a significant rise of HIV noted in teenage girls who are blood donors. The Ministry of Health in Tanzania has worked closely with the World Health Organization, the United Nation' s Children's Fund and the United Nation's Population Assistance Fund in identifying and implementing activities to reduce maternal mortality and morbidity. The workshop recognised that the extent of women's health problems in Tanzania outstrips the allocated resources. Various recommendations were made at the end of the workshop which were eagerly awaited by the Government. Further prioritising of areas needing immediate attention and co-ordinating efforts for effectively addressing the identified recommended actions to government, health professional organisations, women and youth groups, and other non-
governmental organisations look to be a remaining challenge.
Commonwealth Medical Association, Medical Association of Tanzania in collaboration with member associations of Advocacy for Women's Health. Report of a workshop held in Dar-es-Salaam in September 1996
Outlawing violence against women Forty-four countries have enacted legislation against domestic violence; 17 have made marital rape a criminal offence; 27 have passed sexual-harassment laws and 12 have laws against female genital mutilation. This small number of laws vary considerably in strength and enforceability from one legal system to another. Even where laws are enacted that criminalise gender-based violence there are still no guarantees, as prosecutions of perpetrators are rare and successful prosecutions uncommon.
The Progress of Nations, UNICEF, 1997."48
Help wanted: skilled birth attendants History has shown that the presence of a skilled birth attendant is a key factor in bringing down the number of maternal deaths. In 46 countries trained attendants attend 90% or more of the births, and only five of these countries have maternal death rates above 100 per 100000 live births. Countries with the lowest records of births attended by trained personnel also record some of the highest maternal mortality rates. Poverty and war are often a feature of these countries, but thirteen nations with a per capita Gross National Product of less than $500 have managed to achieve rates of 50% or more births being attended by skilled professionals.
The Progress of Nations, UNICEF, 1997:49
Better postpartum care saves lives Strategies aimed at preventing maternal deaths have primarily focused on antenatal and delivery care. More recently, an analysis has shown that the postpartum period is a critical one. Nine studies published since 1985 reveal that more than 60% of maternal deaths occur in the postpartum period, and is the same in both developing and developed countries. Nearly 50% of postpartum deaths occurred within one day of delivery. The main causes of death at this time are haemorrhage, pregnancy-induced hyper-
International Day of the Midwife, 5 May 1998 The theme for this year's International Day of the Midwife is 'The midwife as the key health provider for Safer Motherhood'. Midwives throughout the world will be using the day to raise awareness of the contribution which they can make to making motherhood safer in their countries. Member Associations of the International Confederation of Midwives (ICM) have held special events on this designated day since 1991. The events take differing formats and examples of activities over the years include: processions through streets; market stalls promoting the role of the midwife and, in some cases offering free or reduced maternity care for those women who come to the marketplace that day, as well as demonstrating to the men the type of care available for their wives; street performances of poems and plays which have a reproductive-health message; professional lectures/symposia and workshops; and church services. Initially, monies were not raised on the day, but more recently the day has also been used as a fund raising event. All monies raised are used to further the goals of the Safe Motherhood Initiative, with Member Associations of the Confederation forwarding at least 10% of monies raised to Headquarters for the global addressing of safer motherhood. The International Day of the Midwife is not the only opportunity in 1998 to bring the need for safer motherhood to the attention of communities, professionals and policy makers as World Health Day, 7 April, has been designated by the World Health Organization along the same theme. Member Associations of the ICM are also being encouraged to use this occasion as an awareness raising one. Ten years after the launch of the WHO Safe Motherhood Initiative it is known that the 500000 maternal deaths estimated each year as due to causes relating to pregnancy and childbirth are actually nearer to 600000. During the 10 years a lot has been achieved in many countries as can be shown by improvements in maternal and neonatal mortality and morbidity, but there is still much to be achieved. The role and position of midMidwifery(1997) 13,6[-63
© 1997 Harcourt Brace & Co. Ltd
wives in bringing about improvements in reproductive health care are recognised by the World Health Organization, some governments and other international organisations. The ICM has established itself in Safe Motherhood and recognises that where there have been combined efforts by committed agencies and midwives that the greatest changes for the better have been brought about. It is hoped that once again the midwives can not only raise awareness, but that they can demonstrate their abilities to be leaders in setting policy through delivery of care in communities.
International Confederation of Midwives
Women's Health in Tanzania Culture and society devalue women, thus denying them the right of access to information, adequate nutrition, and health and family planning services. Risk factors for women's health include abortion, particularly of the girl fetus and among adolescents; discrimination in the allocation of food leading to malnutrition and chronic disability; female genital mutilation with its associated health hazards; illiteracy; early marriage and early childbearing; hazards of inappropriate employment for women; and violence at the hands of men. The death of a woman in Tanzania is not only a family tragedy, but affects the whole community as the woman is likely to be a worker in the rural area and likely to have assumed the role of a primary health-care worker. Family health invariably deteriorates following the death of a mother, and it is not unusual for young children to die very shortly after their mother. Sexually transmitted diseases show an increase in prevalence with a significant rise of HIV noted in teenage girls who are blood donors. The Ministry of Health in Tanzania has worked closely with the World Health Organization, the United Nation' s Children's Fund and the United Nation's Population Assistance Fund in identifying and implementing activities to reduce maternal mortality and morbidity. The workshop recognised that the extent of women's health problems in Tanzania outstrips the allocated resources. Various recommendations were made at the end of the workshop which were eagerly awaited by the Government. Further prioritising of areas needing immediate attention and co-ordinating efforts for effectively addressing the identified recommended actions to government, health professional organisations, women and youth groups, and other non-
governmental organisations look to be a remaining challenge.
Commonwealth Medical Association, Medical Association of Tanzania in collaboration with member associations of Advocacy for Women's Health. Report of a workshop held in Dar-es-Salaam in September 1996
Outlawing violence against women Forty-four countries have enacted legislation against domestic violence; 17 have made marital rape a criminal offence; 27 have passed sexual-harassment laws and 12 have laws against female genital mutilation. This small number of laws vary considerably in strength and enforceability from one legal system to another. Even where laws are enacted that criminalise gender-based violence there are still no guarantees, as prosecutions of perpetrators are rare and successful prosecutions uncommon.
The Progress of Nations, UNICEF, 1997."48
Help wanted: skilled birth attendants History has shown that the presence of a skilled birth attendant is a key factor in bringing down the number of maternal deaths. In 46 countries trained attendants attend 90% or more of the births, and only five of these countries have maternal death rates above 100 per 100000 live births. Countries with the lowest records of births attended by trained personnel also record some of the highest maternal mortality rates. Poverty and war are often a feature of these countries, but thirteen nations with a per capita Gross National Product of less than $500 have managed to achieve rates of 50% or more births being attended by skilled professionals.
The Progress of Nations, UNICEF, 1997:49
Better postpartum care saves lives Strategies aimed at preventing maternal deaths have primarily focused on antenatal and delivery care. More recently, an analysis has shown that the postpartum period is a critical one. Nine studies published since 1985 reveal that more than 60% of maternal deaths occur in the postpartum period, and is the same in both developing and developed countries. Nearly 50% of postpartum deaths occurred within one day of delivery. The main causes of death at this time are haemorrhage, pregnancy-induced hyper-