In this study, researchers investigated the prevalence, patterns and associated factors of intimate partner violence against women in Western Ethiopia. A cross-sectional, population based household survey was conducted from January to April 2011, using the World Health Organisation’s standard multi-country study questionnaire. A sample of 1,540 ever married/cohabited women aged 15-49 years was randomly selected from urban and rural settings of East Wollega Zone, Western Ethiopia. Results indicated that lifetime and past 12 months prevalence of intimate partner violence against women stood at 76.5% and 72.5%, respectively. The overlap of psychological, physical and sexual violence was 56.9%. Abduction, polygamy, spousal alcoholic consumption, spousal hostility and previous witnesses of parental violence were factors associated with an increased likelihood of lifetime intimate partner violence against women. The authors of the study call for immediate action at all levels of societal hierarchy, including policymakers, stakeholders and professionals, to alleviate these extremely high levels of domestic violence.
Values, Policies and Rights
In a speech to a plenary session of the 2011 International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA) in Ethiopia in December 2011, Stephen Lewis, Co-Director of AIDS-Free World, pointed to the failure globally to apply knowledge to prevent vertical transmission, and expressed concern that the same not happen in relation to the elimination of pediatric AIDS. He pointed to the profound influence of gender inequality on the spread of HIV and in the burden placed on women to manage the epidemic. He noted the cancellation of the Global Fund's Round Eleven as a "punch below the belt" that will cost Africa lives, and not acceptable at a time when funds are available to finance wars or bail out banks. He called for a high-level crisis meeting on the funding situation for HIV and AIDS, to challenge any 'right to withdraw' in those funding the Global Fund. He argued that "If the MDGs are as important as everyone says, then AIDS must be subdued".
Seychelles has one of the most extensive social policy programmes in the developing world, and has been identified as a model for the rest of Africa. This book provides comprehensive analysis of social policy development in the country from the colonial era onward, focusing on the political and economic developments that have led to the current situation. The challenge now is to maintain current levels of social policy interventions in the face of severe indebtedness and stagnant economic growth. Since the Primary Health Care convention at Alma Ata in 1978, the provision of primary healthcare for all has been achieved in the Seychelles. Private healthcare has been abolished. Public health services are comprehensive with specialised in-patient and out-patient services provided by the main hospital in Victoria. Among the most significant improvements in healthcare was the drop in maternal and child deaths, from 50 per 1000 live births in the 1960s to an average of 10 in the 2000s. Maternal deaths have become a rare occurrence. There has been continued and increasing investment in the health system throughout the past two decades, largely in response to soaring healthcare costs and changing patterns of disease.
In this study, researchers aimed to determine whether the Mexico City Policy, a United States government policy that prohibits funding to non-governmental organisations performing or promoting abortion, was associated with the induced abortion rate in sub-Saharan Africa. Women in 20 African countries who had induced abortions between 1994 and 2008 were identified in Demographic and Health Surveys. A country’s exposure to the Mexico City Policy was considered high (or low) if its per capita assistance from the United States for family planning and reproductive health was above (or below) the median among study countries before the policy’s reinstatement in 2001. The study included 261,116 women aged 15 to 44 years. A comparison of 1994–2000 with 2001–2008 revealed an adjusted odds ratio for induced abortion of 2.55 for high-exposure countries versus low-exposure countries under the policy. There was a relative decline in the use of modern contraceptives in the high-exposure countries over the same time period. In conclusion, the induced abortion rate in sub-Saharan Africa rose in high-exposure countries relative to low-exposure countries when the Mexico City Policy was reintroduced. Reduced financial support for family planning may have led women to substitute abortion for contraception, the authors argue. Regardless of one’s views about abortion, the findings may have important implications for public policies governing abortion.
This report focuses on violence documented in economically marginalised black communities against lesbian, gay, bisexual and transgendered (LGBT) people. The economic and social position of LGBT people in South Africa has a significant impact on their experience, as middle-class members of the group tend to experience less discrimination. The report documents 121 cases of discrimination, harassment, and violence both from private individuals and sometimes state agents, including in terms of police inaction or service provider unwillingness to provide services to this social group. The author highlights that this situation deviates from the equality and non-discrimination on the basis of sexual orientation guaranteed in the Bill of Rights section of the South African Constitution.
In many areas of the world where HIV prevalence is high, rates of unintended pregnancy and unsafe abortion have also been shown to be high. Of the estimated 21.6 million unsafe abortions occurring worldwide in 2008 (around one in 10 pregnancies), approximately 21.2 million occurred in developing countries, often due to restrictive abortion laws and leading to an estimated 47,000 maternal deaths and untold numbers of women who will suffer long-term health consequences. Despite this context, little research has focused on decisions about and experiences of women living with HIV with regard to terminating a pregnancy, although this should form part of comprehensive promotion of sexual and reproductive health rights. In this paper, the authors explore the existing evidence related to global and country-specific barriers to safe abortion for all women, with an emphasis on research gaps around the right of women living with HIV to choose safe abortion services as an option for dealing with unwanted pregnancies. The main focus is on the situation for women living with HIV in Brazil, Namibia and South Africa, as examples of three countries with different conditions regarding women's access to safe legal abortions: a very restrictive setting, a setting with several indications for legal abortion but non-implementation of the law, and a rather liberal setting. Similarities and differences are discussed, and the authors outline global and country-specific barriers to safe abortion for all women, ending with recommendations for policy makers and researchers.
The Global Strategy to Reduce the Harmful Use of Alcohol has much to learn from learn from the Framework Convention on Tobacco Control, according to this article. Over the years, many have called for the creation of a Framework Convention on Alcohol Control. Despite this push and despite the fact that alcohol and tobacco are relatively equal in terms of global disease burden, the international community has been less willing to be tough on the alcohol industry. The debate around alcohol is less clear in some ways than work on tobacco. In the case of tobacco, the efforts have focused on eliminating use. In terms of alcohol, the debate is about reducing the harmful level of consumption. In many countries, consumption of alcohol is acceptable and forms part of many cultural events. But the author notes that we need to pay increased attention to the harm alcohol consumption can inflict on others. Often the debate is framed in terms of the individual right to have a drink, neglecting the true extent of the level of harm others can be exposed to by the drinker.
How governments should address sex work is a major topic of debate in Rwanda and other countries. Some constituencies propose harsher punishment of sex workers as the cornerstone of an improved policy. The authors of this paper argue that an adequate policy response to sex work in the Rwandan context must prioritise public health and reflect current knowledge of the social determinants of health. This does not imply intensified repression, but a comprehensive agenda of medical and social support to improve sex workers’ access to health care, reduce their social isolation, and expand their economic options. Evidence from social epidemiology converges with rights-based arguments in this approach. Recent field interviews with current and former sex workers strengthen the case, while highlighting the need for further social scientific and epidemiological analysis of sex work in Rwanda. Rwanda has implemented some measures that reflect a rights-based perspective in addressing sex work. For example, recent policies seek to expand access to education for girls and support sex workers in the transition to alternative livelihoods. These policies reinforce the model of solidarity-based public health action for which Rwanda has been recognised. Whether such measures can maintain traction in the face of economic austerity and ideological resistance remains to be seen.
Public health practitioners and theorists are diverse and have various social goals that they promote, but the unique status of public health can be traced to the fact that most of what it has historically concerned itself with can be classified as the provision of health-related public goods, the author of this paper argues. He asserts that a public goods framework serves as a useful criterion for distinguishing public health from private health, and it explains why public health goals have special urgency. Public health goals, properly understood, generally require collective action to achieve, and can be endorsed by a wide variety of moral and political theories. The public goods account has the further advantage of establishing a relatively clear and distinctive mission for public health. It also allows a consensus of people with different comprehensive moral and political commitments to endorse public health measures, even if they disagree about precisely why they are desirable.
In this statement, a number of international non-governmental organisations (NGOs) working in health express their support for the report by the United Nations (UN) Special Rapporteur on the right to health. They believe the report is of fundamental importance in securing the right to health, in particular because it consolidates years of health and human rights legal analysis, supporting the conclusion that criminal law is an inappropriate tool for regulating sexual and reproductive health matters. Empirical evidence demonstrates that the misuse of criminal laws and punitive policies in the area of sexual and reproductive health cause disproportionate suffering for women; people engaging in same-sex sexual conduct; people identified as lesbian, gay, bisexual and transgender persons; those living with HIV or AIDS; and other groups who already suffer discrimination. The NGOs support the report’s call to immediately decriminalise abortion, ensure access to a full range of modern contraceptive methods, and facilitate access to full, complete, and accurate information on sexual and reproductive health.