Thursday, July 1, 2010

Tradition an Obstacle to Maternal Health

Their kangas and heavy bead necklaces are the only colour in an arid landscape. The weary women waiting outside the Kangatotha dispensary have walked up to 50 kilometres to receive food aid; now they will walk home carrying their share.

"When food aid is available, we come for it," says Regina Ekwar, a 34-year-old mother of five. "But usually we live on wild fruits, roots, camel milk, goat meat, or even donkey meat - whatever is available."

Government statistics show that fully half of pregnant or breastfeeding women in Turkana are malnourished; a majority of children also lack adequate food, many to the point of needing specialised medical care.
"The tough living conditions have led to a very high infant mortality rate which stands at 66 per 100,000 live births," says Dr Gilchrist Lokoel is the head of Lodwar District Hospital in Turkana Central.

Despite recent floods, which drowned plenty of livestock, the only evident vegetation is the dark green of mathenge, an aggressive alien species - thorny and inedible for people and cattle alike. Erratic rainfall threatening livestock and native plants, long-held patterns of life are being challenged, including customs surrounding the role of men in supporting their wives after childbirth.

"A man is supposed to stay away from his wife for about two years after she has delivered in order to give her time to bring up the child," says Francis Ekatapan, from Napucho village near Lake Turkana.

"If she is the first wife, it is customary for him to go grazing several kilometres away, where he can marry another woman. And if he already has another wife, it is usually good to relocate (to stay with her)."

Ekwar is her husband's second wife - her youngest child is two years old and she is expecting another one. Most of her husband's herd succumbed to drought in 2009, she told IPS. He rarely comes home and Ekwar has little to feed her family. She depends on relief food distributed by humanitarian organisations. 
 Brian Ekai, a primary school teacher, worries that the practice of a husband moving away has not adapted to new circumstances. "This worked well in the past, when the rains came frequently and pastures were plenty. Even when women were left alone at home, they had camels to milk. But this is no longer the case," he says.

"The current living conditions call for manageable families, support from both parents, and frequent medical check-ups because of the emerging diseases that never used to be found here."

Humanitarian organisations are attempting to both address the urgent needs of malnourished women and children and to promote family planning.

"Correcting everything at once is not possible," says Nick Wasunna, senior advisor for World Vision Kenya. "At the moment, we are concentrating on the most vulnerable, who are children under the age of five, lactating mothers and pregnant women who are malnourished.


World Vision is running several programmes addressing both urgent and long-term needs of severely malnourished women and children.

"We prescribe special diets for the moderately malnourished, while the rest of the family members are given a different one under the General Food Distribution programme. Acutely malnourished children, pregnant women and lactating mothers are referred to advanced health facilities for specialised care," says Wasunna.

Alongside the distribution of food, women are taught about family planning, says nurse Julius Ekure, the officer in charge at the Kangatotha dispensary.

"But due to illiteracy, most of them believe that the methods we are encouraging them to use including pills and injectables will eventually render them impotent, while use of condoms is associated
with immorality," Ekure says.

Government figures show contraceptive use here is just three percent, far below the national average of 46 percent. There are six children in the average household in Turkana; the government's target nationwide is four per household.

The additional support for public health from groups like World Vision, Oxfam, Medical Emergency Relief International, the Red Cross, and others is a vital first step, but more is needed.

Lokoel says an image-based awareness campaign is needed to convince people in Turkana to take family planning and medical care seriously.

"The image-based strategy could mean use of posters, drawings, or even drama done in the local language, but tied to their lifestyle. In some cases, we invite village elders whom we have trained to talk to them about the importance of medication because they are the most trusted individuals in the society," he said.

It will be an uphill struggle to overcome deeply-held beliefs and suspicions.

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Violence against women is a worldwide yet still hidden problem. Freedom from the threat of harassment, battering, and sexual assault is a concept that most of us have a hard time imagining because violence is such a deep part of our cultures and lives.