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Blog Posts2019-01-31T16:10:01+00:00
3101, 2019

Zika Response – “Not Too Late” in Jamaica: ASSIST’s Innovative Approach Integrating Gender to Strengthen Psychosocial Support Services Today, for Tomorrow

By Morgan Mickle, Gender Specialist, WI-HER, LLC Participants in Trewlany pose for celebratory photo after successful first training.Photo Credit: Morgan Mickle, WI-HER, LLC (2018) In October 2018 I arrived in Jamaica from the United States to facilitate two weeks of gender sensitization and capacity building training for local health professionals on the island. I recall proudly handing my passport over to the Jamaican immigration official as I stated, “I’m here for a conference on Zika”. To which the official inquisitively responded “Zika? You’re a little too late.” The World Health Organization (WHO) defines Zika virus as a mosquito-borne flavivirus that was first identified in humans in Uganda and Tanzania during the 1950s[i]. Outbreaks of Zika virus have since been recorded in Africa, the Americas, Asia, and the Pacific. Most recently, French Polynesia and other territories in the Pacific experienced a large outbreak of Zika virus in 2013 followed by Brazil in March of 2015. Soon after, outbreaks and evidence of transmission appeared across the Americas, Africa, and other regions of the world. Zika virus is primarily transmitted from the bite of an Aedes mosquito but can also be transmitted through sexual intercourse. Zika virus during pregnancy is a cause of congenital brain abnormalities, including microcephaly, but can also cause pre-term births and miscarriage. Zika virus first appeared in Jamaica in January 2016[ii], with suspected and confirmed cases peaking mid-year[iii] (see Figure 1). As of January 4, 2018[1], the PAHO/WHO reported 7,772 suspected and 203 confirmed cases[2] of Zika virus on the island, a cumulative figure of data collected between 2015 and 2018[iv]. Source: PAHO Jamaica Zika-Epidemiological Report 25 September 2017 In Jamaica, gendered norms regarding women as the nurturers and caregivers are widely prevalent. The United Nations reported that, “while both parents are legally responsible for the maintenance of their child/children, mothers (particularly single mothers) carry a disproportionate burden of care for children[v].” This is especially important in the context of Zika where children affected by Zika need physical therapy, cognitive stimulation therapy, and extra assistance with everyday activities, which can result in an increased financial and care burden. Primary caretakers, usually the mother or another female family member, may face challenges in working outside the home or spending time on non-caregiving pursuits, like education. In addition to isolation, these women and other family members often lack support structures to cope with the demands of caring for a child with severe disabilities and experience challenges to access services[vi]. In Jamaica, the stakes are high as female-headed households account for 45.4 percent of all households[vii]. Also relevant are findings from the recent Women’s Health Survey 2016 – the first-ever survey to measure the prevalence of gender-based violence in Jamaica – which found that one in four (27.8%) women in Jamaica between the ages of 15 and 64 have experienced intimate partner physical and sexual violence in their lifetime[viii] [ix]. As Zika can be transmitted sexually, this context is extremely important to consider. In Jamaica, as in the rest of the region, [...]

2301, 2019

Machismo as a barrier to prevent Zika in Ecuador: Fighting it is a win for all, not only for women

Machismo as a barrier to prevent Zika in Ecuador: Fighting it is a win for all, not only for women By: Elga Salvador “Por el machismo” (because of machismo) has been a constant theme in the focus groups, interviews, and training conducted by WI-HER throughout Latin America and the Caribbean aimed at identifying obstacles to the prevention of the sexual transmission of Zika[1],[2] under USAID’s Applying Science to Strengthen and Improve Health Systems (ASSIST) Project. The Real Academia Española (RAE)[3] defines machismo as "the arrogant attitude men have with respect to women. [...] a set of practices, behaviors and sayings that are offensive against the female gender." However, “machismo” resembles more than attitudes and practices;  the word represents a culture of men power and domination over women, typical of patriarchal societies. When machismo is the norm in a society, it strongly and negatively impacts the lives of women. Women are often considered inferior to men and are pigeonholed into socially constructed models of femininity: homely, dependent, obedient, sweet and compassionate, helpless, virgin, pure, wives, submissive and complacent with their partners, faithful, monogamous, instinctively mothers, caretakers. Mexican anthropologist and researcher, Marcela Lagarde, describes them  as “madresposas” (mother-wives). Women who break these molds and address sex in any way are not accepted as ‘women of the house’ and are often associated with "street women" or "putas." This restricts women from openly talking about the use of contraception.[4] According to male and female key informants, in Ecuador when a woman enters a relationship it’s considered “pertenencia de” ("belonging to him"). Particularly in families of poorer socio-economic status, women have limited decision-making power within their relationship, even regarding their health and, specially, their sexual and reproductive health. In many cases, women cannot decide for themselves to use a family planning method, because, according to health professionals “el hombre propone y la mujer dispone”, meaning the men makes the decision and the woman follows it. According to Lagarde, the success of men is measured by the ownership, possession and use of goods and dependents or subordinates, including women and children.[5] Men must comply with the social expectations that they must be strong, daring, aggressive, healthy, and providers for the family. Machismo is not only harmful to women, but for men too. For example, men often avoid seeking medical care until it is an emergency for fear of appearing weak. This often results in increased morbidity and mortality, because men are not getting timely care for preventable and treatable diseases. Another example is that violence, suicide and homicide are much higher among men compared to women.[6]For example, in the year 2016 in Ecuador there were 371 cases of suicide of men between the ages of 20 and 34, an average of more than one suicide per day throughout the year. Sex is considered an "uncontrollable instinct" in men. Even adolescent boys feel pressure to express sexual prowess in front of their peers. Men feel that they need to demonstrate that they are taking advantage of every sexual [...]

2301, 2019

Ecuador y el machismo como barrera para prevenir el Zika. Combatirlo es una ganancia para todos, no solo para las mujeres.

Por: Elga Salvador ‘Por el machismo’ ha sido el leitmotiv que ha emergido de todas las consultas y entrevistas realizadas por WI-HER en los diferentes países de América Latina y el Caribe dirigidas a identificar obstáculos a la prevención de la transmisión sexual del Zika[1],[2] en el marco del Proyecto de USAID, Aplicando la Ciencia para Fortalecer y Mejorar los Sistemas de Salud (ASSIST). Aunque la Real Academia Española (RAE) defina al machismo como “la actitud de prepotencia de los hombres respecto de las mujeres. […] un conjunto de prácticas, comportamientos y dichos que resultan ofensivos contra el género femenino”; WI-HER considera que no se trata solo de actitudes y prácticas, sino de un problema más profundo, relacionado con la cultura del poder y de la dominación social de los hombres sobre las mujeres, típico de las sociedades patriarcales. No obstante haya todavía estratos sociales que no quieran admitirlo, el machismo impacta fuertemente y de forma negativa en las vidas de las mujeres, que se consideran inferiores a los hombres y que tradicionalmente se encasillan en un modelo de feminidad socialmente construido que las quiere: hogareñas, dependientes, obedientes, dulces y compasivas, indefensa, vírgenes, puras, esposas, sumisas y complacientes con sus parejas, fieles, monógamas, instintivamente madres, cuidadoras … o como lo sintetiza la antropóloga e investigadora mexicana, Marcela Lagarde y de Los Ríos “madresposas”. Como el erotismo y el placer sexual no son aceptados entre de las mujeres de la casa, pues se asocian a las “mujeres de la calle”, a las “putas”, a las madres y esposas queda prohibido hablar y decidir sobre anticoncepción.[3] Según informantes claves de ambos sexos consultados, en Ecuador cuando una mujer está en una relación de pareja se vuelve “pertenencia de”; sobre todo, pero no solo, en las familias de estratos sociales más pobres, la mujer tiene un limitado poder decisional dentro de la relación de pareja, incluso en lo que concierne a su salud, y más si se trata de su salud sexual y salud reproductiva. En muchas ocasiones las mujeres no pueden decidir sobre su método de planificación familiar, porque, según informan profesionales de la salud lo ‘normal’ es que “el hombre propone y la mujer dispone”. Siempre según Lagarde, el éxito de los hombres, por otro lado, se afirma a partir de la propiedad, la posesión y el uso de bienes y de dependientes o subordinados, incluyendo mujeres e hijos.[4] Los hombres deben responder a las expectativas sociales que los quieren fuertes, atrevidos, agresivos, saludables, proveedores. El machismo no es dañino solo para las mujeres, sino para los hombres también, por ejemplo: el temor a levantar dudas sobre su fuerza y virilidad los mantiene alejados de las consultas médicas, limitándoles las posibilidades de atender a tiempo enfermedades causas de muertes prevenibles; igualmente los involucra en riñas, peleas y otras actividades que los exponen a riesgo  y que hacen sí que los homicidios sean una significativa causa de muertes violentas entre los hombres, tanto en Ecuador como en el resto del mundo.[5] El tener que cumplir con las expectativas sociales expone a los hombres a muchas dificultades y [...]

1401, 2019

Adolescentes embarazadas y las barreras que enfrentan para prevenir el zika

Adolescentes embarazadas y las barreras que enfrentan para prevenir el zika Por: Elga Salvador El Hospital Universitario Maternidad Nuestra Señora de la Altagracia (HUMNSA) fue escenario del primer nacimiento del 2019 en la República Dominicana; el mismo día el mismo hospital cuenta con otros récords: registra el primer niño a nacer en el año por el sexto año consecutivo y cuenta la tercera adolescente como madre del primer bebé a nacer [1,2]. Esto tal vez ya no cause asombro en un país donde desde el 1996 nunca se ha registrado un porcentaje de embarazo en la adolescencia inferior al 20% [3]. No obstante la Ley 136-03 de la República Dominicana, en su artículo 396, defina como abuso sexual cualquier relación sexual entre niños/as y adolescentes, con personas que les superan de más de cinco años [4], este primer bebé del año fue procreado por una adolescente de 16 años de edad y un hombre de 6 años mayor que ella. Según la Oficina Nacional de Estadística este no es un caso aislado, las parejas de adolescentes casadas o en unión libre, son entre los cinco y nueve años mayor que ellas en el 35% de los casos y de 10 años o más mayores que ellas en el 23.4% de los casos [5]. Las adolescentes con parejas significativamente mayores que ellas están insertas en relaciones caracterizadas por un fuerte desequilibrio de poder, en muchos casos violentas, y tienen limitado control sobre las decisiones relacionadas con su salud sexual y salud reproductiva, enfrentando en la mayoría de los casos embarazos no planificados [6]. Según un análisis de género realizado en la República Dominicana por el equipo de WI-HER, son muchas las barreras que se enfrentan las adolescentes para prevenir los embarazos en la adolescencia, ante todo la falta de información y educación sexual, el limitado poder de negociación de métodos con sus parejas, pero también el estigma sobre el uso de anticonceptivos [7]. “Los adolescentes no tienen información y orientación oportuna; es importante introducir la educación sexual en las escuelas.” (proveedora de salud, Barahona) “En los sectores, las muchachitas no usan condones. Ellas no los reclaman y los hombres se aprovechan la oportunidad. […] Ambos: adolescentes y hombres adultos.” (hombre, joven, Santiago) “Yo entrego condones a adolescentes sexualmente activas y les digo de no tener relaciones sin condones. La mayoría tienen parejas adultas que quieren relaciones, pero no responsabilidades; ellas usan condones, los terminan rápido. Yo les digo ‘¡!Tú vas rápido!’. […] Otras dicen que el hombre no quiere usarlos, porque no siente igual.” (promotora de salud comunitaria, Santo Domingo) “Los adolescentes no usan condones porque tienen miedo de los padres, sobre todo las adolescentes; no corren el riesgo de cargar condones en sus carteras.” (hombre adulto, Santiago) No obstante en la República Dominicana la normativa vigente contemple el derecho de las personas adolescentes a la salud integral, incluyendo el acceso a consejería de preconcepción y a métodos anticonceptivos [3,7,8], a partir de informaciones recolectadas de informantes clave y durante grupos [...]

1401, 2019

Adolescent Pregnancy and Barriers to Zika Prevention

Adolescent Pregnancy and Barriers to Zika Prevention By: Elga Salvador In the Dominican Republic, adolescent pregnancy has been prevalent with numbers exceeding 20%  over the last two decades.[1] For the sixth consecutive year, the first child born in 2019 in the Dominican Republic was registered at the Maternidad Nuestra Señora de la Altagracia University Hospital (HUMNSA); and for the third year, that baby was born to an adolescent mother. [2,3] Article 396 of Law 136-03 of the Dominican Republic defines any sexual relationship between children or adolescents with partners who exceed their age by five years or more as sexual abuse [4]. However, the first baby of the year was born to 16-year-old girl and a man six years older than her and there were no legal repercussions. While the legal framework to reduce adolescent pregnancy is in place, implementation of the law remains a widespread issue. According to the Dominican Republic National Statistics Office, this is not an isolated case. Thirty-five percent of adolescents in a relationship have partners five to nine years older than them and 23.4% have partners ten or more years older than them [5]. Adolescents with significantly older partners are in relationships characterized by a strong imbalance of power. In many cases this increases their risk of being victims of violence and controlling behaviors. This can limit their decision-making power over their sexual and reproductive health, increasing the risk of unplanned pregnancy [6]. According to a gender analysis carried out in the Dominican Republic by the WI-HER team, adolescents face many barriers to prevent pregnancy, especially lack of information and sexual education, limited power to negotiate methods with their partners, and stigma about the use of contraceptives [7]. The following quotes from focus groups and interviews highlight many of these issues: “Adolescents lack of proper information and orientation, it is important to introduce sexual education in the schools.” (Female health provider, Barahona) “In the suburbs, teenagers don’t use condoms. Girls don’t ask for it and men take advantage of them. [..] Both teenagers and adult men.” (Young man, Santiago) “I give condoms to sexually active girls and tell them not to have sex without them. Most of them have adult partners who look for sex but not responsibilities and they use condoms, they finish the condoms quickly. I tell them “you go fast!” […] Some others say their partners don’t want to use condoms because they say they don’t feel the same.” (Female community health promoter, Santo Domingo) “Adolescents don’t use condoms because they are afraid of parents, especially girls, they don’t run the risk to carry condoms in their bags.” (Adult man, Santiago) In the Dominican Republic, current legislation guarantees adolescents the right to comprehensive healthcare, including access to preconception counseling and contraceptive methods [3,7,8]. Nevertheless, according to information collected through key informants and focus group discussions, some health workers are not aware of these laws. In fact, many providers have biases against offering adolescent sexual and reproductive health services. For example, a community [...]

1012, 2018

Criminalization of Human Trafficking Victims

By: Razan Farmand  Human trafficking is a devastating global issue. Despite its universal reach, human trafficking takes place locally— in nail salon or a favorite restaurant; in a neighborhood home or popular hotel; on a city street or urban farm. The United States government has passed legislation and executive orders to combat human trafficking globally by requiring U.S. contractors and subcontractors to act affirmatively to prevent human trafficking and forced labor when working abroad. Domestically, Congress enacted the Victims of Trafficking and Violence Protection Act in 2000; which established several methods of prosecuting traffickers, preventing human trafficking, and protecting victims and survivors of trafficking. Since its enactment, all fifty states have passed laws that criminalize human trafficking and many have task forces dedicated to implementing policies and procedures to combat it. The next step is for those fifty states to enact and implement laws that protect victims from criminal prosecution for acts they were forced to commit. Victims of modern slavery, whether children or adults, should not be held criminally responsible for their involvement in unlawful activities that are a direct consequence of their victimization. For years, the Trafficking in Persons Report has detailed the importance of protecting victims of human trafficking throughout the law enforcement process. Traffickers often compel victims to engage in criminal activities such as prostitution, pick-pocketing, drug trafficking and even kidnapping by recruiting other victims. Law enforcement authorities often fail to properly screen and identify victims of human trafficking when they detain or arrest criminal suspects. The process of being arrested, detained and prosecuted creates an entirely new traumatic experience and can strengthen the victim’s attachment to the trafficker.   Although many states have made progress in passing legislation to protect victims from criminal prosecution after they have been arrested, there continues to be gaps in identifying victims and challenges in the implementation of these statutes. The criminal justice and delinquency systems are not designed to appropriately respond to sex trafficking victims. Our  justice system is overwhelmed and most the time fails to consider individual circumstances.  This allows these victim’s cases to fall through the cracks. In addition, the criminal legal system itself is not equipped to identify victims or offer them resources or assistance if identified. Cases are typically quickly resolved, usually by way of plea bargaining, in an attempt to address the constant stream of cases entering the criminal legal system. Foreign national victims face an additional risk since the likelihood of deportation significantly increases after a criminal arrest or conviction.  Identifying victims is also challenging as they often distrust the criminal justice system and fear disclosure. In addition, “conflict between current trafficking legislation and existing criminal laws in some states creates a complex situation which ultimately harms the victim.  Victims of sex trafficking can be simultaneously considered criminals under the prostitution law and victims under the trafficking law. When confronted with this tension, law enforcement officials may be more likely to label victims as criminals, largely due to the longstanding history of criminalizing [...]

412, 2018

La intersección de género y discapacidad debe abordarse con urgencia para prevenir la violencia en el contexto de la epidemia de Zika

Por: Maddison Hall, Elga Salvador y Tisa Barrios Wilson Alrededor del 15% de la población mundial vive con algún tipo de discapacidad, y se espera que esta prevalencia aumente en concordancia con el envejecimiento poblacional y el aumento de las enfermedades crónicas. Los datos existentes demuestran consistentemente que las personas con discapacidades experimentan violencia a tasas más altas que las personas sin discapacidades. La falta de apoyo social, el estigma, la institucionalización, la ignorancia y la discriminación contribuyen al riesgo de violencia entre las personas con discapacidad; esta violencia puede originarse a partir de varias fuentes, incluido el personal médico, personas que se ocupan del cuidado y parejas íntimas. Las experiencias de violencia pueden exacerbar las disparidades sociales y de salud que las personas con discapacidades ya enfrentan y que en muchos casos se ignoran. Tanto la discapacidad como el género pueden poner a las personas en mayor riesgo de violencia, pero la intersección de la discapacidad y la violencia de género (VBG) a menudo se ha pasado por alto. La prevalencia de discapacidad entre las mujeres es del 19,2%, que es mayor que la prevalencia global de discapacidad (15%). Los datos que analizan la VBG entre personas con discapacidades son limitada, y los estudios existentes ofrecen resultados contradictorios sobre la prevalencia de VBG entre personas con discapacidad. Las mujeres con discapacidades físicas y visuales en España tuvieron tasas mucho más altas de VBG que las mujeres sin discapacidad. En Camboya, las mujeres con discapacidad corren un mayor riesgo de violencia emocional, física y sexual por parte de sus familiares. Las mujeres con discapacidades tienen más probabilidades de experimentar la violencia de pareja que las mujeres sin discapacidad, y sus parejas tienen más probabilidades de demostrar un comportamiento dominante o propietario. Si bien las mujeres con discapacidad tienen más probabilidades de experimentar violencia que las mujeres sin discapacidades en los Estados Unidos, no existe una diferencia significativa en el riesgo de violencia entre hombres y mujeres con discapacidades. Las tasas de violencia sexual son altas entre las personas con discapacidad, especialmente para las mujeres. Estadísticas del Bureau of Justice Statistics’ National Crime Victimization informaron que en los Estados Unidos entre 2011 y 2015, la tasa de violaciones y agresiones sexuales contra personas con discapacidad intelectual fue siete veces mayor que la de las personas sin discapacidad. Entre las mujeres con discapacidad intelectual, fue alrededor de 12 veces la tasa. Además, las personas transgénero con discapacidades experimentan violencia sexual a tasas más altas que las personas transgénero sin discapacidad. Incluso con datos limitados sobre la prevalencia de la VBG entre las personas con discapacidad, existe una clara evidencia de que las experiencias de las personas con discapacidad en relación con la VBG son únicas. Hay un subregistro de la violencia contra las personas con discapacidad, ya que las personas con discapacidad se enfrentan a distintos desafíos para denunciar la violencia de género o acceder a los servicios. Las personas con discapacidad no pueden acceder a los lugares de servicio o refugios, [...]

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