No pain relief , no working water: the perils of childbirth in Tanzania | Leah McLaren

Natural birth is the only option for many females here, and though dedicated midwives do their best, the risk of infection and sepsis is high

At the Nyarugusu medical dispensary in north-west Tanzania, Eva Paulo, 23, is in her 36 th hour of labour. She paces barefoot in circles around the dusty yard behind the delivery room, her narrow back hunched in pain. Apart from her belly she is a slim female with an angular face, her hair rubbed back into rows of tidy plaits. When a contraction grips her, Paulo leans hard into the nearest tree, shuts her eyes and breathes mutely as the sweat beads off her forehead.

“This is too much,” she says, as another contraction racks her.” I don’t know why it’s taking so long. And the midwives, they don’t tell me anything .”

It is, of course, the universal complaint of women in labour the world over. But for many women in Tanzania,” natural birth” isn’t a preference or an accomplishment- it’s the only viable option.

Paulo is about to give birth for the fourth time in the most basic hospital conditions imaginable. The dispensary is composed of two unassuming cinder-block builds in a jacaranda thicket halfway up a mound. While the staff members will do their best, Paulo will receive no pain relief , no foetal monitoring and no medical interventions. The absence of physicians entails caesarean sections are not performed here.

Another problem- from which so many others stem- is a lack of water. There is no operating water for hand-washing, sterilisation or laundry. Toilets are filthy, squat outhouses a short stroll from the building.

Each morning, staff at the clinic buy 20 jerry cans of water from a local vendor for 500 shillings( about 16 p) each, for basic clean. The money comes out of their own pockets, which is significant for nurses who earn less than PS200 a month. Because of this, pregnant women are required to arrive with their own water.

Paulo’s water sits in the birthing room- three big vats of murky liquid purchased from a shallow well near her house an hour’s walk away.

The water in these buckets will sterilise any implements being implemented in her birth and induce the sweet tea she will drink in the late stages of labour. Finally, it will be used to hand-wash the bloodied linens and rubber sheet on which she devoted birth. A new mom cannot be discharged until she or her relative has done so.

Paulo’s experience is very much the norm. In Tanzania, merely 44% of healthcare facilities that deliver newborns have access to water, decent toilets and handwashing with soap. Of these, merely 24% have these facilities in the delivery room. The situation is similar across the region, with 42% of healthcare centres in sub-Saharan Africa having no water source within 500 metres.

By 8am each day, the dispensary’s open-air waiting area is packed with moms, pregnant women and newborns, most of whom have walked miles to get here. This is an area known for foreign-owned gold mine. What little job there is here is back-breaking and poorly paid. Although healthcare is free in Tanzania, patients have to buy their own drugs.

The medical staff at the dispensary- three registered nurse/ midwives, two trainee nurses, an office director and a lab technician- are clearly overworked. Clad in white smocks, they rush about with clipboards, weighing and immunising dozens of newborns, testing sick patients for malaria, tuberculosis and HIV, often working 24 -hour switchings for no overtime, trying to get ahead of the river of patients, which can number 500 a day.

Buckets
Buckets of water from a privately owned shallow well on the edge of Nyarugusu- the closest water source to Nyarugusu Dispensary, a 15 -minute drive away. Photograph: Sameer Satchu/ WaterAid

Asked if she had a wish list for the clinic, midwife Jackeline Gideon Mwiguta says:” That’s easy. Running water, better equipment, more beds and more faculty .”

The NGO WaterAid is working with local government here to provide a clean, dependable water source for centres like the Nyarugusu dispensary. But this is a remote area in a poor country and progress is slow. A borehole has been excavated near the hospital but the pump has yet to be delivered. With luck, the dispensary will have water by Christmas.

In the birthing room, Pendo, 27, has just dedicated birth to a healthy son called Amos. She lives in a village 10 miles away and went into labour in the middle of the night. She set off for the dispensary with her “aunty”( her mother-in-law’s youngest sister) on a motorbike taxi at first light. After 20 minutes, she felt the need to push and told the driver to stop. Pendo then lay down by the side of the road and dedicated birth to her son. Her aunt cut the cord with a razor blade from her suitcase. Pendo and her aunty, with Amos in a bundle, then got back on the bike and drove the rest of the way to the dispensary. When they arrived, the midwife put a clip on the umbilical stump. That was about an hour ago. Now Pendo is resting under a white sheet while her aunt, who wears a Chelsea FC T-shirt and a traditional kitenge wrap skirt, cradles the baby.

Asked if Amos has been bathed, Pendo shakes her head. They will do it at home subsequently.” We didn’t have time to get water ,” she says.

Nurse-midwife
Nurse-midwife Jackeline Gideon Mwiguta carries the placenta out to the clinic’s disposal pit- an unlined pit in the ground where medical trash is afterward burned. Photo: Sameer Satchu/ WaterAid

A couple of hours later, Pendo and Amos are nowhere to be found. Not waiting to be discharged, they slipped out of the birthing room without the midwives noticing. Mwiguta says this is common. Perhaps they just wanted to go home or, more likely, they couldn’t afforded the 1,500 shillings for water.

Childbirth without water is unpleasant for all the obvious reasons but it’s also dangerous. If a labouring female comes in without her jerry cans and needs an episiotomy, for instance, the midwives must simply wipe down the instruments with bleach, instead of sterilising before cutting. The same runs for the scissors used to cut the umbilical cord.

Without water, the delivery room cannot be properly cleaned between deliveries, of which there are several each day. During the three days I spend there, it smells strongly of afterbirth and the floor is flecked with blood and dirt. Tanzania has induced great strides in lowering infant mortality in recent years, but its rate is still comparatively high. While just 3.6 in 1,000 British newborns will die before their first birthday, in Tanzania that number is 51. One major reason is the prevalence of bacterial infection and its deadly sibling, sepsis. During my day at the dispensary I speak to three bereaved mothers who had lost babies to sepsis in the past month alone.

In the delivery room, here i am suddenly great exhilaration. Paulo is ultimately in transition and ready to push. Lying on the hospital bed draped in only a traditional kitenge, she drinks profoundly from a pink plastic nursery cup of tea and then grips the side of the bed, back arched.

Kushinikiza , kushinikiza ,” says Mwiguta, the Swahili word for “push”. She strokes Paulo’s arm, then unhurriedly snaps on a new pair of latex gloves. Instead of tossing out the packaging, she spreads the white plastic out under Paulo’s bottom- an act that seems both tender and frugal.

As the baby’s worried purple forehead emerges, Mwiguta pushes her fingers sharply under the chin and takes hold of something thick and blue and twisted.” The cord is around the neck- this is why newborn took so long ,” she says, as if remarking on the climate. She tugs the cord, pulling it up and over the baby’s head. Then she instructs Paulo to push once more and a perfect, slippery baby girl shoots out with force, a mess of other stuff coming with her- blood and amniotic fluid. The primordial soup of life.

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‘Why would we invest in a disabled person? ‘: struggle bigotry in Mozambique | Lucy Lamble

In poorer countries, more than 80% of people with disabilities are unemployed and struggling to survive. A educate strategy is helping break down barriers

At 21, Mateus Mbazo from Sofala province in Mozambique faced a stark selection: starve or steal. Recently orphaned, with physical disabilities on his right side affecting his arm and leg, Mbazo had to feed himself and his two younger friends. He had missed out on schooling, and get a job to earn even a meagre sum was a difficult task so a life as a petty burglar seemed the only option.

At his church that he heard about an initiative that would change his life: a programme offering training for people with disabilities.

Now 23, his biggest fear is not how to be offered their own families, but defending the plentiful harvest in his market garden business from local goats, who love to munch on his crops. On his carefully tended plot, lent by the landowner, onions, tomatoes, cabbages, buds and lettuce are flourishing.

Mbazo’s success is unusual in Mozambique, where people with disabilities are four times more likely to be out of work than their contemporaries. In some places, stigma, such as fear of contagion, persists. This reflects the broader painting within the developing world, where it’s estimated that between 80 -9 0 %~ ATAGEND of disabled people are unemployed- by comparison in the UK that figure is 52 %.

Mbazo’s training came from international organisation Light for the World together with social enterprise Young Africa. They are working to give people with disabilities the skills to make a living and in a programme in Sofala, have taught 160 young people- alongside more than 13,500 able-bodied students- in topics from tailoring and cooking to welding and electrical engineering.

Young Africa’s director, Aksana Varela, and her squad are proud of their efforts: the centre has been fitted out with ramps, lecturers have been trained in sign language and assistive computer software installed in the library.

Priority is given to the most disadvantaged.

Chef Joana Nhantote, 27, knows how difficult it can be to persuade employers to look beyond a disability. She lost her hearing at 13.

” It was hard to[ find] a job … not because of the work itself, but because of the discrimination for me being deaf ,” she signs.

Joana Joana Nhantote, 27, a cook at Brasibeira restaurant in Beira. Photograph: Carlos Litulo/ For Light for the World

Now in a permanent job, she says:” It is a bit different from cooking at home. I didn’t know the ingredients, the type of flavouring and how you use it, but now since I finished the course, I can distinguish one from another. I’m a better cook. I love working here .”

Restaurant owner Dauva Barrientos admits that initially she found it hard to develop Nhantote.” But then I stopped and thought to myself- I need to understand how she does things and how she can best understand me. Whatever I do in the kitchen or here at the restaurant she understands me immediately. I do things and I show her, and then she sees whatever I am doing and she does it exactly how I did it. She’s very smart .”

Marta Lucas, 13, in her classroom at the 25 September primary school in Buzi district, Mozambique. Photograph: Carlos Litulo/ Light for the World

” Everyone understands that this is a good way to include people in society but we need to build a strong network involving other sectors like education and health and we need to look more at the decision-making level .”

Shakespeare says governments can see the value.” This is a hard-to-reach population that are sometimes written off as hopeless but here we have CBR joining the dots, joining the people to existing services and enabling them to be economically productive. Its what everyone wants .”

Market gardener Mateus Mbazo is in no doubt of the power of the initiative.” My dream is to develop my skills and become a famous farmer ,” he says.

Women seek islands of refuge in Papua New Guinea’s sea of violence | Helen Davidson

For women in Papua New Guinea, violence at home is horribly normal. Local charities are trying to provide shelters in the absence of government support

In a room in Lae, Paula sits on the floor, Julie on a lounge. Caseworkers and support staff are on seats, and barefoot children peer at the newcomers. The children cant play outside in case their fathers show up at the gate and see them.

Paula, Julie and their children are sheltering at this Salvation Army refuge, having fled their violent spouses. They have little more than their clothes but they are among the luck ones in Papua New Guinea, where epidemic diseases of family violence builds it one of the most dangerous places in the world to be female.

About 50-70 % of women in Papua New Guinea have experienced family or sexual violence at least once in their lifetime. A similar number of PNGs men are believed to be perpetrators.

For the 15 % of the population who lives on urban centres( pdf) like Lae and the capital, Port Moresby, survivors have access to a small but increasing number of support services offered by NGOs.

In Lae, local NGO Femili PNG has for 18 months supported more than 370 abuse survivors. Femili is principally funded by the Australian government and many of its staff were trained by Mdecins Sans Frontires( MSF) when it ran a family support centre at a local hospital. Femili works with the courts, a local police department of three, and a welfare officer, emergency care and procuring interim protection orders.

Julie left her husband after he threatened to sexually abuse their six-year-old daughter. He had long been abusive to Julie, accused her friend of being most children father, and her of being a sorcerer. When he began making advances on his daughter, Julie and her children fled to a relative who set her in touch with Femili. They brought her to the refuge.

Paula gratified her husband in 2010 and they had three children, one who was killed. Her spouse was controlling, she says, limiting her conversations with male relatives and accusing her of talking to humen behind his back. He was violent and verbally abusive.

In September, the basketball team Paula played for stimulated the final, but when she came back from the game her husband accused her of only going to meet humen. He threw her belongings outside. The next morning, he hurled her out too.

I said, If you dont want me to stay with you then buy my ticket and Ill go home to my relatives, she recounts. I said I[ would] take my two children. He said, No, you leave my children and you go.

A A bush knife covered in juice from a fruit, in Tari, Papua New Guinea. The knife is commonly used during disputes and outbreaks of violence. Photograph: Jodi Bieber/ MSF

The next night he got the bush knife and was trying to cut me. So I got these two small ones[ children] and we walked away. I was trying to leave the house, but he pulled my shirt and pulled me down. He punched me here and I fell on top of that small boy.

Women lack safe places to go to when they are assaulted. Many have no choice but to return to an abusive home. Paula says the police dedicated her husband a warning, and he assaulted her again once they were home.

Finally Paula escaped and contacted a family support centre and the police. Her husband was arrested and Paula grabbed her children from the house. She is waiting for him to face court and for her relatives to create enough money to fly her and the children to Port Moresby.

Asked if shes fretted he will track her down, she says: He might, so Im afraid. He said if Im going back hes going to kill me.

Despite violence against women being permeating available data is old, flawed and specific to the small locations where people have been surveyed resources to tackle the problem are minuscule. Shelters are so few that facilities like the Lae refuge are nationally renowned.

While the government has passed new laws against family and working sexual violence it has largely failed to legislate or enforce any of them, and services are provided by NGOs, churches and grassroots organisations. Family, and the traditional welfare network of wantok, also play their parts.

Ume Wainetti, national coordinator of the family and sexual violence action committee, says the government is failing to follow through on commitments. Its either through ignorance or people are not prepared to use the law. Rape charges are very minimal, she says.

Family and sexual violence units attached to 14 police station are proving effective but are resource-starved. The Lae unit has two officers and a commandant, who on any dedicated day face 30 to 40 girls lodging a complaint or seeking interim protection orders against violent partners.

Sebastian Roberts, family and sexual violence coordinator at the department of health, says collaboration between government, authorities and organisations is improving but gaps remain.

The commitment is there in terms of paper, but when it comes to funding we have a problem, he says.

In Port Moresby, concealed behind trees next to a hotel, two dozen women and children shelter in a guesthouse called Haus Ruth. It was opened by the City Mission charity 13 years ago.

We ensure a want “thats really not” being addressed, or was but in a very, very limited fashion, says Ronald Brown, the pastor who runs the mission.

Brown wants to convert the guesthouse into apartments and use the money to accommodate more survivors at a protected community on farmland owned by the mission out of township. Perpetrators frequently show up at the gates of Haus Ruth go looking for their partners.

Its not like in America or Australia where you have a womens refuge tucked in a place where nobody knows, he says.

Here were right on Ela beach, next to a hotel. Everybody knows where we are. Were hoping to eventually, someday, move Haus Ruth, procure it better, and get a bit of distance between them and perpetrators here.

Because[ the number of residents] can change dramatically at any point in time we have to have the capacity to be able to absorb whatever happens. Theyre all brought to us referred by police or other NGOs. Were the only game in town.

I have four young girls there right now who came in alone. Theyre aged 12 to 14. Three of them were sexually trafficked. The fourth has been badly sexually abused.

Its an alarming aspect of the violence, particularly in cities. Girls are trafficked from other provinces and forced into sexual slavery. Some local girls are trafficked by family and forced into sex work.

We do get referrals from outside the community and we do repatriate outside the community, depending upon situations. So if its not safe for the women to be in this community, well pay to get them sent back to a village or an island or wherever they have to go to get away from the perpetrator, says Brown.

The City Mission also operates a halfway house for boys who have lived on the street or been in prison. Brown aims to teach them about respect for women while they are young.

He estimates up to 500 young men are in the programme, and the majority of them grew up surrounded by abuse.

Theyre so used to seeing it, theyre so conditioned to see it, that even after spending a year and a half at City Mission, they are continuing may leave supposing the same way, he says, but adds that the programmes are having a positive impact.

To stop gender-based violence, working with the women and children who have been victims and survivors is patently a necessity, but we need to[ also get] a hold of the young men.

The health departments Roberts concurs. Men are coming on board. Before when the issue of gender was coming in, they ensure it as a womens issue. But after much advocacy and awareness we began to see humen coming in to support women and look at prevention of GBV and promotion of human rights.

Paula and Julie wait at Femili, reliant on wantok to cobble together funds to help them move on with their lives.

I was happy when I came here, says Paula. I felt there are friends here who will help me. I will get a restraining order and go to welfare about these two children. Im not going back to him.

Names have been changed to protect identities. The Guardian travelled in Papua New Guinea with MSF

‘Anti-malarial mosquitoes’ created using controversial genetic technology

Scientists aim to tackle malaria by creating bugs unable to spread the parasite, but caution recommended over unpredictable ecological consequences

Hundreds of genetically modified mosquitoes that are incapable of spreading the malaria parasite to humen have been created in a laboratory as part of a revolutionary approach to combating the disease.

The move marks a major step towards the development of a powerful and controversial technology called a gene drive that aims to tackle the disease by forcing anti-malarial genes into swarms of wild mosquitoes.

The procedure can quickly transform the genetic makeup of natural insect populations, making it a dramatic new tool in the fight against an infection that still claims over 400,000 lives a year. The same technology is being considered for other human diseases and infections that devastate crops.

This is a significant first step, said Prof Anthony James at the University of California, Irvine. The mosquitoes we created are not the final brand, but we know this technology allows us to efficiently generate large populations.

But gene drive technology is so powerful that resulting researchers have recommended scientists in the field to be cautious. A warning published in August in the prestigious publication Science, by squads in the UK, US, Australia and Japan, said that while gene drives have the potential to save lives and bring other benefits, the accidental release of modified organisms could have unpredictable ecological consequences.

They call on scientists to ensure that experimental organisms cannot escape from their labs, be released on purpose, or even find their way out accidentally in the event of a natural disaster. Researchers should also be open about the precautions they take to prevent an unintended release, they said.

In the latest study, mosquitoes were engineered to carry genes for antibodies that target the human malaria parasite, Plasmodium falciparum . When released into the wild, researchers believe the modified insects will breed with normal mosquitoes and pass the anti-malarial genes on to their young, making an ever-increasing proportion of future generations resistant to the malaria parasite.

James and his squad employed a genome editing procedure called Crispr-Cas9 to write anti-malarial genes into the Dna of eggs belonging Anopheles stephensi mosquitoes. A major carrier of the malaria parasite in Asia, the strain is responsible for more than 10% of malaria cases in India.

In lab tests, the modified mosquitoes passed on their anti-malarial genes to 99.5% of their offspring, is recommended that the procedure was incredibly effective and efficient. To track which bugs inherited the antibody genes, the scientists added a tracer gene that devoted carriers red fluorescent eyes.

James, who signed the warn in Science, said more run was needed to perfect the gene drive before modified insects can be tested in field trials. But describing the experimentations in Proceedings of the National Academy of Science, he wrote: Strains based on this technology could have a major role in sustaining malaria control and elimination as part of the eradication agenda.

Dr Simon Bullock, a geneticist at the MRCs Laboratory of Molecular Biology in Cambridge, helped to perfect the use of Crispr genome editing in flies, and also signed the call for precautions over gene drive research. Gene drive technology has great potential to help tackle malaria and other global problems in public health. But the capacities of genetic changes to spread rapidly in the wild population means that great caution should be taken when building gene drive systems in the laboratory.

Accidental or malicious release of a gene drive system into the wild could have unpredictable ecological consequences and thus researchers must use multiple safeguards the hell is robust to human error and nefarious actions. Fortunately, several safeguarding strategies are already available, he said.

But Bullock, who was not involved in the research, was surprised that the California group had not described the safeguards they put in place to ensure the mosquitoes did not escape. Devoted the highly sensitive nature of this technology and their call for transparency in this area of research, Im flabbergasted that the authors have not are set out in the publication detailed information on the containment procedures used in this study and how they were evaluated, he added.

Prof Anthony Shelton who studies pest management at Cornell University in New York said the California-based team was justified in its optimism over the procedure. Before open field test, they need to test their bugs in small arenas and field cages to decide the potential for it to work on a larger scale, he told. In theory this technology should work in the field, but farther exams are needed and only then will the full potential of this breakthrough be realized for the benefit of humanity.

Prof Gregory Lanzaro at University of California, Davis added: Concern that narcotic and insecticide resistance are eroding recent successes in managing malaria has drawn attention to alternative approaches, including the use of genetically modified mosquitoes. This new study marks a significant advance toward the development of this strategy.

Read more: www.theguardian.com

HIV infecting 2m more people every year, warns UN

Goal of eradicating Aids by 2030 will be impossible without more work on prevention, tells UNAids report

Talk of the end of Aids was premature, according to a new UN report that exposes the steady decline in new HIV infections stalled five years ago and that, in some areas, the numbers are rising again.

We are sounding the alarm, told Michel Sidib, executive director of UNAids. The power of prevention is not being realised. If there is a resurgence in new HIV infections now, the epidemic will become impossible to control. The world needs to take urgent and immediate action.

Nearly two million people have been newly infected with HIV every year for the last five years, tells UNAids, one week before the International Aids Conference in Durban. If that continues, it will be impossible to meet the UN goal of eradicating Aids by 2030.

Even though there are many well-understood ways to prevent infections including education about health risks, furnishing condoms and, most recently, narcotics that can protect the partners of those who are infected the numbers are going up , not down, in many regions.

Between 2010 and 2015, there was a 57% increase per year in new infections in eastern Europe and central Asia. The numbers of new infections had been falling for years in the Caribbean, but over the same period they rose annually by 9 %. The annual rise in the Countries of the middle east and North Africa was 4% and in Latin America it was 2 %. Although other regions did not insure a rise in infections, there was no drop-off either.

The trend is a blow to those who had predicted that the epidemic would be over in the foreseeable future. In 2011, Hillary Clinton, then US secretary of state, foresaw the end of Aids, saying that US endeavors had helped to lay the foundations for an historical opportunity, one that the world has today to change the course of this pandemic and usher in an Aids-free generation.

In June, the UN general assembly issued a declaration committing to speed up efforts to end the epidemic by 2030. The roll-out of antiretroviral drugs to people with HIV has cut the death toll, but the above figures from UNAids show that much more will need to be done on prevention.

Money is a major issue. The medication therapy programmes are costly and experts agree that maintaining all those infected now 36.7 million people worldwide on drugs for life is not sustainable if the numbers continue to rise.

But Aids has a lower profile now that the deaths are falling and this has led to a drop in funding from international donors, from a peak of $9.7 bn in 2013 to $8.1 bn in 2015, although the affected countries have increased their spending on HIV, so that now they contribute 57% of the total which was $19.2 bn last year.

Most of the money goes on treatment simply 20% is spent on prevention, says UNAids. The report recommends that resources should be focused on high-risk groups.

In east and southern Africa, for example, three-quarters of all new HIV infections among 10 to 19 -year-olds are of daughters, tells research reports. They do not know enough about HIV and are prey to older men, unequal in their societies and subjected to violence.

Worldwide only three in ten adolescent girls and young women between the ages of 15 and 24 years have comprehensive and proper knowledge about HIV, says research reports. Reaching adolescent girls and young women, especially in sub-Saharan Africa, will be a key factor in ending the epidemic, it says.

Elsewhere, there are other issues. In eastern Europe and central Asia, 51% of new HIV infections occur among persons who inject narcotics. More than 80% of the regions new HIV infections in 2015 were in Russia. There are few damage reduction programmes to help those at risk.

In western and central Europe and Northern america, about half of all new HIV infections pass among gay humen. Between 2010 and 2014, new HIV diagnoses among men who have sex with humen increased by 17% in western and central Europe, and by 8% in North America.

The International HIV/ Aids Alliance, which represents community groups worldwide, said it was concerned about the trend.

Shaun Mellors, the alliances associate director for Africa, said: It is significant that UNAids has publicly acknowledged the concerns that remain about HIV prevention. To respond to this global prevention gap, we need rapid investment and implementation of tailored combining prevention services for all populations at risk of HIV.

Meeting these targets requires a rapid acceleration in treatment and prevention programmes, rooted in human rights and gender equality, and centred on people living with or affected by HIV.

Read more: www.theguardian.com

Rise in use of contraception offers hope for containing global population

More women than ever use family planning, tells the UN, and having one child fewer could dramatically curtail the global population by 2030

The number of women use contraceptives in developing countries has risen to record levels in recent years, such that projections for global population growth could be cut by as much as 1 billion over the next 15 years.

The latest figures by the UN prove more females than ever now use family planning, with some poorer regions recording the most wonderful pace of growth since 2000.

In 2015, an estimated 64% of married females, or women living with a partner, aged between 15 and 49, were utilizing modern or traditional forms of family planning. In 1970, the rate was 36%.

The population division of the UNs Department of Economic and Social Affairs( Undesa) predicts high rates of contraceptive use in Africa over the next 15 years; a region with the largest demand but least access to modern contraceptives.

Undesas projections for global population range between 8 billion and 9 billion by 2030.

The UN projections of population growth already give us an idea of the impact that increased access to family planning could have. If by 2030 the average family size is just one child fewer, then by 2030 the world population is estimated to be approximately 8 billion rather than 9 billion, told Jagdish Upadhyay, head of reproductive health commodity security and family planning at the UN population fund( UNFPA ).

Evidence shows that women who have access to family planning choose to use family planning, often resulting in smaller families, higher educational achievements, healthier infants[ and] greater economic power as well as influence in their households and communities, told Upadhyay.

If all actors can work together to provide women in every country with the entails, which is their right, to voluntarily exert yet another right to freely ascertain their family size, then we are likely to see a significant slowing of global population growth.

In Nigeria, one of the countries predicted to see the biggest population growth over the next few decades and with a contraceptive prevalence rate of 16%, an increase of one percentage point in the use of modern contraceptives would entail about 426,000 more females would be using family planning.

Upadhyay said many countries, particularly those in west Africa which has a high unmet need for contraception, to have been able to reap the demographic dividend: a boost to the economy that occurs when there are growing numbers of people in the workforce relative to the number of dependants.

However, he cautioned that despite the successes of the past 40 years, huge, and sustained, investment in family planning is needed to keep up with demand and gratify the needs of women who are unable to access services.

Julia Bunting, president of the Population Council, told: To impact population projections will require real commitment from countries like Nigeria to invest in high quality, voluntary family planning programmes to expand access to contraceptives.

The timing, scale and pace of those efforts will determine the dimensions of the impact on population projections.

According to Undesa figures, 142 million married women or those living with a partner, who would like to avoid pregnancy and use a modern sort of contraception, are unable to access them. When single females are included, the number rises to 225 million.

Africa has the highest unmet require, with an estimated 33% of women use contraceptives in 2015. East, central and south Africa are expected to increase coverage over the next 15 years, but over that time its big youth population will be reaching reproductive age.

Sarah Onyango, a senior consultant for service delivery at the International Planned Parenthood Federation, said continued increases in contraceptive utilize could have an impact on population figures, but the trend necessitates more detailed analysis.

Over the next 15 years, were going to see growth in contraceptive use and demand because an increasing number of women of reproductive age will require contraceptive services, she said.

Right now, the population of Africa is generally young people almost 50% of the population are youths. If current trends in contraception employ continue, we will probably insure some shiftings in population.

At an international summit on family planning in London in 2012, donors pledged $2.6 bn ($ 1.8 bn) to improve access to contraceptives for 120 million women and girls by 2020.

Last September, world leaders promised to ensure universal access to family planning by 2030, recurring a pledge they had built in 1994.

Read more: www.theguardian.com

The giant rats that love avocado- and can diagnose deadly TB | Kate Lyons

A team in Tanzania have developed African pouched rats to make life-saving discoveries, sniffing out cases of tuberculosis missed by health clinics

After scampering about a sleek glass and aluminium enclosure, a rat named Riziwan has made a crucial discovery.

In just minutes, Riziwan has positively identified 13 people who may have tuberculosis. The discovery is potentially life-saving news for those whose sputum samples were marked as clear by their local health clinics. But it’s all in a day’s- or rather 15 minutes’- work for Riziwan and the other giant African pouched rats that work at Belgian organisation Apopo‘s TB centre in Morogoro, Tanzania.

Riziwan , now almost a year old, has been trained- almost since birth- to pick up the smell of the disease, which is notoriously difficult to detect.

To carry out his run, Riziwan is placed in a large cage. Into its base, technicians insert a metal bar holding 10 dishes of human sputum, sent to Apopo by a TB clinic. All samples have been heat-treated so there is no risk of infection to either rats or humen. One by one, metal grates in the bottom of the enclosure are opened to allow Riziwan to sniff each petri dish.

There is silence among the technicians as Riziwan investigates the samples. He moves on quickly from slots one and two, but at the third he pauses and scratches the metal bottom of the enclosure, indicating that he reeks the disease.

At the seventh hole he scratches again, and again at the eighth. This time Harumi Ramadhani, the training superintendent, presses a clicker, meaning Riziwan has correctly identified a control sample from one of the clinics. It earns him a reward of mashed banana, avocado and rat pellets.

A
Apopo rats find an additional 40% of TB suits on top of those discovered by clinics

In all, Riziwan checks 100 samples. His run done for the day, he is returned to a large open-air playpen. The enclosure is cleaned and a second rat- a female named Pink- is brought in to test his findings.

” No person will be treated only on the comments of a rat ,” says Lena Fiebig, head of the TB programme at Apopo.” The rats at this moment are not approved as a standalone diagnostic tool. We’ll then use a recognised method, and this is mostly concentrated microscopy, where a laboratory technician will re-check these samples. But the rats have already contributed tremendously to narrowing down the focus, so it’s not a team of 10 lab technicians who need a week to re-check .”

On average, Apopo rats find an additional 40% of TB examples on top of those discovered by clinics. Since they started work 10 years ago, they have screened nearly half a million samples and detected more than 12,200 missed lawsuits. They can get through 100 samples in 10 to 20 minutes: a human with a microscope takes four days to test the same number.

The World Health Organization estimates that last year 4. 1m TB occurrences ran undetected, despite it being the world’s top infectious killer in 2016, resulting in 1.7 m demises. Detection rates use conventional light microscopy- the technique used during the clinics that send samples to Apopo for checking- can be as low as 20%.

Tuberculosis is an obvious target for the keen-nosed rats.” It’s known, or perceived, that TB has a specific odour. Reportedly dogs would avoid patients’ rooms with the disease ,” tells Fiebig.” Even physicians have reported cases where they receive a smell off TB patients .”

Workers
Workers at the Apopo TB detection centre

The centre began developing the rats on samples from the central TB laboratory for Tanzania, and the programme became operational in 2007. Apopo now partners with 57 clinics in Tanzania, and has operations in Mozambique and a centre about to open in Ethiopia.

” They are incredible ,” tells Ramadhani.” They can do a lot of things and they’re an easy animal to work with .”

Life is pretty good for the African pouched rats. At the end of the week- on” full-cheek Friday”- they are allowed to stuff their famous pouches with a feast. They live about eight or nine years and when they are too old to run are retired to the playpens.

The versatile species has also proved adept at detecting landmines. In the past 20 years, Apopo’s rats have found more than 100,000 landmines and unexploded regulations, clearing 22 m square metres of land in countries including Mozambique, Angola and Cambodia. The NGO hopes to send teams to Colombia and Zimbabwe next year.

Mine-clearing is still core to what Apopo does and in the early hours of one morning, handlers transport a dozen rats to a 24 -hectare( 29 -acre) field where defused landmines have been interred for them to train with.

The animals, which are nocturnal and susceptible to sunburn, have their tails and ears slathered in clear sunscreen. They are fitted into harness, and methodically check every square inch of ground.

Burhani is being tested today. If he passes- rub at the soil above every interred landmine- he will be sent to Angola to replace a rat nearing retirement. Werrason( named after a Congolese musician) is progressing well, but misses two ours, so is not yet ready to be deployed. The third, Chifupa( named after a late Tanzanian MP) is struggling. She is still on one of the smaller, easier develop fields and misses about half of the mines buried in it. It will be some time before she catches up with the rest of her class.

The human de-miners must have complete religion in the rats’ ability. They are merely let on to minefields when they can detect every explosive in the field during develop, with only one false positive- compared with the tuberculosis rats, which are operational with a sensitivity rate of 75 %.

After a piece of land has been cleared of ours, as part of the handover ceremony to the community, Apopo staff will run across it to prove to sceptical locals that it is safe.

An
In the past 20 years, the rats have found more than 100,000 landmines and unexploded ordinances

Cindy Fast, head of Apopo’s training, the investigations and developing, is always on the lookout for more ways the animals might put their noses to good employ.” We are just beginning to tap into their potential ,” she says.

There is talk of using them in disaster zones, receiving survivors buried in the rubble of collapsed buildings. And this week a group of rats began training to recognise the fragrance of African hardwoods as well as the scales of the pangolin, the most trafficked mammal in the world, so they can be used in anti-smuggling operations.

Slowly, these projects are turning rats from pests into heroes among locals.

” In the beginning it was very difficult to get people to understand what we’re doing ,” says Shaibu Hamisi, one of the mine detecting rat trainers.” People didn’t understand how the rodent could be helpful .” He adds that there is still stigma around the animals.

The trainers miss their charges when they are sent abroad for different projects, Hamisi says, but” when we hear this rat has discovered two landmines today, we feel really proud “.

Read more: www.theguardian.com

One meal a day: the Lake Chad crisis in pictures

The extreme north of Cameroon is suffering a food famine exacerbated by climate change and conflict with Boko Haram

Ramata Modou, 58, holds a photograph of herself. Ramata is community leader at an internal displacementcamp for women and children in Mm

When armed men entered Ramatas village her husband suffered a heart attack and succumbed. Her 17 -year-old daughter was kidnapped, her three-month-old daughter strapped to her back. When she first fled to Mm she slept under trees for two months with her six children.

She now lives in a camp for internally displaced women and children. All the women here have lost the men in their lives spouses, fathers, friends, sons to the conflict. They built their own makeshift homes from sticks and thatch. There is a water pump but no sanitation.

Ramata holds her half-eaten lunch of ground red maize, white rice and crushed mango leaves. It is the only meal she and her children will eat today. The food was gathered by running house to house in the village to beg.

Leaving my village was very difficult. We used to own kine and sheep, but we had to leave all of those things behind. We had no choice, we had to leave. Even the roofs of the houses have now been stolen.

People have fled violence in their village, often in the middle of night, leaving with nothing, sometimes not even their shoes. Those who arrive in Mm are forced to rely on the kindness of new neighbours to provide clothes and food. Most families arrive with nothing, and even a battered spoonful is a gift to be treasured.

Aminas Remains of the daily snack for seven – ground red maize, white rice and crushed mango leaves. This plate is the half-eaten lunch of Ramata Modou, 58, and her family This battered spoonful belongs to 20 year-old Amina, a young pregnant mom of two
A plate of ground red maize, surrounded by a green sauce made from mango leaves A stick of red maize Tomatoes – a luxury in Mm, expensing 160 CFA( 21 p) for three at Mm market A cracked bowl of food, containing a few grains of rice and some beans the last few morsels of a lunch Niebe( black-eyed) beans. Seen in the fissure of a wall at Alis home on the outskirts of Maroua
A bowl of fish bones for flavour. When you only eat one meal day, people look for anything to add flavour. A bowl of fish bones is all that remains of this meal. These small, brittle, dried fish are used to season bland staple foods, such as maize. These fish have almost no meat on their bones This woven bowl contains maize husks. Food is so scarce here that even the chaff of maize is saved and eaten
A piece of charred firewood. Firewood is an important commodity here. Not only is it are applied to cook, but people forage for timber in the bush and sell it in the village to earn money to buy food

How bitter herbs and botched abortions kill three women a day in the Philippines

In a country where more than 65% of women dont use contraceptives and terminating pregnancy is illegal, torturous practices are often the only option

Outside the gates of Manilas Quiapo church, deals are being done. Bitter herbs and abortion drug are traded illegally.

Next to an imposing statue illustrating a foetus clasped in the hands of Christ, stalls offer an array of rosary beads, amulets, mangoes and songbirds. Here, the abortion pill misoprostol is on sale for just$ 5( 3.90 ), as well as the herb pamparegla, which can induce menstruation and aim pregnancy. All this goes on in the shadows of the largest Catholic church in Manila.

The irony is not lost on womens rights activists who want legal access to abortion.

Marevic Parcon has been called an abortion cheerleader. Its no understatement. In a country with an outright ban on processes and conservative opinions on contraception, she is defiant in the face of criticism.

I mean, why not? Is it shameful? At the end of the working day abortion is about human rights, she says. No matter how much they deny the existence of abortion in the country, its happening under their noses.

Parcon is programme coordinator at the Womens Global Network for Reproductive Rights( WGNRR ). If you are for womens rights, it is inevitable to talk about sexual and reproductive health and rights. And you cannot talking here sexual and reproductive health without talking about abortion rights.

Her views dont go down well in a country where more than 80% of the population are Catholic and the church holds tremendous sway.

Such conservative postures kept an act awarding universal access to family planning at bay for 14 years.

More than 65% of women dont use modern contraceptives, and maternal mortality rates are still high in the Philippines, standing at 114 deaths per 100,000 live births in 2015.

It was the efforts of women like Parcon that eventually helped drive the law over the line. The Responsible Parenthood and Reproductive Health Act also referred to as RH law was ultimately passed in 2012.

This whole culture of patriarchy controls womens bodies. Women should be able to exercising their own sexuality and they should be able to enjoy sex, says Parcon, who has been on the frontline of womens rights activism for more than 20 years.

Although its against the law to objective a pregnancy in the Philippines, an estimated 610,000 abortions take place every year.

Its an open secret that techniques are available, albeit unsafe ones.

As well as the herbs and medications on offer at Quiapo, women who want to end unplanned pregnancies have their stomachs massaged hard every day for a week, in the hope of inducing abortion.

It is horrific. It is tantamount to torture, says Parcon. Unsafe abortion is torturous to women, especially the massage kind, because it is so painful.

Others resort to barbaric methods such as inserting barbecue sticks or coathangers into their womb, or throwing themselves down the stairs. Three girls succumb every day from post-abortion complications in the Philippines.

The job of campaigning for womens reproductive health and rights there is tough. But its about to get tougher. Although the work of Parcons organisation, WGNRR, is not funded by the US, Donald Trumps decision to reinstate the Mexico City policy, also known as the global gag rule, will bolster her opponents.

The gag rule bans foreign aid to international healthcare providers who discuss abortion or advocate abortion rights.

It will definitely make it more difficult for any reproductive health NGO, says Parcon.

When you talk about reproductive health you will always touch on abortion. The global gag rule says that even the mere mention of abortion is not allowed. It is a challenge a big, big challenge. But its not something we should be afraid of.

On paper the Philippines looks like its making progress on uphold womens rights. In 2009 the Magna Carta of Women was introduced, promising to eliminate discrimination against females by recognising, protecting, fulfilling and promoting the rights of Filipino girls. The country has also ratified the Convention on the elimination of all forms of discrimination against females( Cedaw ).

But the fight over the introduction of the reproductive health law clearly showed that the country still has a long way to go.

Everything was reduced to the debate of whether or not contraception was[ causing abortion][ but] how are you able enjoy life if you have 12 kids? asks Parcon.

There are other hurdles ahead: the furnish of contraceptives is poor, and legal challenges from religion groups are blocking distribution of the contraceptive implant.

But Parcon remains positive.

My hope is that one day Filippino girls can say abortion and that theres no dishonor in the word. Before, we couldnt even have this conversation. But right now we are having it, so there is hope.

Read more: www.theguardian.com

Hope for ‘end of Aids’ is disappearing, experts alert

Those opposing epidemic say 2030 target is unrealistic as make further efforts to defeat it falter amid rising infection levels and drug resistance

Efforts to combat Aids in Africa are seriously faltering, with drugs beginning to lose their power, the number of infections rising and funding declining, raising the prospect of the epidemic once more spiralling out of control, experts have warned.

The UN has set a target of 2030 for the end of Aids, which has been endorsed by donor governments including the US, where the president, Barack Obama, said the end was in sight last month.

But the reality on the ground, particularly in the developing world, looks very different. Many experts believe that the epidemic will continue to spread and the Aids death toll, still at 1.5 million people a year, could begin to soar again.

Prof Peter Piot, the first executive director of UNAIDS and director of the London School of Hygiene and Tropical Medicine, told the Protector: I dont believe the slogan the end of Aids by 2030 is realistic and it could be counterproductive. It could suggest that its fine, its all over and we can move to something else. No. Aids is still one of the biggest killers in the world.

At the recent International Aids Conference in Durban, South Africa, Bill Gates, a self-proclaimed optimist whose foundation has invested heavily in combatting HIV, warned of trouble ahead.

If we only do as well as we have been doing, the number of people with HIV will go up even beyond its previous peak, Gates said. We have to do an incredible amount to reduce the incidence of the number of people get the infection. To start writing the story of the end of Aids, further ways of thinking about therapy and prevention are essential.

Those fighting the epidemic face a devastating combining of problems 😛 TAGEND Every year, around the world, nearly 2 million people, 60% of them girls and young women, become newly infected with the virus, despite prevention endeavors. In developing countries, HIV is becoming resistant to the drugs used to treat people and keep them well, which means they will increasingly require other drugs that are currently unaffordable. Donor countries are cutting back on funding. A girl walks past Aids information on the wall of the Redemption hospital in New Kru Town near Monrovia, Liberia. Photo: Ahmed Jallanzo/ EPA