The International Centre for Journalists (ICFJ) is now recruiting for young journalists interested in covering health issues to attend and report on a conference in India in December 2018. Selected journalists will travel to Delhi for an orientation and to attend the 2018 Partners’ Forum, hosted by the Partnership for Maternal, Newborn and Child Health (PMNCH) and the Government of India.
Marion: The State of the Nation speech happened last week and despite a number of health challenges continuing to face South Africans, far less was said about this than would have been the ideal. In fact, more was said about the Rhino protection programme.
Within health the broad epidemics of HIV, Tuberculosis (TB), Violence against women (VAW) and substance abuse were noted and plans to remedy these through antiretroviral Treatment (ART) and TB treatment programmes, speaking out against VAW and tobacco control were proposed.
As I was digesting this input the face of a black woman with a bruised face surfaced repeatedly on my media platforms, following her expulsion from the House in the EFF scuffle. This disconnect was jarring.
In my area of focus (reproductive justice) women, and in particular black women, continue to bear the brunt of ill health in South Africa. We need leadership and the implementation of our good policies in order to truly transform the lives of women accessing reproductive health services. Schools need to provide comprehensive sexuality education and provide condom access (both female and male). We also need to continue Human Papilloma Virus (HPV) vaccination programmes to reduce the risk that women will contract cervical cancer late in life.
Women and girls need information about the range of contraception options available and to be able to have a conversation with a health provider and choose the method that is most suitable for them. Should contraception fail and a pregnancy takes place women should have access to HIV testing and also have access to a safe and legal abortion and not have to have to resort to an illegal provider. Maternal health programmes need to continue to welcome women and to provide them with good information about their pregnancy and planned delivery.
The Department of Health needs to strengthen it’s work on sexual and reproductive health and rights and the leadership needs to refrain from using misinformed language that suggests that women use abortion as a form of contraception. Commodities, supplies in relation to reproductive health from female condoms to IUCDS need to be strengthened. These suggestions are not new, our Department of Health has fabulous policies, but little leadership and stewardship to implement them.
Are Rhino’s more important than the health of women in South Africa?
Rebecca: There is good news and bad news.
The good news:
By the end of 2010, over 1 million people in South Africa had been initiated on ART (Republic of South Africa 2010). By 2013, this figure had escalated to 2 010 340 adults reported to be receiving ART in South Africa’s public health services (UNAIDS 2013: A86). The expansion in ART provision was testament to the efficacy of a broad-based alliance of healthcare workers, patients, activists, researchers, government officials, donors and other partners who continue to collaborate in the expansion and improvement of the national HIV response. South Africa’s ART programme has begun to reverse the precipitous decline in life expectancy, wrought by AIDS mortality, that came to characterise South African demography in the late 1990s. Due to the provision of ART, life expectancy in South Africa has increased by six years, and mortality among children and adults has declined by 43% and 20% respectively (Mayosi et al, 2012). By 2010, the life expectancy of patients initiating ART was around 80% of normal life expectancy (Johnson et al. 2013: 5).
The bad news:
The structural factors that increase vulnerability to HIV infection and transmission pose persistent challenges to the progress in South Africa’s health sector, and to the democratic transition more broadly. These factors are manifest in enablers of HIV infection, including unemployment, alcohol abuse and gender violence. While health and social interventions to diagnose, treat and manage HIV have provided some of the services necessary to address the needs of patients, the deep-seated determinants of risk and resilience towards HIV infection in South Africa have remained largely intact.
In South Africa’s struggle for public access to treatment, the attention of health care workers and activists was focused on initiating patients onto antiretroviral treatment. Now that South Africa has the world’s largest cohort of patients on antiretrovirals, we must confront the challenges posed by sustaining a massive public health intervention at a time in which resources for health are declining and there is donor fatigue for funding HIV treatment programmes (Mills et al., 2010).
The stigma surrounding HIV remains prohibitive, preventing the vast majority of HIV-positive people from disclosing their status openly and publicly. While antiretroviral treatment has saved the lives of many, recent studies have shown that, contrary to the expectations of public health specialists, the public provision of treatment has not alleviated HIV stigma in South Africa.
While the fight for public access to ART has won numerous gains for women, the primary focus on their health outcomes as mothers, and the related prioritisation by public health specialists, donors and activists of Prevention of Mother To Child Transmission (PMTCT) initiatives, has shifted attention away from other reproductive health rights. Health interventions that have prioritised treatment for women as mothers has placed primary value on their reproductive capacity rather than their individual health outcomes (Eyakuze, Jones, Starrs & Sorkin, 2008, p. 33).
In spite of the requirement in many healthcare settings that HIV-positve women accept contraception as a pre-requisite for access to ART, social sanctions and individual factors compelling people to become parents continue to play a formative role in the reproductive choices of people with HIV. If the roll-out of ART is to continue to improve the health outcomes of women in Southern Africa, sexual and reproductive health must be repositioned at the centre of HIV prevention and treatment programmes.
South Africa has among the highest rates of rape and sexual assault in the world, but research has shown that very few women report rape or seek healthcare services after being raped or assaulted.[i] Survivors of rape and sexual assault have the right to free medical advice and medications, as stated in the Sexual Offences Act (2007).
Jen: In terms of mentioning women specifically, the 2015 SONA limited itself to describing the fact that ‘some progress had been made in fighting crimes against women and children.’ Whilst that can be debated in other platforms, what is important to consider for women’s health is the very strong linkages between violence against women and HIV and sexually transmitted infection contraction.
In addition to what Rebecca describes above, the links between violence and HIV have been well documented by the World Health Organisation and can be summarised as follows:
rape and sexual violence usually result in trauma to women’s genitalia, increasing the likelihood of contracting HIV and other viruses;
sexual abuse in childhood has been linked to risky sexual behaviour in adulthood, increasing the chances that an individual will contract HIV;
violence or fear of violence can reduce the likelihood that a woman feels safe or empowered to negotiate condom use;
violence or fear of violence, in addition to societal stigma and the gendering of disease, can make it less likely for women to go for HIV and other STD testing; and
violence can make it less likely for women to go for antenatal testing when pregnant, thus reducing the efficacy and reach of programmes designed to prevent mother to child transmission.
Another element that was left out of the State of the Nation was South Africa’s extremely high maternal mortality rate, and the fact that over the past years this has only reduced marginally. South Africa is far off from achieving the maternal mortality rate set by the Millennium Development Goals as made clear in Part 1 of this series. The leading causes of death were non-pregnancy related infection (most often HIV related illnesses) and high blood pressure. It seems essential then that the outreach of maternal health services should be widely expanded.
Our teen pregnancy rates also remain high. Early pregnancy has long term impacts on the lives of girls, and because of patriarchal gender norms continues to impact on girls education and life choices far more than it does on boys. In addition, the number of pregnancies that happen in school should be a serious concern as many of these are legally rape. Where healthy consensual sexual activity happens between adolescents, problems with the legislation around sexual offences have the impact of limiting adolescents access to sexual and reproductive health services, making it more likely that they will not seek treatment for sexually transmitted infections or pregnancy. Possible amendments to this legislation are currently before the Portfolio Committee on Justice. This must be addressed as soon as possible.
The State of the Nation will never be the speech that will solve all women’s health problems. However, there was certainly more space available to address these significant challenges than was used.
The 2nd MenEngage Global Symposium- Men and Boys for Gender Justice will be held in New Delhi, India from 10th- 13th November 2014. We are pleased to announce that the deadline for submission of abstracts has been extended to 15 June 2014.
Please hurry and send in your abstract forms!
The Abstracts may be in English, Hindi, French or Spanish. The details of registration and other rules and fees can be read in the FAQs online at http://menengagedilli2014.net/faq/
The abstracts will need to be submitted around the seven interdisciplinary key tracks of the Symposium:
2. Health and Wellbeing
3. Poverty and Work
4. Sexualities, Identities
5. Care, Relationships and Emotions
6. Peace building
7. Making of Men – from masculinity to humanity
If you live in South Africa, watch the news or social media, or listen to the radio you’ll be aware that violence against women is common. You might also know that in the last five years around 60 000 rapes have been reported each year (that’s each year, not over five years). You could know that estimates vary but that statistically most women do not report a rape against them. You might know that most sexual offences committed against women are committed by someone they know, and that one in four men in South Africa has admitted to raping someone he knows.
When it comes to domestic violence you probably know a bit less. This might be because the South African police services do not report on domestic violence statistics annually, because ‘domestic violence’ is technically not a crime. Why technically? Well, because it depends on what type of violence that is, and it’s up to the police to record it as an incident of ‘domestic violence’. This means that sometimes it’s recorded as assault, assault with the intention to do grievous bodily harm, attempted murder, murder, etc. So, when the police report on these crimes against women (if they disaggregate their data at all) they don’t report how many of them were related to domestic violence. One figure we do have (you’ll see them in these interesting research reports at the bottom of this blog) is that over 200 000 new incidents of domestic violence were reported in 2011. That’s new and reported.
Suffice to say that we have a significant problem of intimate partner violence and violence against women in general in South Africa. There are two main laws which govern these types of violence – the Domestic Violence Act 116 of 1998 and the Sexual Offences Act 32 of 2007. These laws define the crimes, prescribe the role of various Government Departments, and make requirements on those Departments to provide particular levels of services. What these laws (and others that affect women’s rights to safety, housing etc) don’t do, is require Government Departments to budget together. This means that each Department (that’s the South African Police Services, the Department of Health, the Department of Justice and Constitutional Development, and the Department of Social Development) has to try and estimate the scale of the problem, and ask for money to do their bit, separately and in a way that is not connected to working with other Departments or ensuring that victims of violence against women get the best and least traumatising service. Add to the fact that when the scale of the problem is so massive, these services are not going to come cheap.
Yes. I find it as strange as you do. When laws require Departments to work together in implementing them and don’t make sure each Department has enough budget to do so, they are essentially setting themselves up for failure. Even more importantly, when laws don’t make exactly clear what each Department has to do, it is really very seriously tremendously (do you get my point) unlikely that Departments will altrustically go on spending sprees to make sure those services are available.
At a research recent seminar three papers were produced on Government spending in relation to gender-based violence. Two of these looked at specific departments – the South African Police Services and the Department of Justice – and asked Departments to report on exactly what they were spending. The other tried to consider Government spending as a whole. This was almost impossible for a number of reasons:
Government Departments do not budget specifically for violence against women services;
Not all Government Departments provided information to Parliament on their spending when requested to do so;
Sometimes Departments simply did not know how much they spent because they included some services in general budgets.
Nevertheless, the third paper reached an estimate of Government spending at at leastR311 051 687 in the 2013/2014 financial year alone. This excluded the costs of the Department of Health and Social Development who did not report. It also excluded the costs of the Department of Correctional Services (who had not yet been asked on their spending on the perpetrators imprisoned for violence against women), the Departments of Education and Communication who should be responsible for awareness raising and preventing violence in schoools, or the Department of Community Safety.
Violence against women is thus significantly costly for the Government. Urgent prevention programmes and responses are required to ensure that equal spending is invested in prevention as is spent on the response. Critically, Government needs to begin to consider how it could budget more holistically to ensure that services are standardised, and that each and every victim of violence regains her right to safety.
What’s important though is that the highest cost is obviously borne by the victim of violence. It is borne by those who survive it, and those who do not. It is also borne by those young South Africans trapped watching their family members inflicting violence against one another, and learning that this is the way that things are resolved. These costs have not even begun to be measured but it is certain that they will be very high.
To read the research reports, click the links below:
Agang’s have never contested in elections before, so there is no way of telling who they will put in Government or Parliament if they win their seats this time around. We also can’t evaluate them on past behaviour. So all we have to go by is what’s on the surface. They are one of two parties with a female political leader at the head of the party (the other being the DA – analysis on them to follow), but thus far a female political leader has not necessarily meant a feminist political leader.
Could Mamphele Ramphele become South Africa’s first female President? She is no stranger to firsts – she was one of the first people to be detained under the Terrorism Act, the first South African to hold a managing director position at the World Bank and the first black female Vice Chancellor of any South African University (UCT). She has an extensive academic background and is a qualified medical doctor. She is certainly a leader, but is she a leader for women? She is currently one of only two women in leadership within her party.
Our country is at a crossroads – Agang and policy
Agang’s five political policy areas are economy, education, health, public service, safety and security. A dominant theme is ‘our country is at a crossroads’ suggesting that unless something drastic happens to change the status quo, we are heading for disaster. They have a further section titled ‘Zwakala – Be Heard’ where members of the public (that’s you feminists) can help them to formulate policy on other issues. Currently they are asking for input on black economic empowerment and affirmative action.
In terms of economy, the policy narrative explains that current measures of economic redress have resulted in the creation of political and economic elites rather than achieving the trickle down empowerment of all as hoped. They end the section with “To boost our economy and job creation, we must make decisions based on what’s best for the next generation and the future of South Africa, not short-term political gain.” If it were me, that best thing would be the empowerment of women tout suite.
Their solution is five fold: make government accountable, build infrastructure and create jobs, unleash small businesses, let business get to work, and invest in South Africans. These five targets don’t explicitly mention women, although they do mention other vulnerable groups such as the youth and informal traders – many of whom are women – and the need to economically empower them and provide further opportunities. Mamphele Ramphele also noted in her launch speech, that black women specifically face challenges in accessing their rights.
The April 28 Edition of the Sunday Times this year provided a table on the average monthly earnings of women in South Africa based on the 2011 census. 16 108 650 women provided information on their earnings and of them 8 591 823 (53.34%) did not have any monthly income, and a further 1 025 400 women earned between R1 and R400 per month. Any political party that does not address gender inequality in the labour sphere as a core and explicit part of its economic policy, will perpetuate existing labour conditions.
In terms of education Agang’s plan aims to make South Africa a top ten education system globablly, and to immediately make our pass rate 50%. Strategies to achieve this include: put students first, fill 15 000 teacher vacancies, upgrade infrastructure, set minimum standards and top-up social grants for education results (i.e. they’ll give additional social grant money to families for students who achieve a 70% pass in any year and for matriculation). The last idea is interesting, in that it recognises that a good education requires the support of a family. Whether this idea is financially viable however in terms of a our current economic climate where the 2013 Medium Term Budget Policy Statement introduced significant cost-cutting for departments is not clear. It is also not clear where they will get all the teachers they need to implement this strategy, but that’s a conversation for after elections I suppose (textbook suppliers, please be ready this year).
A major gap from their strategy is ensuring that schools are safe places for learners to go. In 2009 and 2010 alone, there were 81 918 learner pregnancies in SA schools. 1 666 of those learners were between grades 3 and 6 (i.e. between 9 and 12 years old). In terms of the Criminal Law (Sexual Offences and Related Matters) Act 32 of 2007, sex with any child under the age of 12 is rape, and sex with any child under the age of 15 is statutory rape (unless the sex occurs consensually between two children between 12 and 15). Teen pregnancies should be a significant concern of any political party that wants to empower the youth through education, or achieve an economy that grows and is supportive of the people. Teen pregnancies affect girl learners far more significantly than they affect male learners, and it is thus imperative that Agang consider the issue of learner safety as central to their policy on education. Training on sexual health and safety for all teachers and learners is important. If these are not included in a political party’s education strategies, they will leave girl learners behind.
Health:Agang recognises that the health system is in crisis and is largely polarised into poorly equipped public health for the average South African, and well equipped and serviced private medical care for the wealthy few. Positively, Agang recognises child and maternal mortality as two issues that are highly problematic. Their plan to solve the crisis includes: increasing health professionals (including the re-opening of nursing colleges), expanding local control (strengthening district and provincial health care systems, making public hospitals non-profits and using the private sector to run supply chains), making performance transparent, increasing private sector access (by providing tax incentives for private providers to work in the public sector and letting the private sector run some public assets) and turning around health outcomes by tackling HIV, TB, maternal and child mortality.
Access to adequate health care is essential for women, and it is true that in some areas in South Africa this is simply not happening. The two leading causes of maternal mortality in SA are HIV/AIDS and high blood pressure. These deaths are preventable and something must change. However, Agang’s drive to privatise much of our health care makes me profoundly uncomfortable. I’m left with questions like: how will we ensure that medicines remain affordable for the average South African if the supply chain is privatised? How will we ensure that if public health facilities are transformed into non-profit entities they will not face the same funding challenges that other non-profits are facing as the government insufficiently funds them and international donors move elsewhere? How will we ensure that our National and Provincial health policies do not become problematically controlled by the interest of pharmaceutical giants and corporations?
Another critical issue that seems to have been left out is the expansion of access to health care through mobile clinics which are able to reach areas where there are simply no health facilities, and the building of more health care facilities in general, though this is mentioned briefly in their ‘vision’ section. If it were me writing the policies here I would also include something on the increased access to contraception and termination of pregnancy facilities so that all women are able to make choices related to their fertility and sexual health. At the moment, it is simply not clear what they think about those issues.
Public service is really the policy section where Agang comes out swinging, and if you monitored any of the initial statements made back when they were just a ‘political party platform’ you will realise that they are a party that is sick and tired of corruption. They site the fact that only 22% of Government Departments received clean audits in 2012, as well as the presence of politicians who have already been found to be corrupt within government (many have just moved to another department e.g. Bathabile Dlamini, the Minister of Social Development, a vital department in securing support and empowerment for women). Their solution includes the introduction of new legislation to ban government officials and their families from conducting business with government as well as legislation to protect whistleblowers. It also includes the allocation of better budgets to the auditor general and public protector, and the ban of officials found guilty of corruption from running for office, holding government positions, or receiving government contracts for five years. Finally it includes training all government officials and employees in anti-corruption requirements.
These suggestions sound promising – especially given the fact that a number of Departments, including the Department of Women, Children and People with Disabilities, have experienced corruption in the past. Thankfully the Department of Women, Children and Persons with Disabilities undertook to root out corruption, however it is certain that those resources could surely have been better used to support the rights of women. Perhaps an additional policy should be the cancellation of all events that do not have a measurable impact in terms of the lives of the population they are meant to serve. See Helen Moffett’s take on this here.
In terms of Safety and Security Agang sites a lack of South African Police Service capacitation, high crime levels, and a lack of convictions as major problems. Their solutions include hiring more police, investing in the police financial and other resources, de-militarising the police, training police, ensuring that police work more closely with communities and private security companies, and improving and investing in the national database that manages and tracks crime.
Through the articulation of the problem in this way, Agang situates the essence of the problem of violence and crime with the police, rather than the largely dysfunctional justice system as a whole. To my mind, it seems imperative that police are equipped both in terms of human and financial resources (and please god, with debriefing so they are all not traumatised by the thousands of scary situations they are placed in daily). However, it also requires that that the Department of Justice and the Department of Correctional Services are equally equipped to convict perpetrators of crime, and to ensure that when they are incarcerated they are able to develop and reform respectively. If not, they are either not arrested, not prosecuted, or released whilst still a danger to society.
In addition, their problem statement and solution does not mention violence against women specifically as part of the problem, despite the scary prevalence of this in South Africa. They also don’t discuss how much of the violence that is perpetrated in South Africa occurs in the home – an area that makes policing incredibly difficult. A stronger and clearer focus on this would do much to strengthen Agang’s policy in this regard. However, it is clear that the fact that violence against women is a complex issue is understood by Ramphele, as her statement in her piece on Women’s Day suggests:
From our family behaviour, to the violent anger of some men, to the police handling of victims and the ability of the judicial system to successfully prosecute rape and abuse cases, the distortion of patriarchal traditional societal norms and the numbed reaction to stories of horrible acts, we are in danger of sending the message to victims that it is something normal, something that women just have to deal with.
The fact is that violence against women is an extreme symptom of the failure of our democracy to provide opportunities for all South Africans. It is a manifest failure of government to address the humiliation of men, especially black men at the hands of apartheid. The disempowerment that men feel is taken out against women closest to them.
Agang’s Interim Constitution provides for the establishment of a Women’s Forum. As yet, it’s not clear whether this has been established. This year, Agang released a statement on Women’s Day that was in line with most political party’s rhetoric on the celebration of women past, the praise for women present, and the hope for women future (somehow this is reminiscent of Scrooge). I have mentioned some of the other statements that came out of that speech, but one statement (about the praise of women present and past) caught my attention:
Women have power that remains under-utilized in our society. Women in my life understood the power that is women – their essential role as bearers and nurturers of future generations of both men and women, their capacity to be connectors of the extended family, their ability to empathize with the vulnerable, their organizational abilities to collaborate to tackle complex problems and their capacity for joy.
I think the picture that this paints of women and their role is extremely tied to patriarchal gender-norms that imply that women are nice and caring and want to make babies so that the population can thrive, and go on to become the economy that we need. But, this implicit essentialising of women’s empathy and men’s anger doesn’t really do much to challenge gender norms. It seems to suggest that we can all keep the gender roles that fitted in well in the old system, get rich, and be happy. I don’t think so. I think something more fundamental needs to shift in our perception of women’s strengths and men’s weaknesses. Gender inequality is bad for everyone because it limits our ideas of what men and women can be, and are in their essence.
Gaps: A clear section on furthering the rights of women, LGBTI people, the disabled, and children could add some pinache and would indicate the strategic thinking that is required to make real change. I also think that a section on their energy and environmental commitments is important given the fact that climate change and our carbon intensive energy commitments will have a negative impact on the environment and will result in further scarcity which negatively impacts women most profoundly.
Overall, there is potential, especially for feminists like you to get involved and contribute to policy. I recommend that you do. If you do, let us know how it goes.