healthcare – Page 2 – UAB Institute for Human Rights Blog

International Day for The Eradication of Poverty

Monday, October 17th is the International Day for the Eradication of Poverty; in 2022 we have a lot to acknowledge and a lot of work to be done. The theme for this day of commemoration is dignity, focused on how every human has the right to live with pride for themselves and respect from others. The first line of the Preamble for the Universal Declaration of Human Rights (UDHR) emphasizes the importance of how the “…recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world,” and that is precisely the ideology behind the founding of this human rights holiday. But why, exactly, is poverty an international human rights issue?

History

Global poverty is defined as “lacking enough resources to provide the necessities of life—food, clean water, shelter and clothing. But in today’s world, that can be extended to include access to health care, education and even transportation.”

This international day of recognition was adopted by the United Nations in December of 1992 to recognize the structures that cause poverty, to listen to and amplify the needs and desires of impoverished persons, and to place a specific focus on how the international community and global leaders can work to solve this persistent social problem. October 17th was chosen to observe this topic because on this day in 1987 a crowd of over a hundred thousand protesters gathered in the Trocadero Plaza of Paris, France to honor the victims of extreme hunger and poverty. In commemoration, a stone was placed in the Plaza, now renamed the Plaza for Human Rights and Liberties, engraved with the following message from Father Joseph Wresinski, “Wherever men and women are condemned to live in extreme poverty, human rights are violated. To come together to ensure that these rights be respected is our solemn duty”.

The right to live free of poverty is not listed in the UDHR, but our current understanding of poverty constituting a violation of human rights has been developing since before the UDHR was proclaimed by the United Nations General Assembly in 1948. This is because living in extreme poverty is almost always accompanied with a loss of essential human rights that were explicitly enumerated in the UDHR, like the right to health, safe food and water and the right to adequate housing as illustrated in Articles 25 of the UDHR and the Human Right to Water and Sanitation. Even in developed and wealthy nations, citizens living in poverty experience obstacles in their ability to access the right to education, work, and political participation named in Articles 21, 23, and 16 of the UDHR.

While persons living in poverty are often denied many, if not all of those fundamental human rights listed above, this holiday gets its theme from Article One of the UDHR, from which this holiday gets its theme: “All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.” Those in poverty often lose this right as limited access to the essential requirements of a quality life places them in a position where they rely on the aid of others, who often treat the impoverished as less than equals. They are patronized and degraded in their daily lives, and the social response to an impoverished person exercising their agency to decline charity is typically one of rebuke.

The Current State of Poverty

Global poverty rates have increased since the beginning of the Pandemic in 2020, and World Bank estimates that we have been set back 3-4 years on our path to ending extreme poverty as of October 2021. In addition to climbing unemployment and poverty rates is the leap in inflation, which has climbed globally as supply chains stretch thin. The Pew Research Center has found that the global middle class shrank while the global poor increased as the pandemic progressed, disrupting the progress of developed nations around the world, particularly in Asia and the Middle East.

These economic impacts affect more than immediate financial conditions of those involved. One side-effect has been a loss in education; as the United States and other wealthy countries moved online in response to the pandemic, other nations (particularly in the Global South) had to close schools entirely. Human Rights Watch has noted that, for millions of school-aged children, the pandemic effectively ended their formal education as alternative school options were few and the need for work and additional income rose. The International economic recovery will be challenging, and may take years to accomplish, but it is paramount that we keep the most vulnerable, both their dignity and agency, in mind as we navigate our collective path forward.

International Human Rights holidays are often overlooked due to their focus on what are often perceived to be niche categories outside of major religious or cultural practices. However, observing human rights holidays is a practice that allows for shared positivity and encouragement as we mark progress and victories in the field. They also provide days of unity to focus on pervasive issues that still need attention and work. On this holiday, join me in taking the time to think about how poverty affects your community, how your community has responded, and how it can alter that response to alter the quality of life for its impoverished population.

Pakistan’s Floods : A Humanitarian and Climate Crisis

One third of Pakistan is underwater following disaster-level floods that have ravaged the country since mid June of 2022. The flooding is a humanitarian crisis of epic proportions, bringing climate change and environmental justice into the focus of conversations about why the floods are so devastating. The record-breaking monsoon rains have affected 33 million citizens, leaving millions displaced and threatening the economy by washing away the fall harvest and essential farmland. Pakistan’s most vulnerable are struggling to access the scarce aid that is available, including the 19 million children affected by the floods. It is an unprecedented, once in a century crisis event exacerbated by climate change, poor infrastructure, and the damages of the recent economic crisis prior to the flooding.

Direct Impact of the Floods: Hunger, Disease and Displacement.

The monsoon rains have killed over a thousand people, roughly 400 of which are children. However, hunger, thirst, disease, and shortages of essential supplies threaten the lives of even more; millions of Pakistani people have been displaced over the course of the floods since June. The United Nations Refugee Agency has estimated that 6.4 million people are in need of immediate support.

Any discussion of rebuilding has been shelved in submerged regions as the flood waters may not recede for months, leaving the thousands of kilometers of roads, tens of thousands of schools, hundreds of thousands of homes, thousands of essential healthcare facilities destroyed by floodwater, and prior residents stranded or displaced. In addition to the initial death toll from the floods, the Pakistani people are facing immediate dangers of water borne disease, lack of access to food, water and shelter, and risks of violence; especially for women, children, and minority groups.

The country’s health system has faced substantial blows, both from loss of structures and supplies caused by the flood and the overwhelming need of those affected. Dehydration, dysentery, cholera, malaria, and dengue fever are ravaging make-shift camps as the flood waters become stagnant and clean water and sanitary supplies become harder to come by. Sindh Province, the second-most populated province in Pakistan, and one of the hardest-hit by the floods, has seen over 300 deaths from water borne-diseases since July. Early disease surveillance by the WHO has revealed that tens of thousands of cases of flood water-caused diseases are already present amongst those within reach of relief efforts. Countless villages remain stranded as roads and highways are underwater, so the true number of deaths, displaced persons, diseased, and persons otherwise impacted by these crises are expected to climb as more recovery efforts continue to search the flooded regions.

Without international aid and intervention, an epidemic of disease caused by the floods will cause a second wave of deaths in Pakistan, of which the elderly, children, and pregnant women will be the largest groups facing losses. International aid, medical and humanitarian organizations have joined the Pakistani government and are regularly dropping medical supplies, malaria nets, food and provisional shelters, but the need continues to grow as more people find their way to temporary camps and the rate of disease climbs.

Human Rights & The Most Vulnerable

A nation’s most vulnerable populations are often the ones who suffer the worst effects for the longest time after a natural disaster like these floods. For Pakistan, those vulnerable groups are women, children, the Khwaja Sira (transgender) community, those living in extreme poverty, religious minorities, and other marginalized groups. Typically, socially disadvantaged groups are living in regions with lesser infrastructure, facing the initial worst impacts of natural disasters, but marginalized status often leads to upwards battles to access humanitarian aid after the disaster as well. There are estimated to be 650,000 pregnant women displaced in Pakistan right now, in urgent need of maternal health care and safe, sterile facilities to give birth in, with many taking perilous journeys in hopes of reaching a hospital or safe places to give birth.

CARE, an international human rights and social justice organization, spoke on this concern. Pakistan Country Director for CARE, Adil Sheraz said, “With entire villages washed away, families broken up and many people sleeping under the sky, the usual social structures that keep people safe have fallen away, and this can be very dangerous for women and girls.” 

Following the 2010 floods in Pakistan, denial of aid and violence against minorities became a prevalent issue and large protests against law enforcement arose due to their failure to protect vulnerable groups. Preventative measures against recurrence of these issues have been few and far between since 2010, and international human rights communities are on high alert for rising reports of discrimination in relief distribution and crimes against minorities. Reports of sexual violence have already increased following the floods.

In addition to some of the most vulnerable Pakistanis are roughly 800,000 Afghani refugees who have been hosted by Pakistan in Sindh and Balochistan; two provinces faced with the worst of the flooding and submersion. Pakistan has a deep history of offering asylum and refuge for those fleeing across the border from conflict in Afghanistan, and is home to 1.4 million Afghani refugees currently in 2022. Following the August 2021 withdrawal of US troops from Afghanistan, the Islamic Emirate government (also known as the Taliban), Pakistan became an even more essential haven for the influx of refugees fleeing a violent authoritarian regime. In the wake of this natural disaster, the loss of $30 billion dollars worth of infrastructure, homes and supplies, and facing an economic crisis, Afghani people with hopes of finding refuge in Pakistan must now find new routes to safety.

Environmental Justice & Climate Change

Though Pakistan faces annual flooding of the Indus river from heavy rains in monsoon season, record breaking rains preceded by an extended heatwave contributed to an unrivaled degree of flooding this summer. Heatwaves brought temperatures around 50° Celsius (122° Fahrenheit) to India and Pakistan between March and May of this year. Monsoon rains followed the spring heatwaves, and in the regions of Sindh and Balochistan rainfall reached 500% above average. The 2022 floods will leave a significant economic, infrastructural, and humanitarian impact on the country of roughly 220 million people. The reason for the dramatic influx in severity is complex, but simple at its core: climate change.

Pakistan is facing an unfair share of the consequences of climate change; while it was responsible for only .3% of global CO2 emissions in 2020, it is likely that this year’s heatwaves and floods will be on the less severe end of what is to come. The United Nations has deemed Pakistan a “climate change hotspot”, stating that people in South Asia are 15 times more likely to die from climate impacts. As the global temperature rises and geohazards become more extreme, disaster-prone regions like Pakistan will face more and more devastation. The best prognosis for the region comes with prevention efforts like strengthening anti-disaster infrastructures. As the global north is responsible for 92% of excess emissions contributing to global warming and climate change, Pakistan, the United Nations, and other international agencies are calling for countries like the United States to make increased contributions to relief funds and infrastructure development overseas.

United Nations Secretary-General Antonio Guterres, while visiting Pakistan in September 2022, said, “…the fact is that we are already living in a world where climate change is acting in such a devastating way. So, there must be massive support to what usually is called adaptation, which means to build resilient infrastructure and to support resilient communities and to create conditions for those that are in the hotspots of climate change. Pakistan is one of the hotspots of climate change. For those countries to be able to prepare for the next disaster and to be able to resist the next disaster, this needs a huge investment and this investment needs to be provided.”

Relief & Aid

Pakistan has faced an overwhelming series of calamities since the start of this year, and the impacts from these disasters are greatly exacerbated by food shortages and an economic crisis prior to the start of the disasters in March. There are millions of people in need of aid, and every bit of support helps. If you are unable to financially contribute, please consider sharing this or other articles about this crisis to increase international attention on those who need our help.

For donations of money, time, or other resources, we have compiled some reputable aid agencies below:

Pakistan’s Red Crescent Society is providing clean drinking water, medical treatments, temporary housing, and other essential aid across flood-hit regions. Donate or get involved with their flood response efforts here.
The United Nations Refugee Agency has provided millions of dollars in aid to Pakistan, and you can contribute here to support their continued relief efforts.
The International Medical Corps are on the ground in Pakistan, providing medical care and responses to both the floods and gender-based violence across the country. Find out more & how you can donate here.
Muslim Aid has reached over 29,000 people in three affected districts of Pakistan, providing hygiene kits, shelter, and essentials to those in need. Contribute to their fund here.

A Bright Future – Recent Human Rights Victories

In the midst of a pandemic and international unrest, it is vital to stay encouraged and optimistic as we continue our efforts to uphold and protect human rights internationally. That is why we at the Institute for Human Rights at UAB will be using this article to break up the negative news cycle and put a spotlight on a few of the amazing victories and progress the international community has made during the pandemic that you might not have heard about. Though positive human rights news may not always make headlines, it is important to recognize each success, just as it is vital we address each issue.

The UN Declares Access to a Clean Environment is a Universal Human Right – July 2022

Of the 193 states in the United Nations general assembly, 161 voted in favor of a climate resolution that declares that access to a clean, healthy and sustainable environment is a universal human right; one that was not included in the original Universal Declaration of Human Rights in 1948. While the resolution is not legally binding, it is expected that it will hugely impact international human rights law in the future and strengthen international efforts to protect our environment. Climate justice is now synonymous with upholding human rights for the citizens of member-states, and the United Nations goal is that this decision will encourage nations to prioritize environmental programs moving forwards.

Kazakhstan and Papua New Guinea Abolish the Death Penalty- January 2022

Kazakhstan became the 109th country to remove the death penalty for all crimes, a major progress coming less than 20 years after life imprisonment was introduced within the country as an alternative punishment in 2004. In addition to the national abolition, President Kassym-Jomart Tokayev has signed the parliamentary ratification of the Second Optional Protocol to the International Covenant on Civil and Political Rights. Article 6 of the ICCPR declares that “no one shall be arbitrarily deprived of life”, but the Second Optional Protocol takes additional steps to hold countries accountable by banning the death penalty within their nation. Though the ICCPR has been ratified or acceded by 173 states, only 90 have elected to be internationally bound to the Second Optional Protocol (the total abolition of the death penalty), and Kazakhstan is the most recent nation to join the international movement to abolish the death penalty globally.

Papua New Guinea also abolished their capital punishment, attributing the abolishment to the Christian beliefs of their nation and inability to perform executions in a humane way. The 40 people on death row at the time of the abolishment have had their sentences commuted to life in prison without parole. Papua New Guinea is yet to sign or ratify the Second Optional Protocol to the ICCPR, but by eliminating the death penalty nationwide the country has still taken a significant step towards preserving their citizens right to life.

India Repeals Harmful Farm Plan – November 2021

Many of you will remember seeing international headlines of the violent protests following India’s decision to pass three harmful farming laws in 2020. The legislation, passed in the height of the pandemic, left small farmers extremely vulnerable and threatened the entire food chain of India. Among many other protections subject to elimination under the farm laws was the nations Minimum Support Price (MSP), which allowed farmers to sell their crops to government affiliated organizations for what policymakers determined to be the necessary minimum for them to support themselves from the harvest. Without the MSP, a choice few corporations would be able to place purchasing value of these crops at an unreasonably low price that would ruin the already meager profits small farmers glean from the staple crops, and families too far away from wholesalers would be unable to sell their crops at all.

Any threats to small farms in India are a major issue because, according to the Food and Agriculture Organization (FAO) of the United Nations, “Agriculture, with its allied sectors, is the largest source of livelihoods in India”. In addition, the FAO reported 70% of rural households depend on agriculture and 82% of farms in India are considered small; making these laws impact a significant amount of the nation’s population. A year of protests from farmers unions followed that resulted in 600 deaths and international outcries to protect farmers pushed the Indian government to meet with unions and discuss their demands. An enormous human rights victory followed as Prime Minister Narendra Modi announced in November of 2021 that they would rollback the laws, and on November 30 the Indian Parliament passed a bill to cancel the reforms. As the end of 2021 approached, farmers left the capital and returned home for the first time in months, having succeeded at protecting their families and their livelihoods.

Sudan Criminalizes Female Genital Mutilation – May 2020

Making history, Sudan became one of 28 African nations to criminalize female genital mutilation / Circumcision (FGM/C), an extremely dangerous practice that an estimated 200 million woman alive today have undergone. It is a multicultural practice that can be attributed to religion, sexual purity, social acceptance and misinformation about female hygiene that causes an onslaught of complications depending on the type of FGM/C performed and the conditions the operation is performed in. Among the consequences are infections, hemorrhage, chronic and severe pain, complications with childbirth, and immense psychological distress. It also causes many deaths from bleeding out during the operation or severe complications later in life. We have published a detailed article about female genital mutilations, gender inequality and the culture around FGM before, which you can find here.

FGM/C is a prevalent women’s rights issue in Africa, and in Sudan 87% of women between the ages of 14 and 49 have experienced some form of “the cut”. While some Sudanese states have previously passed FGM/C bans, they were ignored by the general population without enforcement from a unified, national legislature. This new ban will target those performing the operations with a punishment of up to three years in jail in the hopes of protecting young women from the health and social risks that come from a cultural norm of genital mutilation and circumcision.

Where do we go from here?

While we have many incredible victories to celebrate today, local and international human rights groups will continue to expose injustices and fight for a safer and more equal future for all people. Our goal at the Institute for Human Rights at UAB is to educate; to inform readers about injustices and how they can get involved, and to celebrate with our incredible community when we have good news to share! While the past year has been marked with incredible hardships, it is always exciting when we have heart-warming international progress to share!

You can find more information about us, including free speaker events and our Social Justice Cafes on our Instagram page @uab_ihr! Share which of these positive stories you found most interesting in our comments, and feel free to DM us with human rights news you would like us to cover!

Afghanistan’s Deteriorating Healthcare System

Afghanistan’s healthcare infrastructure is crumbling after its foreign assets were frozen and donor organizations pulled funding after the Taliban takeover. The Taliban is a Pashtun Islamic extremist group that is known for imposing strict religious and conservative rule over their areas of operation including Afghanistan and Pakistan. The organization previously served as the government for southern Afghanistan in 1996-2001 during which the healthcare system had collapsed. The child mortality rate was 2x as high as it was in 2012 and polio was widespread. Safe drinking water and sanitation were also nonexistent.

Over the past two decades, non-governmental organizations (NGOs) have historically provided 75% of the funding and supplies to support the healthcare systems in 31 out of the 34 provinces of Afghanistan. As a result, the Middle Eastern country has seen enormous improvements in the healthcare system. As of 2018, with over 3,000 medical facilities staffed and supplied, about 87% of the population were able to receive services. Maternal and child mortality rates also plummeted and infectious disease treatment programs helped decrease mortality rates.

International donor support started declining even before the Covid-19 pandemic, and Afghanistan’s Ministry of Health and other public health organizations were barely able to compensate. The economic decline at the onset of the pandemic made medical resources even more scarce. Hospitals began charging payment for supplies such as meals and scalpels previously free to patients, and patients were forced to use their own money to buy surgical equipment. In April 2021, President Biden announced that the United States would withdraw all of their 2,500 troops from the Afghanistan, triggering the entire NATO (North American Treaty Organization) alliance to withdraw a total of 7,000 troops. The process was completed in mid-September. Shortly thereafter, the Taliban rose to power once again in Afghanistan.

A pile of international notes from the United States, Turkey, and Europe. Source: Unsplash

The World Bank then froze $600 million in health care aid funded by the US Agency for International Development, the European Union, and others. The $600 million was part of the Sehatmandi project, a global initiative to increase health facilities in Afghanistan, which was a collaboration with the Afghanistan government. The withdrawal shut down 2000 of the 2800 facilities that the project previously funded, leaving healthcare workers and patients out in the wind. Currently, healthcare workers have not received payment in 6 months and do not know when they will receive payment. Many patients struggle to reach the remaining facilities because the trip there is either unaffordable, geographically dangerous, too far, or the route is lined with Taliban conflict.

If provided now, donors feared that donations and allocations would be misused by the Taliban to generate income for the militant group instead of for healthcare problems. There is speculation that if the funds are released, wages will never reach workers and medical supplies will be bought then sold to the public at astronomical prices. All entities are waiting on instructions or action from other governments to search for a way to transfer donations in order to circumvent the regime’s administration.

Healthcare for Children

A toddler girl biting into her shirt sleeve next to her parent. — A toddler girl biting into her shirt sleeve next to her parent in Afghanistan. Source: Unsplash

Hunger is becoming more widespread as inflation rates climb and supply chains grow unsteady. The Integrated Food Insecurity Phase Classification (IPC) reported that half of Afghans will face acute food insecurity before winter arrives.

Malnutrition and malnutrition-related illnesses are far more dangerous than any other disease for children. Specific types of malnutrition called acute severe malnutrition and child kwashiorkor, a severe protein deficiency, is prevalent in Afghanistan and are caused by eating too little food or not at all. It can be treated by administering Ready To Use Therapeutic Food (RUTF) and oral hydration therapy. Over 2 million children under 5 years old do not have access to this life saving treatment in Afghanistan. At least half of the children in the country are victims of malnutrition and in light of the food scarcity, mothers unable to produce breastmilk have resorted to feeding infants water mixed with sugar.

Staffing shortages are also insurmountable. Nurses and doctors fled the country fearing what the Taliban’s takeover could mean for their lives. In the main children’s hospital in Kabul, nurses previously caring for 4 babies now have to care for 24 babies each while hospital staff try to squeeze 3 infants into 1 incubator due to equipment shortages. Current staff are overworked and still have to take up jobs at other institutions to get by. Medicinal needs are also not being met for children and adults. Drug cabinets and storage closets become emptier every day as the influx of patients has depleted the resources faster than can be transported into the country.

A hand holding a cluster of large, yellow tablets. — A hand holding a cluster of large, yellow tablets that are basic medications that Afghans need. Source: Unsplash

Women’s Health

The aid cuts have also decreased access to essential healthcare resources for women and girls, including contraception and family planning. Many women carry out risky pregnancies and are subjected to unsafe reproductive procedures without modern medical equipment. Prenatal and postnatal care for infants is not provided, and postpartum care for new mothers is nonexistent. Despite the labor shortages, a great deal of responsibilities for maternal health clinics are on the backs of midwives. Midwives continue to perform complicated surgeries, dangerous deliveries, and other reproductive procedures.

Expensive medicines and transportation to clinics for health problems are not feasible for the majority of Afghan women. Beginning in early 2017, extremist groups turned their sights on medical facilities in Afghanistan, which led to increase of attacks on aid workers, doctors, and hospitals. Mounting fear against staying in maternity clinics has also driven many women away from seeking help.

Covid-19 Pandemic

The lack of data and accountability in Afghanistan makes it difficult to comprehend the extent to which the virus has contributed to the death rate. Around the world, Covid cases are increasing, and the Afghan population is largely unvaccinated. According to the latest data from the United Nations, only 2.2 million of 39 million individuals have been vaccinated, while 1.8 million doses are waiting to be distributed.

Public health experts worry that an impending 4th wave of the disease will render the healthcare infrastructure irreparable. Dead bodies line hospital morgues and overflow into the outside corridors as the lack of fuel has stopped ambulances from operating. Many sick patients suffering from Covid don’t bother coming to hospitals, because they know they would not be able to receive medical assistance. Hospitals, private practices, and clinics are resorting to hastily assembling makeshift wards outside hospitals to accommodate Covid patients.

The healthcare situation in Afghanistan has been worsening for years, and in light of the looming public health disaster, much more support from the international community is needed. The snowball effect of international neglect will continue unless major monetary, political, economic, and healthcare interventions are considered. Nonprofit health organizations such as Doctors Without Borders have been tackling both maternal and child healthcare as well as managing Covid cases in 5 provinces, but people can help by donating to Doctors Without Borders, United Nations Children’s Fund (UNICEF), and increasing awareness for the healthcare crisis in Afghanistan.

Improper Sex Education and the Effects on Women’s Health in Alabama

Sex Education in the United States

In the United States sex education has historically been underfunded and often used as a tool to shame people for their sexuality. Currently, only 29 states in the United States mandate sex education; however, this still does not ensure that children are taught medical sex education in school. In fact, 37 states within the United States require abstinence to be taught as the only way to prevent sexually transmitted diseases and unwanted pregnancy. Even worse, up until April 2021, seven states in the South prohibited educators from discussing LGBTQ+ identities and relationships, which further stigmatizes youth and puts them at a higher risk of contracting sexually transmitted diseases. Currently, now that Alabama has passed a new bill which removed homophobic language forbidding schools from teaching LGBTQ+ sex education, teachers are able to create sex education curriculum as they please, as long as parents are sent an overview of the curriculum and agree to let their children learn said material.

How U.S. Sex Education Policies Measure Up to the ICPD

According to the 1994 Cairo International Conference on Population and Development (ICPD), “ the objective to achieve universal access to quality education, underlines that gender-sensitive education about population issues, including reproductive choices and responsibilities and sexually transmitted diseases, must begin in primary school and continue through all levels of formal and non-formal education to be effective.” The ICPD further notes that “full attention should be given to the promotion of mutually respectful and equitable gender relations and particularly to meeting the educational and service needs of adolescents to enable them to deal in a positive and responsible way with their sexuality.” When looking at the rights set forth by the ICPD, it becomes clear that the United States is failing their youth populations and exposes them to unnecessary risk by refusing to inform them of the dangers that come with unprotected sex. By not requiring sex education, the United States also fails to inform youth of preventative measures they can take to ensure the utmost safety and consensual enjoyment between parties. This lack of education has not only resulted in a multitude of unwanted pregnancies and an overflooded foster care system; but has led to thousands of people, especially in the South, contracting chronic disease and illness that will impair them for the rest of their lives as well.

Women’s Healthcare in Alabama: The Dangers of Improper Sex Education

While the United States as a whole has failed its constituency by refusing to mandate sexual education to be taught in schools, the state of Alabama stands as a paradigm for just how dangerous a lack of healthy and inclusive sex education can be. According to Human Rights Watch, the lack of sex education in Alabama has led to relatively high mortality rates. These “mortality rates are higher for Black women, poor women, and those who lack access to health insurance.” In fact, according to the CDC, in 2017, Alabama was among the top five states in the country in terms of the highest rate of cervical cancer cases and deaths, and “Black women in Alabama are nearly twice as likely to die of the disease as white women.” While multiple factors are contributing to this alarming statistic, Human Rights Watch found the following issues to be catalysts for these poor outcomes in Alabama: “shortage of gynecologists in rural areas, prohibitive transportation costs often required to travel to see a doctor for follow-up testing and treatment, and Alabama’s failure to expand Medicaid to increase healthcare coverage for poor and low-income individuals in the state”. By refusing to provide access to healthy sex education, Alabama has left thousands of women without the proper knowledge that is necessary to lower the risk of cervical cancer.

A mother and her child during a pediatric check-up — Yahoo Images, a mother and her child photographed during a pediatric check-up

The Current State of Sex Education in Alabama

In Alabama, the current state code claims that abstinence outside of marriage is the “social norm”. By making non-marital sex an abnormality, the legislatures have shown that they have no interest in providing education to youth who may break the “social norm”. Moreover, in the past, Alabama code emphasized that sexual curriculum had to be presented in a “factual manner and from a public health perspective, that homosexuality is not a lifestyle acceptable to the general public and that homosexual conduct is a criminal offense under the laws of the state”. By painting non-heteronormative orientation as “criminal” Alabama consciously stigmatized members of the LGBTQ community for decades, which put them at a higher risk of contracting a chronic disease. In fact, according to SIECUS, Alabama ranked fourth in the nation for reported cases of chlamydia, gonorrhea, and syphilis in youth aged 15-19. Yet, thanks to activists and constituents voicing their concerns, the Alabama legislature has now removed said discriminatory language from their sex education bill. However, there is still a large amount of work that must be done to further advocate for proper, medical sex education to be provided to students.

Yahoo Images, A woman is holding a poster which states “A woman’s place is in the resistance”

Ways to Get Involved

Thanks to the work of activists, legislatures, and constituents alike, Alabama’s laws have been updated so that they no longer criminalize LGBTQ+ individuals within the states schools’ sex education curriculum. Yet, the work is not over, and schools are still able to refuse to educate students on safe sex practices for non-heteronormative relationships, as long as parents of students consent to the curriculum proposed by staff. This continuation of the lack of medical sex education in our school systems is still leaving children vulnerable to ignorance, and exacerbating the current health issues which are prevalent amongst marginalized groups, especially within the South. Certain organizations, such as the Alabama Campaign for Adolescent Sexual Health and Advocates for Youth Sex Education, are currently advocating for proper sex education. If you are interested in getting involved, sign up to be an advocate for proper seed education through AMAZE, or with WISE (Working to Institutionalize Sex Education), to help aid in the fight for proper sexual education for our youth. Furthermore, if you would like to learn more about the rights of LGBTQ+ individuals and current issues within the LGBTQ+ community, then click this link.

A Glimpse at the Battles Women Face in Nicaragua

by April Alvarez

A Human Rights Internship

This 2021 Spring Semester, UAB’s Institute for Human Rights had the privilege of partnering with Clínica Verde in Nicaragua to dive into the human rights issues that women in the country face, especially regarding health care. The internship, directed by Dr. Tine Reuter and Dr. Stacy Moak, has opened doors to important conversations about the importance of voicing and advocating for people who need support. Although the semester just started, those involved with the internship have already been exposed to several educated and experienced scholars that are making a mark on the country and are looking to equip and inspire others to do the same. In just one month, students have learned about the life of women and children have struggled to find economic stability, and access to basic resources. The purpose of this partnership with Clínica Verde is dive deeper into the ways that UAB (University of Alabama at Birmingham) students can serve others even during a global pandemic. Through the development of the course students will develop programs and educational presentations that aim to advocate the same values and goal displayed by the staff at Clínica Verde to reach out to more people in the clinic’s surrounding community but also to those in more rural areas.

Feed My Starving Children (FMSC)

Yolanda Paredes-Gaitan was the first speaker invited to speak to the students. She lived in Nicaragua for twelve years but is now currently living in California and working for the U.S. government. While in Nicaragua, she worked alongside Clínica Verde helping find ways to advocate for human rights issues, now she does that in partnership with the U.S. Valuable information shared through her presentation revealed that 65% of people in Nicaragua live in rural areas that are usually only accessed by walking or horses. Although the country of Nicaragua is rich in resources such as coffee, chocolate, and honey, however the country has been deemed the second poorest country, after Haiti. So why does this matter? It matters because it affects everything, including the quality of life in the country. Every community in the country has what is known as a health post. Each health post is usually the primary place for individuals to go to for basic health care needs, especially since few people have access to a nearby hospital. However, the problem is that most of the posts are rundown and in need of repairs. With the help of Clinica Verde, one post which had a structure that was falling apart, had holes in the roof, had no running water was transformed into a new and improved post that is now a green building that has natural ventilation, lighting and has access to water and the resources needed to provide the community with quality services. The goal of Clínica Verde is not to keep all the knowledge to themselves but instead to spread it with those in the country. Another thing that the clinic has been able to do is to provide posts with the knowledge necessary to run an intensity garden. The reason the clinic does this is because they are not looking to provide the women and children with short term solutions to their problems. They want to equip people with the knowledge to improve their lives long term, so they are more educated on how to live a more healthy and sustainable life.

Who visits the clinic?

People from all around the country visit the country. One lady traveled by bus and walked two hours up a hill just to get back home, but she did it because she loved the care provided by Clínica Verde. However, unlike the traditional view that when patients need care, they must go to the clinic, Clínica Verde travels to rural communities three times a week. Their mission goes beyond what the four walls of their building. They make it a priority to reach those who would otherwise not have time to visit the clinic. Another important thing to note is that the clinic also Nicaragua had no education in optometry until one donor came to the country and changed that. Now the team at Clínica Verde also has a program that helps provide people in the community with free glasses which is centered around the students but also anyone in the student’s lives that may also need glasses. This optometry program has also allowed senior citizens to have surgeries that have saved them from going blind.

Another Battle for Bodily Autonomy in Trans Youth

On February 10, 2021 the Alabama Senate Health Committee voted to criminalize transgender medicaltreatment for minors. With an 11-2 vote, the committee approved Senate Bill 10 (SB-10), a bill that will “outlaw puberty blocking medications and gender-affirming care for minors.” On March 3, the Alabama Senate passed this legislation, and it is currently awaiting Governor Kay Ivey’s approval. SB-10 empowers the legal system to prosecute clinicians and pharmacists with felony charges if they prescribe medication or provide treatment to aid in the transitional processes of minors. Bill sponsor Senator Shay Shellnutt (R-AL) claims that “minors are too young to be making this decision.” The Senator has also admitted that he’s never interacted with a trans teen before submitting the bill. Opponents of the SB-10 refute Shellnutt’s claim by acknowledging this decision is between the medical care provider, the patient, and the patient guardians. As such, SB-10 infringes on the private rights of parents to care for their children with necessary and proper interventions. Shellnut has mentioned that hormonal treatment and other transgender interventions cause long term issues and that a child is not mature enough to be making such a permanent decision. Shellnut’s claims are false; the effects of hormonal drugs that are puberty blockers are reversible. Also, when evaluating long term effects of gender reassignment surgeries, doctors prefer to wait until the patient is at least 18 years old before they perform the surgery.

A person holding a sign with a metaphor describing gender. — Source: www.mindfulword.org

Doctors must take the Hippocratic Oath which defines their ethical conduct and moral reasoning. There are two main tenets of the Oath: “benefitting the ill and protecting patients against personal and social harm and injustice.” Not only does SB-10 force doctors to dishonor the Hippocratic Oath, but it is also medically harmful to the patient pursuing care and prevents them from confiding in their medical care team. Dr. Marsha Raulerson says it will “take away child’s confidence in trusting doctors with their thoughts and to talk candidly.”

Healthcare providers are only one pillar of the support system for patients wishing to transition. So, when healthcare providers are unable to provide care to these young individuals, it can harm their mental and physical wellbeing and contribute to gender dysphoria. Adolescent and young adult years are incredibly formative. It’s in these years that young people thrive and when they are in need of a lot of support and care. When their support systems and adequate healthcare is taken away “adolescents can feel alone, stigmatized, and undervalued”. Rejection, discrimination, and stigma during these formative years can put young adults at a higher risk of mental health disorders such as depression and anxiety. The aforementioned mental health disorders can lead to the usage of addictive substances like drugs and/or alcohol, and suicidal ideation. These factors contribute to significant health disparities within the LBGTQ+ community. It’s vital the care they receive is given without stigma and affirms the patient’s sexuality and gender identity, but this care cannot be given with government intervention that holds traces of transphobia.

Protestors gathering against the transgender military ban legislation. — Source: www.britishherald.com

Gender is a very dynamic concept, and there is no binary. It is up to the individual to choose their identity. Gender reassignment treatments and procedures are one way to reaffirm and respect an individual’s choice. LGBTQ+ youth deserve to know that they are respected and that they deserve quality healthcare and treatment. Healthcare providers should not be prevented from fulfilling their responsibilities. They should be able to provide quality care and treatment for their patients. If they can’t, they should be able to refer the patient to a doctor who can provide adequate healthcare. This is not the first time SB-10 has been passed to the full Alabama Senate. It was passed all the way up to the Governor in 2020 to be signed into action and is only back on the table due to COVID-19 complications. Advocacy is an important aspect of healthcare, and providers should be willing to advocate the most for marginalized communities. It is important to lift barriers to care for these groups, instead of continuing to make healthcare inaccessible.

A separate companion bill (HB-391) is currently in the Alabama House. This bill would restrict transgender students from participating in school athletics with the gender they identify with. Lawmakers that support the bill claim that it protects fairness for female and “keeps them from having to compete against transgender athletes who were born male.” The biggest difference to make right now is to call Alabama Senate representatives and tell them the harms these bills will cause to LGBTQ+ youth and to the healthcare providers that try to help them.

Human Rights in Appalachia: Socioeconomic and health disparities in Appalachia

The previous blog posts in this series are located here:
Human Rights in the Appalachian Region of the United States of America: an introduction
Human Rights in Appalachia: The Battle of Blair Mountain and Workers’ Rights as Human Rights

In the Appalachian region of the United States, there have long been overarching socioeconomic problems that have prevented the region from seeing the same levels of growth as other parts of the country, and even been part of its decline in other domains. Much of Appalachia’s population of twenty-five million people remains remote, isolated from urban growth centers and beneficial resources that exist in cities. The rural towns and counties in which many Appalachian people live have not had the ability to maintain the public infrastructure, furnish the business opportunities, or provide the medical services that are necessary to sustain populations.

There are three regions of Appalachia: the southern region, which covers parts of Georgia, Alabama, Mississippi, the Carolinas, and Tennessee; the central region, which covers parts of Kentucky, southern West Virginia, southern and southeastern Ohio, Virginia, and Tennessee; and the northern region, which includes parts of New York, Pennsylvania, northern West Virginia, Maryland, and northern and northeastern Ohio. While the entire Appalachian region struggles with higher levels of poverty, unemployment, and lack of services and infrastructure, some sub-regions suffer worse than others, and in different ways (Tickamyer & Duncan).

graph of people in poverty by age group — Percent of persons in poverty in rural Appalachia by age group: 2014-2018

Even when compared to other rural areas, Appalachia struggles on measures of educational attainment, household income, population growth, and labor force participation. Rates of disability and poverty are significantly higher in rural Appalachia than they are in other rural areas of America. In 2018, the number of Appalachian residents living below the poverty line was higher than the national average in every age group except those 65 and older. The largest disparity was among young adults (18-24), where the Appalachian population was more than 3% higher than elsewhere. From 2009 to 2018, median household income in Appalachia went up by 5%, not far behind the national average of 5.3%. However, the median household income in Appalachia remains more than $10,000 lower than the national median.

map of population age in appalachia — Map of population age in Appalachia

One area where disparities between Appalachia and elsewhere in the country are particularly noticeable is in healthcare. The Appalachian Regional Commission released in 2017 “Health Disparities in Appalachia”, which reviews forty-one population and public health indicators in a comprehensive overview of the health of the twenty-five million people living in Appalachia. The study found that Appalachia has higher mortality rates than the rest of the nation in seven of the nation’s leading causes of death: heart disease, cancer, COPD, injury, stroke, diabetes, and suicide. In addition, diseases of despair are much more prevalent in Appalachia than the rest of the country. Rates of drug overdose deaths are dramatically higher in the Appalachian region than the rest of the country, especially in the region’s more rural and economically distressed areas. Research indicates that diseases of despair will increase under COVID-19, as well. This will be especially true for women, who experience death from diseases of despair at a rate 45% higher than the national average in Appalachia. The ARC found that, while deaths as a result of diseases of despair were more numerous in metropolitan counties of Appalachia, rates of suicide and liver disease were higher in rural counties.

These issues are exacerbated by the fact that there is a much lower supply of health care professionals per capita, including primary care physicians, mental health providers, specialists, and dentists in Appalachia. The supply of speciality physicians is sixty-five percent lower in the central sub-region of Appalachia than the rest of the nation as a whole. Other factors negatively impact health in Appalachia, as well. Nearly twenty-five percent of adults in Appalachia are smokers, compared to just over sixteen percent of all American adults, and obesity and physical inactivity are extremely prevalent. However, it is worth noting that in some areas of public health interest, such as the occurrence of STIs/STDs and HIV, Appalachia does better than the rest of the country.   Healthcare disparities are an increasingly dramatic phenomenon. From 1989-1995, the cancer mortality rate in Appalachia was only 1% higher than the rest of the US, but by 2008-2014, it had risen to be 10% higher. In the same time frames, the infant mortality rate was 4% higher versus 16% higher, respectively. And, in 1995, the household poverty rate in Appalachia was 0.6% higher than the national average, but by 2014 was 1.6% higher. We like to think of these problems as things of the past, but the gaps are still very much relevant. Fortunately, people living in Appalachian communities are more likely to have health insurance coverage than other Americans. 8.8% of the population in Appalachia do not have health insurance versus the national average of 9.4%.

This year, in the midst of the coronavirus pandemic, some factors of the Appalachian population have put people living there at greater risk of COVID-19. 18.4% of people living in Appalachia are over age sixty-five, which is more than two percent higher than the national average. In more than half of Appalachian counties, over 20% of people are older than 65. This, combined with high rates of obesity and smoking, put many people in the “high-risk” category. COVID-19 has affected Appalachian communities in ways that don’t result in death but make surviving even more difficult. Food insecurity, for instance, is an increasingly severe problem. At one soup kitchen, “…we were serving about 200 people a day, and our numbers have nearly tripled since COVID started,” social worker Brooke Parker, from Charleston, West Virginia, said.
However, perhaps due to the isolated nature of many Appalachian communities, mortality rates from COVID-19 have not been markedly higher than the national averages.

With schools moving to online learning, problems with access to internet in Appalachia become more relevant and pressing. Around 84% of Appalachian households have a computer, which is five percentage points below the national average. 75% have access to reliable internet, which is also five percent lower than average. There is no easy solution to this lack of access to education. Even in non-Appalachian counties, students are being severely impacted by the disruption to their normal education activities.

Human rights organizations ought to keep a close eye on Appalachia as we see the results of COVID-19 on an already vulnerable and at-risk population. The ultimate consequences of the pandemic will likely be more severe here than elsewhere in the country. People living in Appalachia deserve the same assistance being offered to and resources being put towards urban centers in other parts of America. Too often have they seemingly been forgotten.

Additional References:
1. “Health Disparities in Appalachia”. Marshall, J.,Thomas, L., Lane, N., Holmes, G., Arcury, T., Randolph, R., Silberman, P., Holding, W., Villamil, L., Thomas, S., Lane, M., Latus, J., Rodgers, J., and Ivey, K. August 23, 2017. https://www.arc.gov/wp-content/uploads/2020/06/Health_Disparities_in_Appalachia_August_2017.pdf. Retrieved December 3, 2020.
2. Population Reference Bureau. https://www.prb.org/appalachias-current-strengths-and-vulnerabilities/. Retrieved December 9, 2020.
3. Tickamyer, A., Duncan, C. (1990). Poverty and Opportunity Structure in Rural America. Annual Review of Sociology. 16:67-86.

COVID-19’s Impact on Gender Equality

COVID-19 has had a significant impact on the health and social structure of the world. Over one million lives have been lost, and over 35 million people have been infected with the virus. While infectious diseases don’t discriminate by age, race, social class, or gender, these factors do influence how COVID-19 and the related social ramifications will affect the illness experience for different people. For instance, when looking at gender, women have been more severely impacted than men. Men are more likely to die as a result of contracting COVID-19, but women experience the brunt of the long-term social effects, partially due to preexisting gender inequalities.

Looking at the healthcare sector alone, women were affected tremendously for many reasons. First of all, about 70% of healthcare workers are female. This means that a disproportionate number of females are putting their health and lives at risk to improve the lives of others. They were more heavily affected by PPE shortages at the beginning of the pandemic, and when PPE did become available, the “one-size fits all” design, which defaulted to the typical cisgender male body, was often ill-fitting and not conducive to managing menstrual cycles. Additionally, women who work in healthcare delivery have been historically overworked and underpaid. In normal circumstances, many healthcare professions, like nursing, have high burnout rates. However, studies have shown that the pandemic has increased the negative mental health effects of the job, primarily in females and in nurses.

Additionally, women live longer than men, and women are the vast majority of the population in nursing homes. During the pandemic, nursing homes have had to take drastic action to ensure the safety of their residents through restricting visitation and group events. This has led to significant social isolation in nursing homes, and loneliness follows closely behind. Further, many elderly people that live alone are women who rely on the care from their family. With the social distancing and their increased risk for severe disease, this has left many women almost entirely isolated—with the exception of family and friends dropping off groceries. This has led many women over 65 to meet up with friends. This makes them more likely to contract COVID-19, but for many, the increased risk is worth it to not be lonely.

Another health effect of the pandemic for women has been reduced access to healthcare, especially sexual and reproductive health. Across the globe, procedures considered elective were postponed due to concerns of restricting nonessential personnel from being in hospitals. However, many elective procedures can play an important role in a woman’s health. For example, endometriosis is a disease in which the uterine lining grows in areas where it shouldn’t, such as in the fallopian tubes and on the bladder, and it can cause immense pain in women who have it. One of the treatments is surgery to remove the excess growth. This not only may relieve pain but also increase fertility, so women who want to have children are more likely to be able to do so. While this surgery undoubtably improves the lives of women with endometriosis, it is considered an elective surgery, and in many places, women had their surgeries postponed. For women with immense pain, finally seeing the light at the end of the tunnel, this was devastating.

This is one of many experiences that women have faced. Many treatments and prevention methods for women’s sexual and reproductive health are considered nonessential, so many women have had to postpone their HPV vaccines, and STI and cervical cancer screenings. Additionally, some states have tried to roll back abortion services. India had a very strict lockdown, which prevented many women from access to contraceptives. This led to “over 800,000 unsafe abortions,” which is the third most common cause of death among pregnant women in India.

Outside of the healthcare sector, women have experienced many social repercussions due to the pandemic. Even before the pandemic, women were largely responsible for the unpaid care work, such as taking care of children or older family members. Now, with children home from school, and older people less able to do their own errands because of the risk of contracting COVID-19, the burden is falling on women and girls. Because of this, many women have to give up their job, or at least cut back hours, and many girls have to put their education on pause.

mom reading a book and son holding a baby while doing homework — Homeschooling. Source: Iowapolitics.com, Creative Commons

Before the pandemic, there were indications that great strides were being made towards gender equality in society and in work. However, a lot of the progress was lost with the onset of the pandemic and with lockdowns. While female-dominated jobs are typically the most protected during economic downturns, lockdowns affected female-dominated jobs at a higher rate than male-dominated jobs: it is estimated that female job loss was 1.8 times higher than male job loss. This is mainly because women are more likely to work jobs that are part-time or temporary, which makes their job security decrease significantly. As mentioned before, women are more likely to take care of family due to closures in school and older family needing assistance, making them less able to work, even from home. All of these factors mean women will be making less money because of the pandemic.

Finally, because of lockdowns, women are staying home more. While this is frustrating for many people, it can be dangerous for women in abusive relationships. Abusive relationships are dangerous to begin with, but with the added stress of the pandemic and being stuck in the same house for days, weeks, or even months, the severity rises. Additionally, a lockdown places women experiencing domestic abuse in a dangerous situation because it’s harder for them to escape the abuse through women’s shelters. Another way some women would typically be able to escape a domestic violence situation would be through a community, but even in normal circumstances those can be hard to come by as it’s typical for abusers to isolate their victims, and with the added isolation of the pandemic, it’s even harder.

Everyone has been significantly impacted by the pandemic. However, some people have been affected more than others, especially when indirect health effects and social effects are taken into account. Because of the disparity between the effects on men and women, we must aim interventions at women and girls. Not doing so could negatively affect years of progress made toward gender equality, and negatively impact the mental and physical health of women in the future.

COVID-19 and Teenage Pregnancies

by Grace Ndanu

It takes a lot of love, effort and dedication to be a good mother. For that reason, I believe it is important that everyone has the choice whether or not to be a parent, and when to take on that responsibility. Unfortunately, many girls around the world do not get to choose. Globally, the COVID-19 pandemic remains a pain to society because it is definitely complicating the efforts of reducing teenage pregnancies. It has caused an immeasurable disruption to every aspect of our lives in the last few months. To contain the spread of the novel coronavirus, governments have taken drastic measures to minimise the spread. Learning has been suspended, with schools being closed indefinitely. Religious meetings and worship programs have been affected similarly meaning there will be no more youth programs in the religious institutions, including churches and mosques for the time being.

In Kenya, the Ministry of Education has put in place strategies to ensure continuity of education through distance online learning delivered through radio, television and the internet. However, these strategies have further widened the inequality gap, as learners from poor, vulnerable, and marginalized households are unable to benefit from continued learning through these platforms due to lack of access. Further, with the loss of livelihoods particularly in low income households, some children may be forced into income-generating activities to support their families’ survival. Also, school closure has stopped the provision of school meals and sanitary towels.

And it’s more complicated for girls living in refugee camps or girls that are internally displaced. For them, school closures are even more devastating as they are already a disadvantaged group. Girls at secondary level are only half as likely to enroll as their male peers. While the magnitude of the COVID-19 crisis is unprecedented, we can look to the lessons learned from the Ebola epidemic. At the height of the epidemic, five million girls were affected by school closure across Guinea, Liberia and Sierra Leone, the countries hardest hit by the outbreak. And poverty levels rose significantly as education was interrupted.

There is evidence that links poverty with teenage pregnancies during this pandemic. One reason is because many young girls are getting involved in economic activities to supplement what their parents are bringing home. On the other hand, as the cases rise day by day there is a strain on the healthcare system, leading to the disruption of healthcare services, re-prioritization of sexual and reproductive and health services and a. shortage of contraceptive commodities and essential drugs. As SRHR services are reducing, sexual behaviour is rising since the teenagers have nothing to do, and it seems to be more risky where parents don’t really care what their children are doing while at home. I feel that there will be more unintended pregnancies all over the world, many of which will occur among teenage girls.

As I have discussed, there is no culture or tradition, it just happens. There are girls, especially those who come from communities or families that are rooted in culture and traditions, these girls must undergo what their parents wants them to, and the girls have no choice in the matter because their hope was school where they would run for help.

A positive pregnancy test — Source: Creative Commons

For example, in the Maasai community, when a girl is at least nine years old she is circumcised then married after two to four weeks. These girls are now expected to take care of their husband and to bear children at that early age.

Unintended pregnancies among teenagers may result in some difficulties in the lives of young girls. There are unsafe abortions, which may happen as a decision of the girl maybe to feel clean and also as a result of family decision in order to keep the family name clean. There is increased poverty where a girl who is being provided everything with the struggling parents bring another baby who needs to be taken care off and be provided everything as they are babies and as they grow all the way to adulthood. At some point there may be denial where by the parents kick out their daughters because of getting pregnant early because they have disgraced the family. This may cause psychological problems because she doesn’t have the supporting system which may force her to get married not only at an early age but also to an old man who may be violent on her. If not marriage she may have suicidal thoughts. Early pregnancies are the leading cause of deaths among the teenage girls because their bodies are not yet matured to give birth. The girls who are forced into marriage as teenagers, the responsibility that they are given drains them off because also their minds are not yet matured to do what is expected of them, which may lead them to be beaten and abused. Everyone deserves to enjoy their childhood.

Something has to be done before it’s too late. The governments should have committees that will develop and implement proven solutions. Different stakeholders should work to respond and to prevent by meeting the unique needs of adolescents by may be providing sanitary towels and also help them access SRHR services. The people responsible for taking care of pregnant teenage girls should teach them how to improve their sexual and reproductive health and well-being. Lastly I believe there are already existing activists in our towns and villages and they can potentially help to reduce negative coping mechanisms, such as child, early and forced marriage, especially during this time, where every energy is driven to the corona situation.