2008 Top Ten Wins for Women's Health

Wednesday 24 December 2008

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by: Beth Fredrick, RH Reality Check

Inside a contraceptives education class in India. (Photo: Global Campaign for Microbicides)

1) New US Administration Offers Hope for Women and Girls

The election of Barack Obama as the 44th President of the United States provides an opportunity to uphold human rights, promote health for all, and change the future of millions. Women's health and rights advocates in every corner of the world expressed excitement and hopefulness.

What's next: For many, the most urgent issues facing the United States are the financial crisis and the wars in Iraq and Afghanistan, but achieving global peace requires securing every woman's right to a just and healthy life. The International Women's Health Coalition (IWHC) was among the first to outline an agenda for women's rights and health for the new administration and is working with the transition team and other advocates to promote priorities for women and girls.

2) A New "Mexico City Policy" Leads the Way on Comprehensive Sexuality Education

Prior to the XVII International AIDS Conference in Mexico City in August, health and education ministers from throughout Latin America and the Caribbean pledged to invest in comprehensive sexuality education and increase access to health services to strengthen the region's HIV/AIDS response. The resulting Mexico City Declaration on Sex Education in Latin America and the Caribbean was unanimously endorsed.?

What's next: Advocates, including IWHC, are working with the Pan American Health Organization to assist countries in fulfilling their commitments, including dramatically increasing the number of schools that provide comprehensive sexuality education by 2015.

3) U.S. Citizens Turn Back Attempts to Restrict Abortion Access

In November, U.S. voters overwhelmingly rejected ballot measures to restrict access to safe abortion in South Dakota, Colorado, and California. In April, the Council of Europe called for all 47 member countries to make abortion safe and legal.

What's next: In South Dakota, abortion opponents insist that they will try to pass an abortion ban in 2010, and a new organization has formed to push measures in 17 other states similar to the measure to provide rights to a fertilized egg defeated in Colorado. These campaigns are costly and out of touch with a wider global trend of liberalizing abortion laws, according to a recent study by researchers at Harvard School of Public Health and the Center for Reproductive Rights. ?

4) Indian Government Puts the Power of Prevention in Women's Hands

This year, India's National AIDS Control Organization (NACO) will provide sex workers in four states with about 1.5 million female condoms, which is the only woman-initiated HIV prevention technology currently available.

What's next: Female condoms are available in 116 countries, and public-sector programs are underway in over 90 countries. In Cameroun, IWHC partner The Society for Women and AIDS in Africa - Cameroun Chapter is advocating for a national strategic plan to ensure that women, including those living in rural areas, have continued access to female condoms.

5) Clinton Global Initiative Prioritizes Adolescent Girls

At the Clinton Global Initiative (CGI) annual meeting in September, longtime IWHC partner Bene Madunagu, head of the Girl's Power Initiative (GPI) in Nigeria, spoke to the need for comprehensive sexuality education programs for the 1.5 billion people in the world today between the ages of 10 and 25.

What's next: Over the next two years, IWHC will invest nearly $1 million in 19 organizations in Nigeria, Cameroun, Pakistan, Brazil, Peru, and Mexico to ensure that education and health services for young people integrate human rights, gender equality, health, and sexuality. GPI will continue to collaborate with education officials in four Nigerian states to reach nearly one million young people with information and education about their health and rights.

6) Women's Advocates Secure Advances in Ecuadorian Constitution

After a year of negotiations, Ecuador's Constitution now says that young people must receive sexuality education and that the State has an obligation to provide sexual and reproductive health services to its people.

What's next: Ecuador's president, Rafael Correa, is opposed to legalization of abortion and same sex marriage. CEPAM-Quito and other advocates were unable to prevent some harmful language, including prohibition of marriage and adoption by same-sex couples, but are working to protect the advances and prevent further challenges.?

7) Colombia's High Court Rules on the Side of Science - and Women's Rights

In June, the highest administrative court in Colombia ruled that the sexual and reproductive health services provider Profamilia can continue to import and distribute emergency contraception (EC)-in accordance with women's right to access a full range of safe and effective contraceptive methods.

What's next: Since 2000, Profamilia has provided EC to Colombian citizens through its network of clinics. Yet emergency contraception in Colombia still requires a prescription-an important barrier to access, considering that EC must be taken within 72 hours of unprotected sex. Profamilia has worked to overcome this barrier by offering EC to women without an appointment. ?

8) Connecticut, Colombia and Others Stand Strong for Sexual Rights

This year, Connecticut joined Massachusetts in legally recognizing same-sex marriages. Internationally, a Colombian court extended pension benefits to same-sex partners, acknowledging that to exclude them would violate the principles of non-discrimination and human dignity.

What's next: In November, California voters approved Proposition 8 by a slim margin, overturning an earlier state Supreme Court decision allowing same-sex marriage. The decision has sparked peaceful protests and candlelight vigils throughout the state, and three lawsuits have been filed to overturn Proposition 8. Globally, IWHC's partners continue to promote sexual rights in the face of conservative opposition. For example, the International Centre for Reproductive Health and Sexual Rights in Nigeria is currently working with other African feminists to combat unbalanced attacks by some media groups on lesbian, gay, bisexual, transgender, queer, questioning and intersex community groups there. ?

9) U.S. States Prioritize Youth Health Over Ideology

In 2008, the number of U.S. states refusing to participate in the federal government's abstinence-only-until marriage education program (Title V) reached 25, as state governments recognize what research and evaluations have repeatedly shown: abstinence-only programs are ineffective.

What's next: Despite pushback from the states, Congress may vote to extend Title V for another year or longer. President-elect Obama has repeatedly called for "age-appropriate" and "science-based" sex education in schools. The U.S. federal government and the states now have a new opportunity to work together to develop state and federal programs that support the comprehensive sexuality education young people need to make informed choices about their bodies and their health.

10) Muslim Women in the United Kingdom Granted Equal Rights in Marriage

Muslim leaders in the United Kingdom succeeded in creating a new marriage contract under Sharia'h law that gives husbands and wives equal rights, after four years of negotiations. The new contract no longer permits men to practice polygamy and grants women the right to initiate divorce.

What's next: This change represents a powerful example for Muslim leaders and communities throughout the world. In Northern Nigeria, Islamic Sharia'h law was introduced at the state level in 2000. Based in the state of Kano, IWHC partner Action Health Information Projects (AHIP) has built relationships with over 1,000 religious leaders throughout northern Nigeria to encourage their support for women's reproductive health through their sermons and influence in the community. Each of these leaders reaches an average of 5,000 people every week through Friday congregational prayers and sermons.

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For the complete report, visit IWHC.

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A military spouse speaks out

Carissa S. Picard stands at the entrance to Fort Hood, Texas. Picard is the founder and president of Military Spouses for Change. (Photo: Erich Schlegel / Dallas Morning News)

The Invisible Injuries of the Invisible Ranks

Friday 02 January 2009

by: Carissa S. Picard, t r u t h o u t | Perspective

Expectations

I never expected it to be so damn windy in Texas. I expected it to be still, dry and hot - something like Arizona, maybe. Of course, nothing is really what I expected it to be when I married Caynan.

I never expected to feel so lonely, so isolated, so out-of-place and out of sorts all the time, always in that in-between place of neither here nor there, neither this nor that. As an Army wife (excuse me, as six percent are male, Army "spouse"), you are no longer a civilian, but you are not a soldier either.

I don't know what military life was like before 9/11, but I can tell you what it is like now: and it isn't quirky and wacky and "just like civilian life but different." There is a reason Sarah Smiley (a female Dave Barry) is a Navy wife and Jenny (the cartoon) is an airman's wife: Army and Marine wives have less to laugh about.

In March 2008, The Associated Press reported that 72 percent of Iraq deaths were Army, 24 percent were Marine, two percent were Navy and one percent was Air Force. These percentages obviously reflect who is being deployed the most; i.e., who is being exposed to combat and who isn't. However, there is not a huge difference in the overall size of each individual branch; e.g., the Army has a little more than 500,000 active duty soldiers, the Marines have nearly 195,000 troops, and the Navy and the Air Force each have approximately 330,000 service members.

Consequently, there is a disproportionate burden for this "global war on terror" being placed upon the Army and the Marines. Not to mention the repeated 12- to 15-month tours with no guaranteed dwell time for soldiers, whereas rumor has it (as well as news reports) that Marines at least serve six- to seven-month tours at a time.

Casualties of War

My ex-husband called me the other day and asked me what a "Blue Star wife" was. I explained that it was a wife whose husband was serving in combat.

Then I asked him if he knew what a Gold Star wife was. Of course he didn't.

"That's a wife whose husband has died in combat."

"Wow," he replied, "that's, uh, kind of sick, isn't it?"

I laughed. I knew what he meant. The "Gold Star" comes across as a quasi-cultural "WAY TO GO!" for the surviving family member (as the term technically applies to the entire family). And let us not forget the "Silver Star" for the family of a service member wounded in a war!

There is no star for a lifetime of sacrificing one's own career and/or educational aspirations to support a service member. In times of peace, as well as war, the military demands that family comes second to the military. ("Army needs come first!") The household moves are frequent (every two to three years). The inability of the service member-parent to participate in parenting brings tremendous challenges to working in an era where two-income households are the norm for maintaining a decent standard of living. The lack of family, friends and community makes loneliness an expectation, not just a fear.

What color star should a spouse get for years of living like this?

These designations are all "unofficial," of course. Everything pertaining to the familial appendages known as the spouse and children of the service member is unofficial.

As for Army spouses (like myself), we exist in this in-between world. We are no longer civilians, yet we are not "soldiers" either. We are expected to live the military life without being seen, heard, prepared, paid, or recognized for our service. We are called "the silent ranks," but really, we are invisible too. The "new" Army likes to say it "recruits the soldier but retains the family," but the reality of "if the Army wanted you to have a family it would have issued you one" remains.

We are outsiders living inside an institution that doesn't want to see or hear us. Civilians and lawmakers lack interest in our experiences with the military as well as with the wars - yet our experiences with these are second only to those of the service member. There aren't any star-studded galas for our service and sacrifice or public service announcements and national dialogues about how war affects us (and/or our children).

Veterans' rights advocates talk to the "signature" wounds of the Afghanistan and Iraq wars, traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Both are "invisible." Both are hard to diagnose. Both fundamentally alter the service member in ways that are complex and confusing - to the afflicted and the non-afflicted alike.

Also unseen, however, are the injuries of those who love the service member, whose own changes, traumas and afflictions frequently go unidentified and untreated. We call our returning warriors with invisible injuries the "walking wounded;" I include military spouses and children in that definition.

Consider the 19-year-old bride who witnessed her husband's suicide on webcam in Iraq. Or the (very young) children who watched their father wrestle their large family dog to the living room floor and break its neck, followed by threats to do the same to them if provoked. Or loving one person for seven years, waiting for him for a year, and being abused by a stranger when he returns.

You don't have to wear a uniform to be wounded by these wars - but no one outside of those of us impacted seem to know this.

There are many things that I may not be able to tell you about actual combat, but this much I know is true: by the time this deployment is over, my husband will not be the only veteran in this marriage.

A Call to Arms

Nothing prepares you for war. There is no training center for spouses. You are either going to make it or you won't.

My husband Caynan is a helicopter pilot for the Army. A few nights before he left, we went over all the materials the families were given by the unit in preparation for their departure: the handy flip chart with emergency information about my husband's unit, how to get a Red Cross message to him in case of a family emergency here (as if they would let him leave the combat zone for it anyway), information about communication black outs, who will contact me if something happens to him, etc..

What really had me in stitches were the leave dates and the return dates - those were hysterical.

They're Not Waving, They're Drowning

In June, the parade of terribles begins. News from the front: soldiers being electrocuted in the showers, self-inflicted gunshot wounds, 10-year-old suicide bombers, sexual assaults on female soldiers.

I am learning not to worry about that which I cannot control (i.e., the life or death of the father of my children), although much of your time will be spent listening and validating the feelings and experiences of others: your soldier-spouse, your warrior-children.

As for your own feelings, questions, and pain: Who has time for those? Civilian friends don't understand and your army spouse girlfriends run hot and cold' AWOL half the time, coping with their own dramas and lashing out at you as often as you, unfortunately, perhaps, lash out at them. Moreover, since we are NOT soldiers, there are no 24-hour mental health clinics for us on installations, no "rest and resiliency clinics," no pre- or post-deployment mental health assessments for us or our children. Even our pain and our coping are "unofficial."

Some days I can't decide which is worse, the breaking spirit of your soldier or the breaking hearts of your children. These are invisible injuries that no one has names for, no one tabulates, no one keeps track of ... no one but the mother/spouse/father/sibling/family member who witnesses it and knows that some people will become stronger and some people will simply break.

For example, when a soldier deploys to combat, those of us at home eventually get "the call."

The call comes when his (or her) veneer of strength has cracked. When something really bad has happened; when he (or she) has witnessed (or done) something that he/she was not prepared for or expecting to be upset by; when the surreal becomes real and that reality comes crashing down upon them with crushing force.

Nothing prepares you for this call, and you will usually hang up hurting and feeling totally useless.

Over the next few months, you will get emails, calls and/or letters, referring to incidents giving you glimpses into a world where "humanity" has been turned on its head consistently and violently. Your soldier will ask a lot of rhetorical questions that will make your heart hurt. All the while your children will be asking a lot of real questions that will make your heart break. You live in fear that you will handle their struggles poorly and long-term emotional or psychological damage will occur and of course, it will be your fault. It is illogical, but it is your fear nonetheless.

Caynan's call came a few weeks after he left us and two days after he started flying real medevac missions in Iraq. Unfortunately for him, even when combat missions settled down for our troops as we were handing security for large areas of the country over to the Iraqis, our medevac helicopters still go in and pick up injured Iraqis as well as wounded Americans; i.e., there is little reprieve from the carnage.

The first soldier to die in Caynan's Blackhawk did so with his legs lying on his chest, having been completely blown off by an IED blast to the Bradley he was driving.

Caynan, in broken sentences, tries his best to tell about "the look, baby, the look when the spirit leaves the body, the body changes, the eyes are different, everything is different, you know before the machines know, he's dead, he's just dead." But that wasn't the worst of that mission. When they landed at the Baghdad CSH and unloaded this dead soldier, the aircraft's rotor wash blew one of his disembodied legs off his chest. A crew chief had to chase the leg as it rolled across the dusty landing zone to return it to this 26-year-old soldier who would never use it again.

"It's so surreal. You're watching this happening but it's like a movie ... It just doesn't seem real. How is this happening? How am I sitting in this helicopter watching this dead man's leg roll across the tarmac like this? It just doesn't seem real baby. This can't be real ..."

Silently I listened. Silently I cried. Because it was real and we both knew it.

The next call came at 4 AM. Caynan sounded like he might actually have been crying. In bits and pieces I got the story, but mainly he repeated, "The screaming, my God, the screaming."

Apparently, two men were picked up. A US soldier and an Iraqi interpreter were hit by an IED. While they made it to the CSH alive, there was an "ungodly amount" of blood. Caynan "never knew blood could smell like that." But it wasn't the blood that disturbed Caynan; it was the screaming. He said he couldn't get the interpreter's screaming out of his head.

"I've never heard anything like that before, Carissa. I can't his screams out of my head."

I had nothing to say. All I could do was remind him that he got them to the CSH alive. But getting them to the CSH alive doesn't erase those screams and I know that. And I worry about him. I wonder how long those screams will haunt him.

Jennifer told me that Stephen called her once, just once, when he was in charge of viewing all the Apache videos when we lent air support on a ground attack in 2008, and all he could say to her, over and over, was "you're my normal. You and the kids, you're my normal. THIS, THIS IS NOT NORMAL."

What Stephen was referring to was our Apache pilots using Hellfire missiles on apparently unarmed Iraqis and laughing about it. In case you are wondering, Hellfire missiles are NOT supposed to be used on human targets, period.

Nonetheless, it is my youngest son, Connor, who leaves me feeling helpless and hurting most of the time. Three months into this tour, a failed webcam attempt led to our first nightmare. I was awakened by Connor crying out, repetitively, "Mommy, I want Daddy. I want Daddy, Mommy. I want Daddy, Mommy, I want Daddy."

I did the only thing that I could do: I held him tight, rocked him back and forth, and told him (repeatedly) that I knew he missed his Daddy.

Two broken records painfully breaking the silence of night until Connor fell asleep in my arms, his tears still wet on his face and - having soaked through my shirt - my shoulder.

Imagine my surprise when two months later Connor sees a picture that Caynan sent us (from Iraq) of himself in the cockpit of the Blackhawk and asks me, "Is that your friend, Mommy?"

"No, baby, that's your Daddy in Iraq," I respond - probably an octave higher than I should have. He didn't seriously NOT recognize his own father? When did THIS happen?

I pick up the photo to talk to Connor about what Caynan is doing in Iraq (again) but Connor has walked away and is playing with Legos, clearly not interested. I have to find out where to get one of those "daddy" dolls made ...

After getting Connor to bed, and letting Caleb watch a movie in my bedroom because of course I have no idea how to force him to go to sleep, I go outside to sit on the front steps to smoke a cigarette and ponder what Connor will be like when he sees his dad again. Add that to my list of mommy failures; I have had to start taking Caleb to therapy at Darnall Army Medical Center, since apparently he wishes Connor was dead and has started drawing pictures of himself dying horrible deaths.

To my left I see the spouse who drinks every night, with her cigarettes and a beer. I wave. To my right lives the Mormon spouse who doesn't drink or smoke but is addicted to Percocet, so she never leaves her house. No one to wave to there.

A 2008 RAND study reports that at least one in five soldiers are returning from war with PTSD. When are they going to do a study on the spouses and children left behind in these wars? The ones who self-medicate or are prescribed anti-depressants (parent and child alike), who can never look at the world or the Army or themselves the same way again? What have we lost in service to this country?

We are only a third of the way through my husband's deployment and I can already identify our wounded. Am I the only one paying attention?

If this country wants to maintain an all-volunteer force, then the Department of Defense and Congress need to start recognizing the service of military families in actions and not just words. An investment in the family IS an investment in the service member. Fortify and strengthen the family and you fortify and strengthen your forces.

Taking care of military families is not just a moral imperative - it is a troop multiplier.

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Carissa S. Picard is the wife of an active duty Army pilot, an attorney, the founder and president of Military Spouses for Change, and a freelance writer whose work can be found on Military.com and Bloggernews.net.