Tackling discrimination against the Roma community

The Roma community is considered one of the largest transnational minorities in Europe, with an estimated 10-12 million people. However, it’s a group with one of the lowest life expectancies and worst health records in Europe, since Roma often lack access to proper housing, education, employment and political representation. One of the causes of this is the discrimination often faced by the Roma community, which has led to the rise of extremist movements in countries like Hungary, to mob violence in Romania in the 1990s and  to episodes of hate speech in countries like France.

The European Union (EU) supra-national bodies and Member States have used a wide range of  legalpolicy and financial instruments to support the social inclusion of the Roma Community. Alongside the support offered by international partner organisations such as the  Open Society Institute, the World Bank and the Council of Europe, their commitment to improve the welfare of Roma has taken shape as the Decade of Roma Inclusion (2005- 2015), where further measures to raise the living standards of Roma were pledged.

Yet, although mechanisms for social and administrative accountability exist at both the international and national level, the programmes implemented have had limited success and the Roma have not always been able to benefit fully from the investments made. A recent  Communication Document sent by the European Commission to the European Parliament, highlighted that Member States often do not make proper use of the funds they receive due to poor administration, limited capacity to absorb funds and inadequate involvement of Roma NGOs in the formulation and implementation of policy proposals. Although the participation of Roma in the policy decision-making process has been declared to be essential for the successful integration of the Roma community, Roma citizens are still underrepresented in mainstream parties, governments or European institutions, including the Fundamental Rights Agency.

Currently, an increasing wave of migration from Roma citizens from Eastern and Central Europe is being experienced by some Western countries. As a result, a  high level meeting was recently held inStrasbourg among government delegates from France, Italy, UK, the Netherlands and Spain to debate priorities for addressing issues of national security given the current situation. No representative from countries where Roma are coming from was invited to take part. It is debatable whether the meeting will be of benefit to both parties. Previous measures taken by France, for instance, have had little success. Paying for Roma citizens’ flight tickets home alongside other monetary incentives may have in fact led a larger number of Roma to migrate to these countries.

Nevertheless, there is hope that the highly committed civil society organisations could change the current situation. A number of Roma NGOs have pledged to fight for the rights of the Roma community and have made considerable progress in ensuring Roma citizens’ social inclusion. For instance, the implementation of  a health mediator at the initiative of a local NGO (Romani CRISS) was a successful scheme, which was later adopted by the Romanian national government and promoted by the Council of Europe as positive practice for Roma inclusion. Nevertheless, despite the progress reported by NGOs, the problems this community face are multi-sectoral and require a combination of expertise from the public sector and Roma NGOs and resources from national, regional and local authorities. Stronger transnational representation structures, allocation of funds at local level and actively consulting and involving Roma community are initiatives that could help Roma to become responsible and active citizens.

Yet, a number of fundamental questions still remain unanswered:

– What level of commitment is required from international organisations, home and recipient national governments and local authorities to ensure the Roma community’s successful social and political integration?

– To what extent should Roma citizens participate in policy decision-making and how much responsibility should lie with Roma NGOs?

– To what extent is the deportation of Roma from some Western countries based on European Union law, given the legitimacy of the EU directive on Free Movement of Persons?

It is beyond the scope of this blog to provide any specific solutions since the issues are transnational and depend on individual countries’ willingness to take action. However, it is surely vital to ensure that such questions are considered.

*Diana Pirjol [2011] did an MPhil in Epidemiology and has a particular interest in the Roma Community in Europe. Picture credit: UNDP and Creative Commons.

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Maternal health is an issue for all

Maternal health has been a hot topic in the news this year, with the 2012 London Summit on Family Planning being a big focus of media attention. The ensuing debate has not been without controversy – particularly with regard to whether boosting (or not) women’s access to contraception is a development priority.  The media attention makes this a good time to consider what maternal health is and why it is important.

Maternal health is most simply defined as the health of women before, during, and after pregnancy. Indeed, it is at the heart of Millennium Development Goal number 5, which seeks to reduce the maternal mortality ratio by 75% and achieve universal access to reproductive health.

The World Health Organization (WHO) notes that in 2010, approximately 800 women died every day due to complications of pregnancy and childbirth. This amounts to 287,000 preventable deaths a year.

Causes of maternal mortality include unsafe abortions, obstructed labour, high blood pressure, severe bleeding after childbirth, and post-natal infections. Poor maternal health is also influenced by malnutrition from low iron levels and iodine deficiency.

Often overlooked, inequality is another crucial factor in understanding the structural causes of high maternal mortality. For example, in most ‘developed’ countries women generally have access to reproductive services and support and skilled medical care. Consequently, maternal mortality rates are very low. (This is not to say that issues around maternal health in ‘first world’ countries are nil – indeed, recent debates in the United States around access to contraceptives indicates otherwise). Conversely, in many ‘developing’ countries maternal mortality is extremely high. Within these countries the rural/urban divide shows further patterns of inequality, where two out of every three rural women gives birth without the support of a skilled medical attendant. Such glaring regional discrepancies underscore the fact that most maternal deaths can be avoided.

The impacts of a lack of investment in maternal health and subsequent high maternal mortality are many and severe. From a gender-rights perspective, that such a high proportion of women’s lives are put at risk over largely preventable circumstances is unacceptable and points to women’s persistent inequality.  There are also impacts on families and communities that might not be as obvious but are equally as tangible – for example, women are overwhelmingly responsible for the care of others. This includes babies, children, the sick and the elderly. Their care work is on top of formal (paid) and informal (unpaid) contributions to the workforce. In rural areas of developing countries (where maternal mortality is highest), women also produce over half of all food consumed.  In failing to care for women, we also fail to care for the wellbeing of all other community members, not to mention the economy.

In light of all this, how can we make maternal health a priority?

The solution is simple: We must direct resources towards women. This can be done through state funding, international aid, and private donations. And it can include a whole number of things: investment in public hospitals and local health clinics, improvement and multiplication of centres for safe childbirth, and access to skilled doctors, nurses and midwives. It also includes access to education (for women and men) about reproductive health and family planning, and universal availability of contraceptives.

Across the globe we can find a diversity of important examples of what is currently being done to improve maternal health:

In rural Ghana, long travel distances over sometimes impassable roads, lack of emergency transport vehicles and a severe shortage of skilled healthcare facilities means that many women give birth –and face complications – at home. The past three years has actually seen an increase in what were already dire rates of maternal mortality. Local NGOs are demanding the improvement of road access to health clinics and increased state health funding so that women can have access to skilled emergency medical attention if necessary.

Inequality in access to skilled care at the time of childbirth is striking in Peru, where indigenous women in particular are at a severe disadvantage. Issues of poverty and imbedded racism are related to a lack of medical care that respects their cultural norms and values and is delivered in their native languages. International NGOs in the Andean region work to engage the government in an initiative to integrate indigenous birthing practices and sensitivity to cultural differences into skilled healthcare delivery. They’ve found that more women are likely to access skilled care during childbirth when it is provided in this way.

There are also important global campaigns to improve education for women and men around sexual and reproductive health and family planning in countries where maternal mortality and lack of access to contraceptives poses the greatest threats. Such work recognises that maternal, and community health more generally, are far better when women are able to plan how many, under which circumstances, and when they bear children.

All of these examples highlight different ways in which maternal health can be improved – and there are many more that have not not been mentioned.  After twelve years, we remain a long way off achieving the 5th Millennium Development Goal. Campaigns that promote maternal health deserve our full support  – maternal health is not an individual issue, but one that should be of utmost priority for all communities.

*Tara Cookson is a Gates Cambridge Scholar and is doing a PhD in Geography. She is critically exploring the effects of the more recent post-neoliberal policy shifts on women’s lives as carers within the Latin American region, focusing specifically on those policies that seek to ‘empower’ women and alleviate poverty.  Picture credit: Joey Clifton and Creative Commons.

A youthful vision for a water and food secure world

The ‘world of water’ met last month at the World Water Week in Stockholm. This is an annual event organised by the Stockholm International Water Institute (SIWI), a think tank which aims to bridge the gap between science and policy on water-related issues.

At its 22nd meeting, the conference theme was on ‘water for food’, an intriguing and crucial topic for global sustainability. About 2,500 experts, academic and stakeholders, coming from more than 90 countries, were involved in seminars, discussions and panels debating upon challenges, strategies and solutions to address water and food security issues, which are currently affecting billions of people, particularly in the developing world.

Amongst the many important issues and solutions discussed during the conference, the following themes captured most of the attention:

– the need to reduce food waste. Today we lose between 30-50% of the food produced (and along with it the water used).

– the need to shift to more resource-efficient diets: Given that meat production requires between 50-100 times more water than cereals and there will be 9 billion people in 2050, there may be not enough water and food for everyone if we keep our diets at high level of animal protein(s)

–  links between sanitation and agricultural markets: basically, how we can safely reuse sewage.

For the first time, the floor was given to young professionals, through the presence of a Young Scientific Programme Committee, Young Rapporteurs and Young Vision Leaders. This is because the SIWI recognises the importance of involving young professionals in the debate, as this generation will be in charge of solving water and food issues by 2050.

As a young professional in the sector, I was very lucky to coordinate the Young Vision Leaders (YVLs), a group of five professionals coming from different backgrounds and geographical areas with the objective of developing a vision with a set of solutions for a water and food secure world by 2050.

During the whole week, we (the YVLs) engaged with many other young professionals through informal chats, video interviews and social media (Twitter, blog, Instagram and Youtube). Drawing from the many inputs and ideas from our contemporaries, we developed a vision for a water and food security, and, together with another YVL . I had the honour to present at the closing ceremony of the World Water Week. For more details about the vision, go to youtube (wwweekyvl), http://www.watermedia.org or click here.

We called ourselves the generation of the ‘adaptive idealists’ because we want an ideal world (we cannot accept otherwise), where universal and equal access to improved sanitation, safe water and food is ensured. At the same time, we recognise that the only way to achieve our ‘ideal world’ is by being ‘adaptive’ (developing solutions, strategies and approaches which are continuously checked and modified to respond to changing conditions). This is because we see that the only certain thing about the future as being uncertainty.

It was an incredible experience that enriched me both professionally and personally. Now it is time to start implementing some of these solutions…

*Luca Di Mario [2009] is a Gates Cambridge Scholar and a PhD candidate at the Centre for Sustainable Development. He is currently focusing on how to scale up the safe reuse of sanitation waste in agriculture in the developing world. Picture credit: smokedsalmon and www.freedigitalphotos.net.

Are we protecting the well-being of egg donors?

According to the World Health Organization 8-12% of women are unable to conceive without medical facilitation. The last 25 years have brought about hope for those facing infertility, with spectacular scientific developments in assistive reproductive technologies (ARTs): technologies that assist in achieving and monitoring a pregnancy. One example being in vitro fertilisation (IVF).

The use of donor eggs in IVF treatment has become an increasingly popular option for women experiencing difficulties achieving pregnancy, spurring markets for egg donors. Multiple jurisdictions have developed legislation in order to regulate the use of ARTs and the resulting markets, citing as an objective: protection of the well-being of individuals engaging with ARTs. Differences across jurisdictions are most prevalent in regards to reimbursement and compensation for gamete (i.e. sperm and egg) and embryo donation, as well as for surrogacy. In Canada, for instance, only reimbursement of egg donor expenses is permitted, whilst in the USA women can be paid for their eggs.

Egg donation is a complicated, time-consuming and invasive procedure. There are risks to a woman’s physical health and mental well-being. For women in particular, ARTs and the market that stems from them have brought about a variety of concerns and dilemmas. Pertinent to egg donation are concerns around donor autonomy when engaging with these technologies – centrally, the role that compensation plays in these markets. There are concerns for women surrounding the business side of egg donation: concerns of a conflict of interest on the part of clinicians and researchers. Also, egg donation brings with it opportunities of coercion by financial incentive or other.

Legislation in various jurisdictions has been put in place in order to limit risks stemming from the use of ARTs. While many feminists have critically evaluated the impact of ARTs, less attention has been placed on the impact of ART regulation, specifically, whether regulation seeks to alleviate concerns for participants, such as egg donors.

The predominant regulation debate regarding egg donation has centred on whether or not egg donors should be compensated. And if so, how much? Making compensation debates the dominant focus, however, has perhaps misconstrued our perception of the problem by diverting our attention from all components of the issue. A core issue of ARTs, for instance, is that the market for egg donors is a unique one – fuelled by intended parents willing to go to great lengths to conceive, including crossing international borders to go to jurisdictions where donors may be more available. Neglecting these components inhibits us from creating legislation that might help us in achieving our goal: to best protect the well-being of individuals, such as egg donors, engaging with ARTs. For instance, if our goal is to ‘protect’ the well-being of donors should this not include those women beyond the physical boundaries of our own jurisdiction?

ART regulation in all jurisdictions should not be blindly assumed to fulfil its goals and needs to be considered in its context: a legal system that has often failed to encapsulate female reproduction. We need to look beyond the compensation debate. In order to address all concerns, ART legislation might best be critically evaluated in terms of whether it helps to solidify systems that promote donor well-being. Promoting donor well-being should perhaps include regulation that enhances a donor’s ability to determine whether donation is a good decision for them. Also, through regulation such as around medical practice that minimises harm to a donor’s physical well-being. It is important that we remain mindful that the ramifications of our ‘solution’ to the dilemmas posed by egg donation should not be any less scrutinised than the dilemmas posed by the technologies themselves.

*Katie Hammond is a Gates Cambridge Scholar. She recently completed her MPhil in Multi-Disciplinary Gender Studies, and will be starting her PhD at the University of Cambridge in fall 2012 as a Smuts International Scholar. She is exploring the experiences of egg donors and the impact of regulation surrounding egg donation, focusing on Canada. Picture credit: Creative Commons and kicksie.