The survey estimates that 29 percent of Nepalese children under the age of five are malnourished and that the burden is not distributed equally between genders. Boys and men, for example,  traditionally eat meals first and consume the most nutrient-rich foods, while women and girls eat what is left over.

Indra Raj Panta, program officer for UNICEF’s Decentralized Action for Children and Women in Nepal explains, “Girls are neglected because they are thought not to need strength.” This sentiment does not reflect the labor responsibilities demanded of Nepalese women and girls, who continue to labor throughout their pregnancies. The result is a cycle of women delivering underweight babies who are then subject to stunting and wasting. IRIN notes, “Girls who are not fed well turn into women who are more likely to give birth to low weight babies, and so the cycle perpetuates.”

Read the full IRIN article.

Read the Nepal Demographic Health Survey Preliminary Report.

Photo by I, Seeteufel [GFDL (www.gnu.org/copyleft/fdl.html), CC-BY-SA-3.0 (www.creativecommons.org/licenses/by-sa/3.0/) or CC-BY-SA-2.5-2.0-1.0 (www.creativecommons.org/licenses/by-sa/2.5-2.0-1.0)], via Wikimedia Commons

Defendant Joe Sullivan, now 33, is represented by Bryan Stevenson of the Equal Justice Initiative, a nonprofit legal advocacy organization. Mr. Stevenson maintains that the Eighth Amendment prohibits the cruel and unusual punishment characterizing such sentencing of youths under 14. In a quote from the New York Times, Mr. Stevenson comments, “To say to any child of 13 that you are only fit to die in prison is cruel. It can’t be reconciled with what we know about the nature of children.”

Bryan S. Gowdy, the lawyer for convicted juvenile offender Terrance Graham, expressed skepticism about a case-by-case determination of juvenile crimes not involving murder, saying, “At that age we cannot make a determination about whether or not the adolescent will or will not reform.”

These cases have received immense media attention and responses from practitioners at the frontline of health care and criminal justice for youths.

Drawing from his global health and justice work with children, Paul Farmer commented yesterday in a Boston Globe Op-Ed about the issues at stake in these Supreme Court hearings:

These are serious crimes and both young men must be held accountable. The question before the court is whether they should be held accountable in a way that takes into consideration their immaturity, lack of judgment, vulnerability to peer pressure, and – perhaps most important – their capacity for redemption, growth, and change. If the court strikes down life without parole for juveniles as unconstitutional, no offender would have an automatic right to parole release. Juvenile offenders would simply be given the opportunity to appear before a parole board and make the case that they have changed and deserve another chance.

 

Article 37 of the UN Convention on the Rights of the Child states that children must not be subjected to torture, inhuman or degrading treatment or punishments, including capital punishment or life imprisonment without the possibility of release. Only two nations in the world have not ratified this convention: Somalia and the United States. It is noteworthy that sentences of life without parole for juveniles were uncommon in the United States before the 1990s, a period of fear about a potential rise in juvenile crime that was based on data later proven false.

 

There are those who argue that international laws and norms should have no bearing on how the United States decides to dispense justice. But having treated thousands of children all over the world, I can say with confidence that American children are not more vicious, less human, or less deserving of mercy and compassion than children in any other country. Every other nation in the world finds ways to hold young people accountable for their actions without sentencing them to languish in prison until they die. The United States must do the same for its children.

Paul Farmer, MD, PhD, is professor of social medicine in the Department of Global Health and Social Medicine at Harvard Medical School, where he is chairman, and is cofounder of Partners In Health, an international nonprofit health care organization. He is the author of “Pathologies of Power’’ and co-editor of “Global Health in Times of Violence.’’

Sexual violence against civilian populations during armed conflict is recognized as a deliberate tactic of war, the gravity of which determines whether it is considered a war crime, a crime against humanity, or an element of genocide [see Statute of the International Criminal Court art 7.1(g) and art 8.2(b)(xxii); Security Council Resolution 1325 on women, peace and security (SCR 1325) para 11; Security Council Resolution 1820 on widespread or systematic violence in armed conflict paras 1, 4]. The widespread and systematic rape, sexual slavery, forced prostitution, and recruitment and kidnapping of civilians is at pandemic proportions in the Democratic Republic of the Congo (DRC). The majority of victims are children. By November 2008, World Vision spokesperson, Kevin Cook, and Save the Children spokesperson, George Graham, considered the DRC to be potentially the world’s worst place to be a child. The Congolese army is the single biggest perpetrator of sexual abuses according to a Human Rights Watch report published in July. This is despite commitments from both the government and the military that those found guilty of such human rights abuses would be punished. However, sexual violence offenses extend beyond the Congolese army to rebel groups, armed actors, and even UN personnel.

The deadliest war since World War II, the forgotten conflict in the DRC as been particularly devastating for women and children, who remain targets of sexual violence. These attacks are frequently exceptionally brutal, including gang rape, rape with a weapon, and rape accompanied by serious bodily harm. The medical consequences include death from injuries, contraction of HIV, pregnancy, or the development of a fistula. The psychosocial impact can be just as serious. Victims face stigma and familial and social rejection or ostracism. This can restrict their access to education or marriage and leave them displaced and at risk of further abuse.

In March 2009, a Comprehensive Strategy on Combating Sexual Violence in the DRC was finalized by the UN Office of the Senior Advisor and Coordinator on Sexual Violence after consultation with key stakeholders. The four strategic components are the following:

1. Combating impunity for cases of sexual violence;
2. Prevention of sexual violence and protection of victims;
3. Security sector reform; and
4. A multi-sectoral response for survivors of sexual violence

Further, the Sexual Violence Research Initiative, an initiative of the Global Forum for Health Research, facilitated its first conference, SVRI Forum 2009: Coordinated evidence-based responses to end sexual violence, earlier this month. Held in Johannesburg, South Africa, the global event assembled 200 experts for the purpose of endorsing research, highlighting good practice in program design, and fostering increased partnership and network building in the field of sexual violence.

Internationally, there is a need to redress the inadequacy with which sexual violence is addressed. The degree to which sexual violence is a gross human rights violation and public health concern is frequently downplayed. This has limited the development of empirically based policy and public health prevention programs and response services.

It is important, therefore, to substantiate the legitimacy of sexual violence as a major public health concern for policymakers, researchers, and programmers by raising the profile of this frequently taboo subject and bringing it into the public arena. Public health scholars and human rights advocates, thus, have a key role to play in directing the research agenda and contributing to institutional capacity building.

Strategies require a systematic, coordinated effort to address sexual violence through increased information exchange, enhanced partnership formation, and further engagement in multi-disciplinary actions. The Interagency Standing Committee Taskforce on Gender and Humanitarian Assistance consisting of over 20 key stakeholders within the UN and NGOs developed cross-cutting minimum intervention guidelines to prevent and respond to sexual violence in humanitarian settings.

Of necessity is the focus on cross-cultural sensitivity in the design and implementation of interventions. Different socio-cultural conceptualizations of mental health and well-being need to be recognized so that measures are directed in a culturally meaningful manner. Ideally, rather than transpose an existing model from a locality with a different value system, programs should foster participatory programming that incorporates indigenous healing principles and existing systems and structures. Furthermore, it is important to focus on inclusion of stakeholders (both male and female) and empowerment. An illustrative example includes the indigenous healing practices utilized for war-affected children in Angola and Mozambique. Purification or cleansing rituals of former child soldiers attended by family and community mark the transition from the “contamination” of war and death to acceptance and validation. These symbolic healing methods address the local conceptualization of psychosocial well-being in terms of appeasing the spirits in a culturally meaningful manner.

An article in the current WHO Bulletin highlights the intrinsic difficulties in developing a national framework and implementing a multi-sectoral program (psychological well-being, physical health, and justice measures) to respond to sexual assault victims. The lesson from the field contextualizes the problem in the resource-poor, horizontal primary health care system present in Kenya. It presents challenges and lessons learned that can be used to inform policy. It is through the dissemination and sharing of such research that the issue of sexual violence receives greater visibility. Increasingly, researchers will be able to build on the body of literature to evaluate, shape, and deliver better services for survivors of sexual violence. It is from such initiatives that activists and researchers can advance sexual violence research, policy, and programs that will translate to meaningful changes in the lives of those affected.

Selected links for additional reading:

Association for Women’s Rights in Development (AWID)

BBC News Africa, Country Profile DRC

GBV Prevention Network

Harvard Humanitarian Initiative

IASC Sub-Working Group on Gender and Humanitarian Action

Interagency Gender Working Group (IGWG)

Joint Consortium on Gender Based Violence

Reproductive Health Response in Conflict Consortium

Sexual Violence Research Initiative

Stop Rape Now

United Nations Development Fund for Women (UNIFEM)

United Nations International Research and Training Institute for the Advancement of Women (UN-INSTRAW)

United Nations Population Fund (UNFPA)

VDay, 2009 Spotlight: DRC

WHO Gender-Based Violence Site

HIV stigmatization is widespread, especially among people who do not understand how the virus is transmitted. Fear that their children will become infected can lead parents to demand the removal of HIV-positive children from school or to remove their own children to prevent interaction with HIV-positive students.

A recent Time Magazine article describes the stigmatization of HIV orphans in Ho Chi Minh City, Vietnam. The situation in Vietnam shows that it is not enough to have strong laws to protect the rights of HIV-positive individuals (as Vietnam does) — countries also need to have programs of active community involvement so that HIV-positive individuals are not targeted by their fellow community members.

Restriction of children’s access to school because of HIV stigmatization is not just a problem in Vietnam. On August 25, the Times of India reported that an 8-year-old boy was thrown out of school because of his HIV status. There have also been recent reports from Thailand and Uganda of children being barred from school or harassed because of their HIV status.

The social and economic consequences of poor education mean that it is imperative that HIV interventions focus not only on treatment and prevention but also on combating stigmatization. Many children who are affected by HIV stigmatization are already vulnerable because of loss of family support structures — these children should not be further disadvantaged because of the fear and ignorance of their communities. More needs to be done to reduce HIV stigmatization and to make sure that HIV-positive children — and the other children who would be removed from school because of fear — get the education they deserve.

In a study published in the October 2009 issue of Economic Development and Cultural Change, two researchers from Tufts University, Steven Block of the Fletcher School of International Affairs and Patrick Webb of the Friedman School of Nutrition Science and Policy, explored the links between smoking, food expenditures, and childhood malnutrition in Indonesia. A survey was administered to households in rural Java, most of which were poor. Based on the surveys, the researchers found that households with at least one smoker spent 10% of their budget on tobacco and that 70% of the money used to purchase tobacco apparently came from funds that would otherwise be used for food. Households with at least one smoker spent 68% of their budget on food, in contrast to nonsmoking households, where the average food expenditure was 75% of the total budget.

The 7-percentage point difference in food spending between households with at least one smoker and households of nonsmokers might not seem substantial, but the researchers found that this decrease in food expenditures was associated with a difference in childhood nutritional status as measured by height-for-age. The reduced nutritional status of the children may be related to the types of foods being purchased; in households with at least one smoker, less money was spent on fruit, vegetables, and meat, which are important sources of nutrients in the heavily rice-based diet of most rural Indonesians.

It is already known that smoking puts people at risk for many diseases, including cancer, heart disease, chronic obstructive pulmonary disease, and childhood asthma and that tobacco use causes more preventable deaths than anything else. This new report shows that we have another compelling reason to advocate for reducing tobacco use: reducing child malnutrition.

More information:

Economic Development and Cultural Change Press Release on smoking and malnutrition study

WHO: Tobacco and the Tobacco Free Initiative

CDC: Smoking and Tobacco Use

Groups conducting investigations on the Gaza Strip include Amnesty International, Human Rights Watch, the International Committee of the Red Cross, the UN Human Rights Council, and the Palestinian Center for Human Rights. The results of these investigations have generally indicated that “Israeli forces inflicted civilian death and destruction on an unjustifiable scale” during the assault. Amnesty International estimated that 1400 Palestinians (including 300 children) were killed during the attack, although Israeli officials put the number at closer to 1100 and stated that most of those deaths were Hamas terrorist operatives. The Israeli government has not cooperated with any investigations and vehemently denies these claims; a spokeswoman for the Israeli military stated recently that their forces went to “extraordinary lengths” to avoid civilian deaths during the offensive.

Many of these reports have also concluded that in the six months since the Israeli military attack known as Operation Cast Lead, inhabitants are still unable to recover from the devastating attacks. The lack of construction materials, medical supplies, and other humanitarian aid allowed into the area are prolonging reconstruction and recovery. Insufficient supplies, an overloaded water and sanitation infrastructure, and unavailable health care continue to thwart recovery efforts and attempts to improve public health. Unemployment in Gaza was at 44% in April of this year, partly because 96% of all industrial businesses have shut down due to restrictions on import and export of goods. Injured or ill patients who require medical attention outside of Gaza (medications and equipment are often scarce in hospitals, as little is allowed in) have to wait for months to receive permits to leave, and many are never allowed to leave at all.

For more information:

Hamas rocket attacks on civilians unlawful

Seven Palestinians die in Gaza tunnel accident

Impunity for war crimes in Gaza and southern Israel a recipe for further civilian suffering

IDF soldiers give testimonies to counter Gaza war crimes claims

Hamas bends to pressure in Gaza and abroad

Hamas’ deadly campaign in the shadow of the war in Gaza

Gazan doctor and peace advocate loses 3 daughters to Israeli fire and wonders why

The UNHCR report Witchcraft allegations, refugee protection and human rights: a review of the evidence points out that witchcraft provides an answer to the question “why me?” when misfortune strikes. Unfortunately for many areas in Africa and elsewhere in the world, misfortune seems to be striking with vengeance. Particularly in countries where the people have been scarred by war, famine, economic collapse, death, and HIV infections, there are many “why me?” questions to be answered. As Father Horácio Caballero, director of a shelter that cares for children accused of witchery in Angola, says, “when AIDS begins to kill, someone in the family gets blamed for it.” Other children in Angola have been accused of transforming into animals and eating crops at night. Yet scientific analysis found that late rains had caused poor crop yield during that period.

Some common traits in children accused to have witchcraft are: stubbornness, learning disabilities, physical disabilities such as epilepsy, unruly behavior and not taking school seriously. Many of these traits deemed “witch-like” are usually considered normal adolescent behavior in the West. Children suffering from disease such as AIDS and malaria are also prime targets of witchcraft accusations.

While Father Caballero demonstrates the concern many clergy have to protect children from such accusations, not all religious and spiritual leaders share his understanding. Clergy play a large role in advising communities and families on which children are involved in sorcery. Children exhibiting traits as mentioned above are often brought to the local pastor or village healers for diagnosis. Arnold Mushiete, a social worker helping children accused of witchcraft in Kinshasa, Congo suggests that in a culture of death and broken family units, parents are very easy prey for greedy, ruthless clergy.

Religious and spiritual leaders may blame economic problems and health issues on the family’s weakest members. Sometimes clergy or healers are paid to perform exorcisms or “deliverance” ceremonies, thus increasing the incentive to “identify” witches in the family. Some pastors charge up to US$50 in Congo, which is an exorbitant fee considering the average annual salary is US$100. Save the Children’s The Invention of Child Witches in the Democratic of Congo report found that revitalized churches operate on a profit-making basis and will practice exorcism for financial gain.

Many children are often abandoned on the streets. Save the Children estimated that 70 percent of the 15,000 street children in Kinshasa have been accused of witchcraft.  Unfortunately, witchcraft has also been used as a pretext for abandoning unwanted children. Girls accused of witchcraft and abandoned face particularly horrific fates. Without protection, they are often raped and forced into prostitution.

Movements for banning the practice of condemning a child to witch craft are growing but still few. Akwa Ibom state in Nigeria has added a new clause to the Child Rights act, sentencing anyone found guilty of branding a child a witch to up to 12 years in prison. During his visit around Africa, the pope also spoke out against the practice of witchcraft and the use of Christ name to justify violence against children. Recently, videos documenting the plight of children accused of witchcraft have been released. To protect children from such severe human rights violations, more education of the population and government enforcement of child protection are needed.

Last month, the World Bank published a review of its health, nutrition, and population programs from 1997 through 2007, totaling US$17 billion in support. The review found that a third of the projects in this portfolio did not meet their objectives, and that, “none of the projects with explicit fertility or population objectives achieved them.”

The Bank’s current (2007) Population Strategy does not promise much greater success. Amidst a general endorsement of past approaches, the report states that they will target high fertility countries, where total fertility rates (average number of children born to a woman over her lifetime) exceed 5.

However, this strategy does not appear to take into account the level of unmet need – the proportion of women who no longer want to have children but lack access to contraception – in these countries. From an economics perspective, this is analogous to trying to sell a product to a new market with no indication that anyone wants to purchase it.

In fact, there is reason to believe that most people in these high fertility “markets” do not currently want to use contraception.

In a 1994 paper, Dr. Lant Pritchett – a World Bank economist – famously pointed out that worldwide 90% of differences in total fertility rates could be explained by differences in desired fertility. In other words, in most cases women and couples are having children because they want to have children. While Pritchett’s conclusions have been the subject of heated debate, the distinction between wanted and unwanted fertility remains crucial.

In discussing the Bank’s future population strategy, the report notes in passing that, “both demand and supply-side activities are important.” In public health terms, this refers to increasing access to acceptable and effective contraceptive methods (supply) while also promoting a decrease in desired fertility rates (demand).

As the Bank seeks more effective investments in its population portfolio, this distinction warrants additional discussion.

“Supply-side” approaches to population programs are much easier to implement and track than demand-side approaches. And in cases where there is unmet need, distributing condoms or other contraceptive interventions alone may in fact reduce fertility rates. However – and this is key – “supply-side” approaches must target communities with high unmet need, not just high fertility.

While “demand-side” approaches are more difficult to implement, they are also more likely to address the broader needs of high fertility populations, such as disparities in access to education and healthcare. In order to effectively transform attitudes about fertility, “demand-side” programs must be guided by a broader empowerment approach – emphasizing expanded access to information and opportunities – rather than a blunt goal of reducing fertility rates.

The Program of Action resulting from Cairo’s 1994 International Conference on Population and Development underlined the importance of empowering couples, seeking to infuse a rights-based approach into population program design:

The aim of family-planning programmes must be to enable couples and individuals to decide freely and responsibly the number and spacing of their children and to have the information and means to do so and to ensure informed choices…the principle of informed free choice is essential to the long-term success of family-planning programmes…Governmental goals for family planning should be defined in terms of unmet needs for information and services.

The distinction between “supply-side” and “demand-side” population interventions is important in the context of a rights-based approach to health. The design of population programs must be based on careful attention to the needs and rights of vulnerable groups, rather than the ease of implementation. While “supply-side” programs might focus on expanding access to existing technologies, “demand-side” approaches might seek to address gender gaps in education or racial disparities in access to family planning services.

Going forward, the Bank should be explicit about its population strategy. Interventions aiming to expand access to contraception should target populations with significant unmet need. But reducing total fertility rates below 5 will also require expanding the opportunities and resources available to women and couples.

As Pritchett concluded in his 1994 working paper, “reducing the demand for children – for instance by giving girls more education – is vastly more important to reducing fertility than providing more contraceptives or family planning services.”