{"id":58,"date":"2017-04-25T15:49:21","date_gmt":"2017-04-25T15:49:21","guid":{"rendered":"https:\/\/opentextbc.ca\/womenintheworld\/?post_type=chapter&#038;p=58"},"modified":"2017-05-04T18:15:20","modified_gmt":"2017-05-04T18:15:20","slug":"chapter-3-women-and-health","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/womenintheworld\/chapter\/chapter-3-women-and-health\/","title":{"raw":"Chapter 3: Women and Health","rendered":"Chapter 3: Women and Health"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3 itemprop=\"educationalUse\">Chapter Summary<\/h3>\r\n<ul>\r\n \t<li><strong>\u00a0<a href=\"#over\">Overview<\/a><\/strong>\r\n<ul>\r\n \t<li><a href=\"#over1\"><strong>Unequal in Health<\/strong><\/a><\/li>\r\n \t<li><a href=\"#over2\"><strong>Recent Trends Encouraging<\/strong><\/a><\/li>\r\n \t<li><a href=\"#over3\"><strong>More to be Done<\/strong><\/a><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><a href=\"#prof\"><strong>Profile: Salwa Al-Najjab<\/strong><\/a><\/li>\r\n \t<li><a href=\"#proj\"><strong>Project: Mothers2Mothers<\/strong><\/a>\r\n<ul>\r\n \t<li><a href=\"#proj1\"><strong>International Partnerships<\/strong><\/a><\/li>\r\n \t<li><strong><a href=\"#proj2\">Empowering Women, Protecting Children<\/a>\u00a0<\/strong><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><a href=\"#ques\"><strong>Questions<\/strong><\/a><\/li>\r\n \t<li><a href=\"#add\"><strong>Additional Resources<\/strong><\/a><\/li>\r\n<\/ul>\r\nThis chapter discusses women\u2019s health as an indicator of a nation\u2019s political, social, and economic development. As women are half of any given nation\u2019s population, productivity is lowered when women\u2019s health is poor. Women\u2019s health is important from human rights and economics perspectives. Nearly 380,000 women die from preventable causes related to pregnancy each year. The majority of maternal deaths occur in sub-Saharan Africa and South Asia. However, maternal deaths declined by one-third globally between 1990 and 2008. Also, while women are marrying later throughout the developing world, large unmet family planning needs remain.\r\n\r\nThe chapter examines two cases of women and organizations who have been breaking down barriers in health. Salwa Al-Najjab is a Palestinian activist who was the only female student in her medical school and went on to provide crucial health services for women in Palestinian refugee camps. Najjab\u2019s work led her to become cognizant of the economic, social, and environmental determinants of health. She founded the Women\u2019s Social and Legal Guidance Center in Ramallah. The second case study concerns the mothers2mothers (M2M) program, which operates 680 sites across sub-Saharan Africa, reaching 85,000 new and expecting mothers per month. M2M provides treatment and testing for HIV-positive pregnant women and ensures access to medication. The program provides employment and community engagement opportunities for women who are HIV-positive, and participants can become empowered members of the community.\r\n\r\n<\/div>\r\n<div class=\"textbox key-takeaways\">\r\n<h3 itemprop=\"educationalUse\">Key Words<\/h3>\r\n<ul>\r\n \t<li>Abortion<\/li>\r\n \t<li>Antiretroviral (ARV) medication<\/li>\r\n \t<li>Elton John AIDS Foundation<\/li>\r\n \t<li>Global Information and Advice on HIV &amp; AIDS (AVERT)<\/li>\r\n \t<li>Guttmacher Institute<\/li>\r\n \t<li>Highly Active Antiretroviral Treatment (HAART)<\/li>\r\n \t<li>HIV\/AIDS<\/li>\r\n \t<li>Johnson &amp; Johnson<\/li>\r\n \t<li>Juzoor Foundation for Health and Social Development<\/li>\r\n \t<li>Mother-to-child transmission<\/li>\r\n \t<li>Mothers2mothers<\/li>\r\n \t<li>Prevention of mother-to-child transmission (PMTCT)<\/li>\r\n \t<li>Salwa Al-Najjab<\/li>\r\n \t<li>Stigma<\/li>\r\n \t<li>United Nations Joint Program on HIV\/AIDS (UNAIDS)<\/li>\r\n \t<li>United Nations Population Fund (UNPF)<\/li>\r\n \t<li>United States Department of State<\/li>\r\n \t<li>U.S. Center for Disease Control (CDC)<\/li>\r\n \t<li>U.S. President\u2019s Emergency Plan for AIDS Relief (PEPFAR)<\/li>\r\n \t<li>Women\u2019s Social and Legal Center<\/li>\r\n \t<li>World Health Organization (WHO)<\/li>\r\n<\/ul>\r\n<\/div>\r\n&nbsp;\r\n<div class=\"page\">\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"781\"]<img src=\"https:\/\/opentextbc.ca\/womenintheworld\/wp-content\/uploads\/sites\/183\/2017\/04\/39-1.jpg\" alt=\"\" width=\"781\" height=\"583\" \/> Figure 3.1: Healthy women are an asset to their families and society. They remain fit to care for their families, earn income and contribute to their communities. A woman and child in Botswana.[\/caption]\r\n\r\n<\/div>\r\n<h2 id=\"over\" class=\"chapter\"><span class=\"gray\">Overview\r\n<\/span><\/h2>\r\n<p class=\"subchapter1\"><strong><span class=\"gray\">By Lori S. Ashford<\/span><\/strong><\/p>\r\n<p class=\"nonindent\"><span class=\"dropcaps\">W<\/span>omen\u2019s health can be a barometer of a nation\u2019s progress. Countries afflicted by poverty, corruption, war or weak governance often neglect their most vulnerable citizens. Frequently these are women. When women are unhealthy, their productivity is lowered and their children and families are less secure. This has an economic impact. So investing in women\u2019s health makes sense from both an economic and a human rights perspective.<\/p>\r\n\r\n<h3 id=\"over1\" class=\"section\">Unequal in Health<\/h3>\r\n<p class=\"nonindent\">Women live longer than men, statistics show, but they may spend a greater proportion of their lives in poor health for a variety of reasons, attributable less to biological differences than to poverty and gender discrimination. Poor families may invest less in their daughters, giving them less nutrition, health care and education than their sons. Such disadvantages early in life have long-term consequences for girls\u2019 health and well-being. For example, adolescent childbearing, common in countries and communities that condone child marriage, poses health risks and limits life prospects for the teen mothers and their children. If women are undernourished they risk having low birth-weight babies who, in turn, face a higher risk of early death and poor health. An added threat to the health of women and girls exists in countries where there is a cultural preference for sons, such as China and India. Sex-selective abortions and female infanticide are responsible for millions of \u201cmissing girls.\u201d The resulting shortage of women relative to men can have alarming social repercussions. An April 2011 report in <em>The Economist<\/em> cited evidence that a skewed sex ratio in India has led to increased trafficking of girls, among other abuses. Data from U.N. Population Fund studies also support this (UNFPA, 2004).<\/p>\r\n<p class=\"indent\">Pregnancy and childbirth take a heavy toll on women\u2019s health in the developing world. According to 2010 estimates by the World Health Organization (WHO), 358,000 women die of preventable causes related to pregnancy and childbirth every year; 99 percent of these deaths are in developing countries. In contrast, in developed countries where women deliver their babies in hospitals and have access to care for pregnancy complications, maternal deaths are extremely rare.<\/p>\r\n\r\n<div class=\"page\">\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"757\"]<img src=\"https:\/\/opentextbc.ca\/womenintheworld\/wp-content\/uploads\/sites\/183\/2017\/04\/41-1.jpg\" alt=\"\" width=\"757\" height=\"476\" \/> Figure 3.2: Two Afghan doctors examine a patient\u2019s x-ray at Rabia Balkhi Women\u2019s Hospital in Kabul, Afghanistan.[\/caption]\r\n\r\n<\/div>\r\n<p class=\"indent\">The vast majority of the world\u2019s maternal deaths occur in the two poorest regions: sub-Saharan Africa and South Asia. In sub-Saharan Africa, where high fertility multiplies the dangers that mothers face over a lifetime, one in 31 women is likely to die as a consequence of pregnancy or childbirth (WHO, 2010). In developed countries, that chance is one in 4,300. Outside of Africa, Afghanistan is the riskiest place on earth to become pregnant and bear children, with a one in 11 lifetime chance of dying from pregnancy-related causes.<\/p>\r\n<p class=\"indent\">Millions of women suffer physical injuries or long-term disabilities, such as incontinence or ruptured organs, resulting from lack of proper care during pregnancy and childbirth. Many of these disabilities go unreported because women in developing countries consider them normal. The technology and knowledge to prevent needless deaths and injuries has long been available, but geography, substandard health systems, gender bias and political inertia all create barriers to making motherhood safer.<\/p>\r\n<p class=\"indent\">The HIV\/AIDS pandemic also threatens women\u2019s health in poor countries and communities. Where the virus is spread through heterosexual contact, women are more vulnerable to infection than men for physiological and social reasons, such as women\u2019s economic dependence on men, their lack of power to ask male partners to practice safer sex and \u2014 too often \u2014 coerced sex. According to a 2009 UNAIDS report, \u201cAn estimated 50 million women in Asia are at risk of becoming infected with HIV from their intimate partners \u2026 men who engage in high-risk sexual behaviours.\u201d<\/p>\r\n\r\n<h3 id=\"over2\" class=\"section\">Recent Trends Encouraging<\/h3>\r\n<p class=\"nonindent\">The good news is that today women are marrying later throughout the developing world. They are delaying first births and having fewer children than their mothers did. These trends reflect the fact that more girls are staying in school and more women and couples are practicing family planning. But there still is a large unmet need for family planning: According to a 2009 report from the Guttmacher Institute, more than 200 million women worldwide who want to avoid pregnancy do not use modern contraception. This contributes to tens of millions of unplanned births and unsafe abortions annually, often among the poorest women, who are least able to obtain and use the health services they need.<\/p>\r\n<p class=\"indent\">Estimates from WHO in 2010 revealed that maternal deaths dropped by about one-third globally from 1990 to 2008, thanks to a number of factors such as increased availability of contraception, prenatal care and skilled assistance during childbirth. Countries as diverse as Bolivia, China, Eritrea, Iran, Romania and Vietnam have made remarkable progress. Much more work remains to be done, however, for all countries to meet the Millennium Development Goal to reduce maternal deaths by three-fourths (compared with 1990 levels) by 2015.<\/p>\r\n\r\n<h3 id=\"over3\" class=\"section\">More to be Done<\/h3>\r\n<p class=\"nonindent\">Where countries have prioritized women\u2019s health in national policy, great progress has been made. Women should be encouraged to recognize and speak out about their health care needs, so policymakers may learn and take action. Concern about women\u2019s issues, including health care, prompted President Obama to appoint Melanne Verveer the first ambassador-at-large for women\u2019s issues, to help address such problems. Secretary of State Hillary Rodham Clinton has made global women\u2019s issues a high priority of the U.S. State Department. In 2009 President Obama designated $63 million \u2014 to be spent over six years \u2014 for the Global Health Initiative, a partnership among U.S. agencies to boost health care in the developing world, particularly for women and children. HIV\/AIDS treatment projects such as mothers2mothers, which is highlighted in this chapter, are funded by the U. S. Agency for International Development and the U.S. President\u2019s Emergency Plan for AIDS Relief.<\/p>\r\n\r\n<div class=\"page\">\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"706\"]<img src=\"https:\/\/opentextbc.ca\/womenintheworld\/wp-content\/uploads\/sites\/183\/2017\/04\/43-1.jpg\" alt=\"\" class=\"\" width=\"706\" height=\"438\" \/> Figure 3.3: Partnerships between local groups and international organizations provide health care and counseling for pregnant women and new mothers in Madagascar[\/caption]\r\n\r\n<\/div>\r\n<p class=\"indent\">Improving women\u2019s health starts by recognizing that women have different needs from men and unequal access to health care. Focusing a \u201cgender lens\u201d on health services is necessary to reveal and address the inequalities between men\u2019s and women\u2019s care. This means paying more attention to girls, adolescents and marginalized women who suffer from poverty and powerlessness and changing the attitudes and practices that harm women\u2019s health. Also, men should be partners in promoting women\u2019s health, in ensuring that sex and childbearing are safe and healthy and in rearing the next generation of young leaders \u2014 both girls and boys.<\/p>\r\n<p class=\"bio\"><strong>Lori S. Ashford,<\/strong> a freelance consultant, has written about global population, health and women\u2019s issues for 20 years. Formerly with the Population Reference Bureau (PRB), she authored the widely disseminated PRB \u201cWomen of Our World\u201d data sheets and \u201cNew Population Policies: Advancing Women\u2019s Health and Rights\u201d for the <em>Population Bulletin,<\/em> among other publications.<\/p>\r\n\r\n<h2 id=\"prof\" class=\"chapterr\"><span class=\"gray\">PROFILE: <\/span>Salwa Al-Najjab - <span class=\"gray\">Palestinian Health Care Activist<\/span><\/h2>\r\n<p class=\"subchapter1\"><strong><span class=\"gray\"><em>By<\/em> Naela Khalil<\/span><\/strong><\/p>\r\n\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"445\"]<img src=\"https:\/\/opentextbc.ca\/womenintheworld\/wp-content\/uploads\/sites\/183\/2017\/04\/44-1.jpg\" alt=\"\" width=\"445\" height=\"555\" \/> Figure 3.4: Overcoming gender bias in male-dominated hospitals wasn\u2019t easy for Salwa Al-Najjab, but her success has inspired other Arab women. Her Juzoor Foundation brings medicine to poor and underserved communities.[\/caption]\r\n<p class=\"nonindent\"><span class=\"dropcapsr\">S<\/span>alwa Al-Najjab was the best female math student in her class, and her passion for mathematics would have led her to study at the College of Engineering, but for her Russian math teacher\u2019s advice to study medicine: \u201cWith your intelligence and your strong personality, you will be of more benefit to the women of Palestine as a doctor than as an engineer,\u201d the teacher said. Salwa Al-Najjab followed her teacher\u2019s advice, and today she is changing medical care in the Palestinian Territories.<\/p>\r\n<p class=\"indent\">The hospital environment stirred Al-Najjab\u2019s curiosity and her love of knowledge. She hadn\u2019t realized that her medical career also would show her that many women lived in very different circumstances from her own. Al-Najjab admits: \u201cThe hospital and the medical profession opened my eyes wide to conditions which I hadn\u2019t realized were as bad and as difficult as they were.\u201d Her lifelong professional and personal battle to support women\u2019s rights and to help provide better health care for women started when she began practicing medicine in 1979 at Al-Maqasid Hospital in Jerusalem.<\/p>\r\n<p class=\"indent\">She expanded her efforts to create better conditions for women in the mid-1980s. Carrying her physician\u2019s bag and instrument case, Al-Najjab visited Palestinian villages and refugee camps to give women medical check-ups and treatment. She volunteered her time under the most difficult and complex conditions. She was creating change on the ground.<\/p>\r\n<p class=\"indent\">Today, after more than 30 years of work in hospitals and clinics in different parts of the Palestinian Territories, Al-Najjab heads the <em>Juzoor<\/em> (Roots) Foundation for Health and Social Development, based in Jerusalem. She continues to enthusiastically pursue her dream, although now, she says, it is more difficult \u201cto influence health care policy decisionmakers to improve and develop the level of health care services provided to women, and to bridge the gap between service providers and recipients.\u201d<\/p>\r\n<p class=\"indent\">Al-Najjab\u2019s optimism is infectious. She maintains her smile despite the challenges she has faced in her life. During her early school years, she attended eight different schools in Ramallah, Hebron and Jordan. Her father worked first at the Jordanian Ministry of Education, then at UNESCO, so her family moved frequently. This meant she and her three siblings often changed schools, making it difficult to maintain long-term friendships. However, it was always easy for her to maintain her academic excellence.<\/p>\r\n<p class=\"indent\">Al-Najjab traveled to Russia to attend Moscow University in 1971. After one year of Russian language study, she enrolled at Kuban Medical School in Krasdnada. Dealing with her fellow students was more difficult than learning a new language or other demanding subjects. Some Arab students looked at her disapprovingly; others underestimated her ability to succeed because she was a woman. She persevered in her studies, defying those who doubted her, and became a model of academic success. She became a mentor to Palestinian women studying abroad.<\/p>\r\n<p class=\"indent\">Her first job at Al-Maqasid Hospital presented her with major challenges. She was the only female resident doctor, and she began working in the obstetrics and gynecology section. It was difficult for the male doctors to accept a female colleague and professional competitor. The hardest thing for Al-Najjab was that the female nurses did not accept her either, because they were accustomed to dealing with male doctors. They believed that a male doctor was more competent and professional than his female counterpart. The atmosphere at the hospital reflected this masculine bias in the way they divided the work: Al-Najjab would do routine examinations of female patients at the hospital clinic, while the male doctors would perform surgical operations and circumcisions. They did not expect that this quiet, beautiful young woman would resist this arrangement, nor that the section head would support her.<\/p>\r\n<p class=\"indent\">Al-Najjab says: \u201cI refused to accept their masculine [-biased] division of labor, and I stuck to my position: \u2018I will participate in surgical operations, and I will perform circumcisions on boys.\u2019 This didn\u2019t please them, and they nicknamed me \u2018the rooster.\u2019\u201d<\/p>\r\n<p class=\"indent\">Al-Najjab says that the first time she experienced discrimination against women was at the hospital: \u201cI grew up in a family that offered the same opportunities to both sexes. Even my grandfather, back in the 1960s, allowed my aunts to study in Britain, to work outside of the house and to spend the night away from home. Therefore, the attitude that I faced from my colleagues at the hospital astonished me.\u201d<\/p>\r\n\r\n<div class=\"page\">\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"725\"]<img src=\"https:\/\/opentextbc.ca\/womenintheworld\/wp-content\/uploads\/sites\/183\/2017\/04\/46-1.jpg\" alt=\"\" width=\"725\" height=\"567\" \/> Figure 3.5: A nurse in a West Bank community clinic examines patients. The clinic is part of USAID\u2019s Health Flagship Project to improve community health care.[\/caption]\r\n\r\n<\/div>\r\n<p class=\"indent\">Al-Najjab also learned about the unequal status of women. She says, \u201cI felt that I was getting to know my society for the first time. I would feel distraught when I delivered the baby of a girl who was no older than 15, or when I heard women affirming to me, unprompted, that men had a monopoly over decisions regarding who their daughters would marry, whether or not to use contraceptives or how many children they would have.\u201d Al-Najjab adds, \u201cWomen don\u2019t have the right to defend their own right to an education \u2026 It\u2019s a cycle that must be broken.\u201d<\/p>\r\n<p class=\"indent\">Al-Najjab\u2019s family valued knowledge. Her father defied convention by sending her to study in Russia. Although her mother hadn\u2019t completed her studies, she encouraged her four children, girls and boys alike, to continue their education. All of them graduated from college.<\/p>\r\n<p class=\"indent\">\u201cUnlike other mothers, mine never talked to me about marriage. Instead, she would always talk to me about the importance of education for a woman\u2019s life,\u201d Al-Najjab recalls.<\/p>\r\n<p class=\"indent\">After seven years at Al-Maqasid Hospital, during which time she helped establish several high-quality clinics in Jerusalem and its suburbs, Al-Najjab left the hospital to work in the field. \u201cI discovered that only a small number of people go to hospitals, either due to poverty or ignorance,\u201d she says. \u201cIf I wanted to provide health care to women, I had to go to them, wherever they were.\u201d<\/p>\r\n<p class=\"indent\">In 1985, Al-Najjab and a group of health professionals began visiting villages and refugee camps to provide health care. People\u2019s reactions were positive, but some doctors criticized her for damaging doctors\u2019 \u201cprestige\u201d by going to the patients rather than insisting that people come to the doctor.<\/p>\r\n<p class=\"indent\">By breaking this rule of prestige, Al-Najjab and her colleagues found conditions that they did not encounter in well-organized clinics equipped with winter heating and summer fans. They met people in far-flung places who suffered from a severe lack of health care compounded by the complex political conditions resulting from the Israeli-Palestinian conflict. Al-Najjab says, \u201cI treated women who had no bathrooms in their homes and others living in homes unfit for human habitation. I came into contact with a bitter reality that overturned all of my convictions regarding the concept of health: I realized that it wasn\u2019t only a question of physical well-being, but that health is also related to economic, social and psychological conditions, and to the environment.\u201d<\/p>\r\n<p class=\"indent\">She has fought many battles and continues to do so. Her convictions and her decisions are sometimes contrary to social traditions that limit women\u2019s rights. Al-Najjab is an activist who gets things done. She co-founded the Women\u2019s Social and Legal Guidance Center in Ramallah. The center shelters women who are victims of violence, offers them legal assistance, refers their cases to the police and refers them to a safe house for their protection.<\/p>\r\n<p class=\"indent\">\u201cI used to believe that as the years went by, change for the better would take place. But what I am noticing today is the opposite. In this social environment of political frustration and poverty, fundamentalist movements have strengthened and are actively working to move society backwards at every level. Women and women\u2019s rights are the most prominent victims,\u201d she says.<\/p>\r\n<p class=\"indent\">Besides leading the Juzoor Foundation, which seeks to influence health care policies, Al-Najjab heads the Middle East and North Africa Health Policy Forum, where she continues to strive for change. She was nominated by the U.S. Consulate General in Jerusalem for the U.S. Department of State\u2019s 2010 International Women of Courage award.<\/p>\r\n<p class=\"indent\">With a husband and three children, in addition to her medical practice and activism, Dr. Salwa Al-Najjab has a full life. Her prescription for success is this: \u201cWe cannot but be optimistic about life.\u201d<\/p>\r\n<p class=\"bio\"><strong>Naela Khalil<\/strong> is a Palestinian journalist. She won the 2008 Samir Kassir Award for freedom of the press.<\/p>\r\n\r\n<h2 id=\"proj\" class=\"chapterg\"><span class=\"gray\">PROJECT: <\/span>Mothers2mothers - <span class=\"gray\">Help for HIV-Positive Women<\/span><\/h2>\r\n<p class=\"subchapter1\"><strong><span class=\"gray\"><em>By<\/em> Maya Kulycky<\/span><\/strong><\/p>\r\n\r\n<div class=\"block\">\r\n<p class=\"nonindent\">HIV\/AIDS is the scourge of Africa, but in Kenya, the nongovernmental organization mothers2mothers enables HIV-positive women and their families to live full lives despite the disease.<\/p>\r\n\r\n<\/div>\r\n<p class=\"nonindent\"><span class=\"dropcapsg\">T<\/span>eresa Njeri, a single mother in Kiambu, a northern suburb of Kenya\u2019s capital, Nairobi, has a dream. She wants to build a home for herself and her six-year-old son. Recently, Teresa bought a plot of land. When she looks out over it she pictures the house she plans to build, with three bedrooms, a \u201cbig kitchen\u201d and a yard where her son can play. Teresa is confident and optimistic. But planning for a bright future, and having the means to make it a reality, is a big change for her. Ten years ago Teresa was convinced that she and her son were going to die.<\/p>\r\n<p class=\"indent\">In 2001, Teresa was diagnosed as HIV-positive when she was five months pregnant. \u201cThe first thing that came to my mind was death,\u201d says Teresa. \u201cAll of my hopes were shattered.\u201d The nurse at the clinic told Teresa she could protect her baby from HIV, but the nurse \u201cwasn\u2019t convincing, she was not very sure.\u201d Regardless, Teresa joined a prevention of mother-to-child transmission (PMTCT) program. Meanwhile, she disclosed her status to her husband, who also tested HIV-positive. Like others who were afraid of the stigma associated with HIV, the couple hid their status. They separated shortly after the birth of their son, who is HIV-negative.<\/p>\r\n<p class=\"indent\">A few months later, Teresa was hospitalized and told she had AIDS. When her father discovered her status from the hospital staff, he told her family, who isolated her and took her son away to live in the family\u2019s village. \u201cSo I was left alone, all alone in the world,\u201d Teresa remembers.<\/p>\r\n<p class=\"indent\">Teresa fled, sought treatment and volunteered to speak to others with AIDS. But she says she still \u201cdidn\u2019t have any focus in life. I didn\u2019t have any hope. I didn\u2019t know what to do.\u201d Then Teresa found mothers2mothers, thanks to nurses in the hospital where she volunteered. They told her that mothers2mothers was seeking to hire women trained in PMTCT. Teresa applied and became a mothers2mothers mentor mother.<\/p>\r\n\r\n<div class=\"page\">\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"452\"]<img src=\"https:\/\/opentextbc.ca\/womenintheworld\/wp-content\/uploads\/sites\/183\/2017\/04\/49-1.jpg\" alt=\"\" width=\"452\" height=\"564\" \/> Figure 3.6: Mathakane Metsing carries her daughter at their home in Khatleng, Lesotho. She was helped by \u2014 and now works for \u2014 mothers2mothers as a peer educator.[\/caption]\r\n\r\n<\/div>\r\n<div class=\"page\">\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"758\"]<img src=\"https:\/\/opentextbc.ca\/womenintheworld\/wp-content\/uploads\/sites\/183\/2017\/04\/50-1.jpg\" alt=\"\" width=\"758\" height=\"557\" \/> Figure 3.7: Ntsiuoa Ralefifi (center) at a mothers2mothers support group at Mafeteng hospital in Lesotho. When she learned she was HIV positive, she enrolled in the transmission prevention program.[\/caption]\r\n\r\n<\/div>\r\n<h3 id=\"proj1\" class=\"section\">International Partnerships<\/h3>\r\n<p class=\"nonindent\">Mothers2mothers \u2014 funded by USAID, PEPFAR (U.S. President\u2019s Emergency Plan for AIDS Relief) and the CDC (U.S. Centers for Disease Control), the Elton John AIDS Foundation, Johnson &amp; Johnson and other corporate and foundation partners \u2014 trains and employs HIV-positive mothers to be \u201cmentor mothers\u201d to provide counseling, education and support to newly diagnosed HIV-positive pregnant women and new mothers. It is an innovative, sustainable model of care at the forefront of prevention of mother-to-child HIV transmission. Mothers2-mothers operates 680 sites in nine sub-Saharan African countries, reaching about 85,000 new pregnant women and new mothers a month.<\/p>\r\n<p class=\"indent\">The African continent is struggling under the burden of HIV\/AIDS. Of the 33 million people carrying HIV worldwide, 22 million live in sub-Saharan Africa. Ninety percent of HIV-infected babies are born in the region and 75 percent of the world\u2019s HIV-positive pregnant women live in 12 African countries, according to studies done by AVERT (<a class=\"hlink\" href=\"http:\/\/www.avert.org\">www.avert.org<\/a>), the UNAIDS Regional Support Team for Eastern and Southern Africa (<a class=\"hlink\" href=\"http:\/\/www.unaidsrstesa.org\/unaids-priority\/2-preventing-mothers-dying-and-babies-becoming-infected-h\">http:\/\/www.unaidsrstesa.org\/unaids-priority\/2-preventing-mothers-dying-and-babies-becoming-infected-h<\/a>) and the <em>World Health Organization Universal Access Report 2010<\/em>. Meanwhile, the region is desperately short of doctors and nurses.<\/p>\r\n<p class=\"indent\">Mothers2mothers fills a gap by enlisting HIV-positive mothers to counsel pregnant women about how testing and treatment can ensure their babies are born healthy and that, if necessary, they can get medication. Mentor mothers work beside doctors and nurses in health care facilities, helping patients understand, accept and adhere to the interventions that are prescribed. They are paid members of the medical team.<\/p>\r\n\r\n<h3 id=\"proj2\" class=\"section\">Empowering Women, Protecting Children<\/h3>\r\n<p class=\"nonindent\">The results are clear. In Lesotho, data collected by mothers2mothers show that 92 percent of pregnant women who attended the organization\u2019s instruction sessions three or more times took antiretroviral (ARV) medication during pregnancy, compared to 71 percent of those who attended once. Adhering to the ARV regime is critical to decreasing mother-to-child transmission of HIV. Furthermore, 97 percent of frequently-attending mothers2mothers clients get CD4 tests, which determine the number of T-helper cells with which the body combats infections. A CD4 test shows how advanced an HIV infection is and is a first step toward receiving the life-saving highly active antiretroviral treatment (HAART).<\/p>\r\n<p class=\"indent\">Women are empowered by the support they receive in mothers2mothers programs. They become peer educators who are role models in their communities, while earning a salary and gaining valuable work experience.<\/p>\r\n<p class=\"indent\">Teresa credits mothers2mothers with giving her a sense of purpose. Her mothers2mothers colleagues encouraged her to pursue her college degree. She is studying community health and development. \u201cI feel like God created me \u2026 to talk to these women, and help them, empower them, encourage them,\u201d she says.<\/p>\r\n<p class=\"indent\">Teresa points to her success in helping a pregnant woman from the traditional African religion of Wakorino, whose adherents often eschew professional medical care. \u201cI saw her when I was coming to work,\u201d she says. She gave the woman her telephone number, and \u201cthe following day she called me and said, \u2018I am here at the [hospital] gate.\u2019\u201d The woman tested HIV-positive. \u201cI told her, \u2018Don\u2019t worry, because you are going to live a very long time.\u2019 I disclosed my status to her.\u201d Teresa convinced her to adhere to PMTCT treatment and deliver in the hospital. The woman gave birth to an HIV-negative child. \u201cI feel like a star,\u201d Teresa laughs.<\/p>\r\n<p class=\"indent\">Mothers2mothers is working to expand its reach to women in more countries and in countries where it currently operates. The impact is clear and the method is simple \u2014 a woman talking to another woman can help prevent mother-to-child transmission of HIV.<\/p>\r\n<p class=\"bio\"><strong>Maya Kulycky<\/strong> is the global communications manager at mothers2mothers. She also lectures in political journalism at University of Cape Town, South Africa. She previously reported for ABC News and CNBC. A graduate of Johns Hopkins University, she received a master\u2019s degree from the University of London, Goldsmith\u2019s College, and a law degree from Yale Law School.<\/p>\r\n\r\n<div class=\"textbox exercises\">\r\n<h3 id=\"ques\" itemprop=\"educationalUse\">Multiple Choice Questions<\/h3>\r\n<h4>Questions<\/h4>\r\n<ol>\r\n \t<li>The following factors are major contributions to gender inequalities in health\u2026\r\n<ol>\r\n \t<li>Biological differences (Women are unhealthier by nature)<\/li>\r\n \t<li>Poverty and gender discrimination<\/li>\r\n \t<li>Adolescent marriage and childbearing<\/li>\r\n \t<li>Cultural preferences for sons over daughters<\/li>\r\n \t<li>All except for A<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>The vast majority of the world\u2019s maternal deaths occur in\u2026.\r\n<ol>\r\n \t<li>South Asia<\/li>\r\n \t<li>Sub-Saharan Africa<\/li>\r\n \t<li>South-East Asia<\/li>\r\n \t<li>Latin America<\/li>\r\n \t<li>Both A and B<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>The riskiest country on earth to become pregnant is\u2026\r\n<ol>\r\n \t<li>Malawi<\/li>\r\n \t<li>Cambodia<\/li>\r\n \t<li>Lesotho<\/li>\r\n \t<li>Afghanistan<\/li>\r\n \t<li>None of the above<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>Existing technologies and knowledge that make pregnancy and childbirth safer do not reach some populations due to\u2026\r\n<ol>\r\n \t<li>Geography<\/li>\r\n \t<li>Sub-standard health systems<\/li>\r\n \t<li>Gender bias<\/li>\r\n \t<li>Political inertia<\/li>\r\n \t<li>All of the above<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>The WHO estimates that maternal deaths dropped one-third globally from 1990 to 2008 thanks to\u2026\r\n<ol>\r\n \t<li>Contraception<\/li>\r\n \t<li>Prenatal care<\/li>\r\n \t<li>Skilled assistance during childbirth<\/li>\r\n \t<li>Abstinence<\/li>\r\n \t<li>Answers A, B, and C.<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>President Obama designated $63 million towards global health through\u2026\r\n<ol>\r\n \t<li>The Bill and Melinda Gates Foundation<\/li>\r\n \t<li>Mothers2mothers<\/li>\r\n \t<li>The Global Health Initiative<\/li>\r\n \t<li>U.S. President\u2019s Emergency Plan for AIDS Relief (PEPFAR)<\/li>\r\n \t<li>None of the above<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>Encouraging recent trends in women\u2019s health globally <strong>DO NOT<\/strong> include:\r\n<ol>\r\n \t<li>More girls are staying in school longer<\/li>\r\n \t<li>Girls are delaying their first births<\/li>\r\n \t<li>More women and couples are practicing family planning<\/li>\r\n \t<li>Many women have insufficient access to contraception<\/li>\r\n \t<li>All of the above<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>_____________ founded the Women\u2019s Social and Legal Guidance Center in Ramallah, Palestine.\r\n<ol>\r\n \t<li>Maya Kulycky<\/li>\r\n \t<li>Teresa Njeri<\/li>\r\n \t<li>Salwa Al-Najjab<\/li>\r\n \t<li>All of the above<\/li>\r\n \t<li>None of the above<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>Salwa Al-Najjab started which Jerusalem-based institution?\r\n<ol>\r\n \t<li>Juzoor (Roots) Foundation for Health and Social Development<\/li>\r\n \t<li>Kuban Medical School<\/li>\r\n \t<li>Al-Maqasid Hospital<\/li>\r\n \t<li>All of the above<\/li>\r\n \t<li>None of the above<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>The most difficult aspect of practicing medicine for Al-Najjab was:\r\n<ol>\r\n \t<li>Performing circumcisions on boys<\/li>\r\n \t<li>Being the only female doctor<\/li>\r\n \t<li>Male doctors not accepting a female colleague<\/li>\r\n \t<li>Not being accepted by female nurses, who were used to working with male doctors.<\/li>\r\n \t<li>None of the above<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>Al-Najjab stated that she first experienced discrimination\u2026\r\n<ol>\r\n \t<li>Growing up at home with her family<\/li>\r\n \t<li>At Kuban Medical School in Russia<\/li>\r\n \t<li>When she began practicing at Al-Maqasid Hospital in Jerusalem<\/li>\r\n \t<li>Working in Palestinian refugee camps<\/li>\r\n \t<li>None of the above<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>The factors of Al-Najjab\u2019s upbringing that empowered her to pursue a career in medicine include\u2026\r\n<ol>\r\n \t<li>Her family valued knowledge<\/li>\r\n \t<li>Her family included boys and girls to go to school alike<\/li>\r\n \t<li>Her mother never spoke about marriage<\/li>\r\n \t<li>She observed her aunts moving abroad to study<\/li>\r\n \t<li>All of the above<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>By seeing patients within conflict zones, rather than being confined to the hospital, Al-Najjab realized\u2026\r\n<ol>\r\n \t<li>The importance of the economic, social, and psychological determinants of health<\/li>\r\n \t<li>The value of privatized pharmaceutical research<\/li>\r\n \t<li>The importance of technology in treating neglected tropical diseases<\/li>\r\n \t<li>All of the above<\/li>\r\n \t<li>None of the above<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>The Women\u2019s Social and Legal Guidance Centre performs the following functions\u2026\r\n<ol>\r\n \t<li>Shelters women who are victims of violence<\/li>\r\n \t<li>Offers them legal assistance<\/li>\r\n \t<li>Refers their cases to the police<\/li>\r\n \t<li>Refers them to a safe house for their protection<\/li>\r\n \t<li>All of the above<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>Mothers2mother is <strong>NOT<\/strong> funded by\u2026\r\n<ol>\r\n \t<li>USAID<\/li>\r\n \t<li>PEPFAR<\/li>\r\n \t<li>Centre for Disease Control (CDC)<\/li>\r\n \t<li>Bill and Melinda Gates Foundation<\/li>\r\n \t<li>Elton John AIDS Foundation<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>Of the 33 million people carrying HIV worldwide, how many live in sub-Saharan Africa?\r\n<ol>\r\n \t<li>10 million<\/li>\r\n \t<li>25 million<\/li>\r\n \t<li>22 million<\/li>\r\n \t<li>15 million<\/li>\r\n \t<li>30 million<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>Mothers2mother\u2019s service provision includes\u2026\r\n<ol>\r\n \t<li>Enlisting only nurses who are mothers<\/li>\r\n \t<li>Recruiting only female doctors<\/li>\r\n \t<li>Enlisting HIV-positive mothers to counsel pregnant women about how testing and medication can ensure that babies are born healthy<\/li>\r\n \t<li>Providing foreign women health practitioners to carry out capacity-building workshops<\/li>\r\n \t<li>All of the above<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>Mothers2mothers program participants experience the following outcomes:\r\n<ol>\r\n \t<li>Experience a sense of purpose<\/li>\r\n \t<li>Participate in a community with other HIV-positive mothers<\/li>\r\n \t<li>Assume leadership roles amongst their peers<\/li>\r\n \t<li>Earn a salary and work experience<\/li>\r\n \t<li>All of the above<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>What percentage of women who attend mothers2mothers instruction sessions over three times per week begin antiretroviral treatment?\r\n<ol>\r\n \t<li>82%<\/li>\r\n \t<li>75%<\/li>\r\n \t<li>99%<\/li>\r\n \t<li>92%<\/li>\r\n \t<li>63%<\/li>\r\n<\/ol>\r\n<\/li>\r\n \t<li>What percentage of mothers frequently attending mothers2mothers trainings decide to receive CD4 tests?\r\n<ol>\r\n \t<li>60%<\/li>\r\n \t<li>70%<\/li>\r\n \t<li>100%<\/li>\r\n \t<li>97%<\/li>\r\n \t<li>90%<\/li>\r\n<\/ol>\r\n<\/li>\r\n<\/ol>\r\n<h4>Answers<\/h4>\r\n<ol>\r\n \t<li>Answer E (all except for A) is correct. The chapter states that biological differences (answer A) are lesser determinants of health inequalities. Instead, poverty and gender discrimination (B), adolescent marriage and childbearing (answer C), and cultural preferences for sons (D) are listed as factors that exacerbate gender inequality in health.<\/li>\r\n \t<li>The correct answer is E. The vast majority of the world\u2019s maternal deaths take place in South Asia and sub-Saharan Africa (both A and B are correct).<\/li>\r\n \t<li>The correct answer is Afghanistan (answer D).<\/li>\r\n \t<li>The correct answer is all of the above (answer E).<\/li>\r\n \t<li>The correct answer is E (answers A, B, and C).<\/li>\r\n \t<li>The correct answer is the Global Health Initiative (answer C). The Bill and Melinda Gates Foundation is a private foundation (answer A), and mothers2mothers (answer B) was funded by the Global Health Initiative. PEPFAR (answer D) was the response to HIV\/AIDS initiated by President George W. Bush in the year 2000.<\/li>\r\n \t<li>The correct answer is D (insufficient access to contraception). While staying in school (answer A), delaying first births (answer B), and practicing family planning (answer C) all illustrate progress in women\u2019s health, many women still do not have access to contraceptives (answer D).<\/li>\r\n \t<li>The correct answer Salwa Al-Najjab (answer C). Maya Kulycky (answer A) is the global communications manager at mothers2mothers and Teresa Njeri (answer B) was a participant in the mothers2mothers program.<\/li>\r\n \t<li>The correct answer is the Juzoor (Roots) Foundation for Health and Social Development (answer A). The Kuban Medical School (answer B) is where Al-Najjab earned her medical education in Russia and the Al-Maqasid Hospital (answer C) is a Jerusalem-based hospital where she began practicing medicine.<\/li>\r\n \t<li>According to Al-Najjab, the hardest thing about practicing medicine at Al-Maqasid hospital was also not being accepted by female nurses who were used to dealing with male doctors (answer D). Discrimination experienced by being the only female doctor (answer B) and being seen as less professional by her male colleagues (answer C) were also significant challenges, but not having the support of female nurses was especially difficult.<\/li>\r\n \t<li>Al-Najjab first experienced discrimination when she began practicing at the Al-Maqasid Hospital (answer B).<\/li>\r\n \t<li>The correct answer is all of the above (answer E).<\/li>\r\n \t<li>Al-Najjab realized the importance of the economic, social and psychological determinants of health (answer A).<\/li>\r\n \t<li>The correct answer all of the above (answer E).<\/li>\r\n \t<li>Answer D is correct. Mothers2mothers is not funded by the Bill and Melinda Gates Foundation. The funders for the mothers2mothers program include USAID (answer A), PEPFAR (answer B), the CDC (answer C), and the Elton John Aids Foundation (answer E).<\/li>\r\n \t<li>22 million is correct (answer C).<\/li>\r\n \t<li>Mothers2mothers enlists HIV-positive mothers to counsel pregnant women about how testing and medication can ensure that babies are born healthy (answer C). The program does not enlist only nurses who are mothers (answer A), recruit only female doctors (answer B), or recruit international women health practitioners to run capacity-building workshops (answer D).<\/li>\r\n \t<li>The correct answer is all of the above (answer E).<\/li>\r\n \t<li>The correct answer is 92% (answer D).<\/li>\r\n \t<li>The correct answer is 97% (answer D).<\/li>\r\n<\/ol>\r\n<\/div>\r\n<div class=\"textbox exercises\">\r\n<h3 itemprop=\"educationalUse\">Discussion Questions<\/h3>\r\n<ol>\r\n \t<li>What are some of the structural health factors influencing the differing levels of poor health among men and women? How is women\u2019s health issues affected by politics and culture?<\/li>\r\n \t<li>How do gender norms influence the way health is viewed and discussed?<\/li>\r\n \t<li>What encouraged Salwa Al-Najjab to pursue a career in medicine?<\/li>\r\n \t<li>What did Salwa Al-Najjab realize about health during her tenure at the Al-Maqasid Hospital?<\/li>\r\n \t<li>How does the mothers2mothers campaign build community and support among HIV-positive women?<\/li>\r\n \t<li>What are the connections between health and economic growth? What are the benefits and drawbacks of using economics and rights-based perspectives in the context of women and health?<\/li>\r\n \t<li>If technologies and knowledge to treat and prevent maternal deaths and injuries are available, why are they not reaching certain populations?<\/li>\r\n \t<li>Scholars and practitioners in the public health field have begun using the term \u201cvertical transmission\u201d instead of \u201cmother-to-child transmission.\u201d What could be the reasons for this evolution in terminology?<\/li>\r\n \t<li>Salwa Al-Najjab stated that it was \u201cdifficult to influence health policy decision makers\u201d while she was providing medical services in Jerusalem. What does this statement demonstrate about the differences between service provision and policy advocacy? Further, what are some challenges in influencing policy change that are particular to the Palestinian context?<\/li>\r\n \t<li>The chapter states that while 75% of the world\u2019s HIV-positive pregnant women live in 12 African countries, sub-Saharan Africa is desperately short of doctors and nurses. What are the reasons for this? (You will have to look outside of the text.)<\/li>\r\n<\/ol>\r\n<\/div>\r\n<div class=\"textbox exercises\">\r\n<h3 itemprop=\"educationalUse\">Essay Questions<\/h3>\r\n<ol>\r\n \t<li>To what extent should health fall under the responsibility of the individual, and to what extent should it be under the purview of the state?<\/li>\r\n \t<li>Under which presidency was the U.S. President\u2019s Emergency Plan for AIDS Relief (PEPFAR) implemented? (You will have to look outside of the text.) What, if any, were some challenges or oversights of the program and what were their implications in terms of gender and sexual orientation?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<div class=\"textbox examples\">\r\n<h3 id=\"add\" itemprop=\"educationalUse\">Additional Resources<\/h3>\r\n<strong>Bill &amp; Melinda Gates Foundation.\r\n<\/strong>More information about the Bill &amp; Melinda Gates Foundation.\r\n\r\n<a href=\"http:\/\/www.gatesfoundation.org\/\">http:\/\/www.gatesfoundation.org\/<\/a>\r\n\r\n&nbsp;\r\n\r\n<strong>Courtenay, W.H. <\/strong>\u201cConstructions of Masculinity and their Influence on Men\u2019s Well-Being: A Theory of Gender and Health.\u201d <em>Sco Sci Med.<\/em> (2000). 50(10): 1385 \u2013 1401.\r\nPaper on the linkages between masculinity, social status, economics, and sexual orientation influence men\u2019s health outcomes.\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10741575\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10741575<\/a>\r\n\r\n&nbsp;\r\n\r\n<strong>Diaz-Tello, F. <\/strong>Invisible Wounds: Obstetric Violence in the United States.<em> Reproductive Health matters 24<\/em>(47), 56 \u2013 64. (2016).\r\nContributes to the growing attention to coercion of pregnant women by health care personnel in the USA.\r\n\r\n<a href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0968808016300040\">http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0968808016300040<\/a>\r\n\r\n&nbsp;\r\n\r\n<strong>Institute for Health Metrics Evaluation.<\/strong> \u201cGlobal Health Data Visualizations.\u201d\r\nDatabase with graphics and visualizations allowing the user to compare illnesses, causes, and demographics across states, regions, and globally.\r\n\r\n<a href=\"http:\/\/www.healthdata.org\/gbd\/data-visualizations\">http:\/\/www.healthdata.org\/gbd\/data-visualizations<\/a>\r\n\r\n&nbsp;\r\n\r\n<strong>Hickel, J.<\/strong> \u00a0\u201cNeoliberal Plague: AIDS and Global Capitalism.\u201d <em>Al Jazeera.<\/em> (2012).\r\nA critical piece on the impact of structural adjustment policies, privatization, and border security on global health, particularly the HIV &amp; AIDS crisis.\r\n\r\n<a href=\"http:\/\/www.aljazeera.com\/indepth\/opinion\/2012\/12\/201212685521152438.html\">http:\/\/www.aljazeera.com\/indepth\/opinion\/2012\/12\/201212685521152438.html<\/a>\r\n\r\n&nbsp;\r\n\r\n<strong>Ramjee, G. &amp; Daniels, B. <\/strong>\u201cWomen and HIV in Sub-Saharan Africa.\u201d <em>AIDS Research &amp; Therapy<\/em> <em>10<\/em>(30): (2013).\r\nArticle expanding on the particular vulnerabilities of women to HIV &amp; AIDS in Sub-Saharan Africa.\r\n\r\n<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3874682\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3874682\/<\/a>\r\n\r\n&nbsp;\r\n\r\n<strong>The World\u2019s Women 2015.<\/strong> \u201cHealth.\u201d (2015).\r\nAnnually updated data and analysis on the gendered dimension of health, with indicators including HIV rates, STIs, access to information, antenatal care, and non-communicable diseases.\r\n\r\n<a href=\"http:\/\/unstats.un.org\/unsd\/gender\/chapter2\/chapter2.html\">http:\/\/unstats.un.org\/unsd\/gender\/chapter2\/chapter2.html<\/a>\r\n\r\n&nbsp;\r\n\r\n<strong>Wood, S. Abracinskas, L. Correa, S. &amp; Pecheny, M<\/strong>. Reform in Abortion Law in Uruguay: Context, Process and Lessons Learned. <em>Issues in Current Policy<\/em>: (2016).\r\nExamines the strategies and actors that led to passing Uruguay\u2019s \u201cVoluntary Interruption of Pregnancy\u201d bill through a feminist lens.\r\n\r\n<a href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0968808016300428\">http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0968808016300428<\/a>\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3 itemprop=\"educationalUse\">Chapter Summary<\/h3>\n<ul>\n<li><strong>\u00a0<a href=\"#over\">Overview<\/a><\/strong>\n<ul>\n<li><a href=\"#over1\"><strong>Unequal in Health<\/strong><\/a><\/li>\n<li><a href=\"#over2\"><strong>Recent Trends Encouraging<\/strong><\/a><\/li>\n<li><a href=\"#over3\"><strong>More to be Done<\/strong><\/a><\/li>\n<\/ul>\n<\/li>\n<li><a href=\"#prof\"><strong>Profile: Salwa Al-Najjab<\/strong><\/a><\/li>\n<li><a href=\"#proj\"><strong>Project: Mothers2Mothers<\/strong><\/a>\n<ul>\n<li><a href=\"#proj1\"><strong>International Partnerships<\/strong><\/a><\/li>\n<li><strong><a href=\"#proj2\">Empowering Women, Protecting Children<\/a>\u00a0<\/strong><\/li>\n<\/ul>\n<\/li>\n<li><a href=\"#ques\"><strong>Questions<\/strong><\/a><\/li>\n<li><a href=\"#add\"><strong>Additional Resources<\/strong><\/a><\/li>\n<\/ul>\n<p>This chapter discusses women\u2019s health as an indicator of a nation\u2019s political, social, and economic development. As women are half of any given nation\u2019s population, productivity is lowered when women\u2019s health is poor. Women\u2019s health is important from human rights and economics perspectives. Nearly 380,000 women die from preventable causes related to pregnancy each year. The majority of maternal deaths occur in sub-Saharan Africa and South Asia. However, maternal deaths declined by one-third globally between 1990 and 2008. Also, while women are marrying later throughout the developing world, large unmet family planning needs remain.<\/p>\n<p>The chapter examines two cases of women and organizations who have been breaking down barriers in health. Salwa Al-Najjab is a Palestinian activist who was the only female student in her medical school and went on to provide crucial health services for women in Palestinian refugee camps. Najjab\u2019s work led her to become cognizant of the economic, social, and environmental determinants of health. She founded the Women\u2019s Social and Legal Guidance Center in Ramallah. The second case study concerns the mothers2mothers (M2M) program, which operates 680 sites across sub-Saharan Africa, reaching 85,000 new and expecting mothers per month. M2M provides treatment and testing for HIV-positive pregnant women and ensures access to medication. The program provides employment and community engagement opportunities for women who are HIV-positive, and participants can become empowered members of the community.<\/p>\n<\/div>\n<div class=\"textbox key-takeaways\">\n<h3 itemprop=\"educationalUse\">Key Words<\/h3>\n<ul>\n<li>Abortion<\/li>\n<li>Antiretroviral (ARV) medication<\/li>\n<li>Elton John AIDS Foundation<\/li>\n<li>Global Information and Advice on HIV &amp; AIDS (AVERT)<\/li>\n<li>Guttmacher Institute<\/li>\n<li>Highly Active Antiretroviral Treatment (HAART)<\/li>\n<li>HIV\/AIDS<\/li>\n<li>Johnson &amp; Johnson<\/li>\n<li>Juzoor Foundation for Health and Social Development<\/li>\n<li>Mother-to-child transmission<\/li>\n<li>Mothers2mothers<\/li>\n<li>Prevention of mother-to-child transmission (PMTCT)<\/li>\n<li>Salwa Al-Najjab<\/li>\n<li>Stigma<\/li>\n<li>United Nations Joint Program on HIV\/AIDS (UNAIDS)<\/li>\n<li>United Nations Population Fund (UNPF)<\/li>\n<li>United States Department of State<\/li>\n<li>U.S. Center for Disease Control (CDC)<\/li>\n<li>U.S. President\u2019s Emergency Plan for AIDS Relief (PEPFAR)<\/li>\n<li>Women\u2019s Social and Legal Center<\/li>\n<li>World Health Organization (WHO)<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"page\">\n<figure style=\"width: 781px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/opentextbc.ca\/womenintheworld\/wp-content\/uploads\/sites\/183\/2017\/04\/39-1.jpg\" alt=\"\" width=\"781\" height=\"583\" \/><figcaption class=\"wp-caption-text\">Figure 3.1: Healthy women are an asset to their families and society. They remain fit to care for their families, earn income and contribute to their communities. A woman and child in Botswana.<\/figcaption><\/figure>\n<\/div>\n<h2 id=\"over\" class=\"chapter\"><span class=\"gray\">Overview<br \/>\n<\/span><\/h2>\n<p class=\"subchapter1\"><strong><span class=\"gray\">By Lori S. Ashford<\/span><\/strong><\/p>\n<p class=\"nonindent\"><span class=\"dropcaps\">W<\/span>omen\u2019s health can be a barometer of a nation\u2019s progress. Countries afflicted by poverty, corruption, war or weak governance often neglect their most vulnerable citizens. Frequently these are women. When women are unhealthy, their productivity is lowered and their children and families are less secure. This has an economic impact. So investing in women\u2019s health makes sense from both an economic and a human rights perspective.<\/p>\n<h3 id=\"over1\" class=\"section\">Unequal in Health<\/h3>\n<p class=\"nonindent\">Women live longer than men, statistics show, but they may spend a greater proportion of their lives in poor health for a variety of reasons, attributable less to biological differences than to poverty and gender discrimination. Poor families may invest less in their daughters, giving them less nutrition, health care and education than their sons. Such disadvantages early in life have long-term consequences for girls\u2019 health and well-being. For example, adolescent childbearing, common in countries and communities that condone child marriage, poses health risks and limits life prospects for the teen mothers and their children. If women are undernourished they risk having low birth-weight babies who, in turn, face a higher risk of early death and poor health. An added threat to the health of women and girls exists in countries where there is a cultural preference for sons, such as China and India. Sex-selective abortions and female infanticide are responsible for millions of \u201cmissing girls.\u201d The resulting shortage of women relative to men can have alarming social repercussions. An April 2011 report in <em>The Economist<\/em> cited evidence that a skewed sex ratio in India has led to increased trafficking of girls, among other abuses. Data from U.N. Population Fund studies also support this (UNFPA, 2004).<\/p>\n<p class=\"indent\">Pregnancy and childbirth take a heavy toll on women\u2019s health in the developing world. According to 2010 estimates by the World Health Organization (WHO), 358,000 women die of preventable causes related to pregnancy and childbirth every year; 99 percent of these deaths are in developing countries. In contrast, in developed countries where women deliver their babies in hospitals and have access to care for pregnancy complications, maternal deaths are extremely rare.<\/p>\n<div class=\"page\">\n<figure style=\"width: 757px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/opentextbc.ca\/womenintheworld\/wp-content\/uploads\/sites\/183\/2017\/04\/41-1.jpg\" alt=\"\" width=\"757\" height=\"476\" \/><figcaption class=\"wp-caption-text\">Figure 3.2: Two Afghan doctors examine a patient\u2019s x-ray at Rabia Balkhi Women\u2019s Hospital in Kabul, Afghanistan.<\/figcaption><\/figure>\n<\/div>\n<p class=\"indent\">The vast majority of the world\u2019s maternal deaths occur in the two poorest regions: sub-Saharan Africa and South Asia. In sub-Saharan Africa, where high fertility multiplies the dangers that mothers face over a lifetime, one in 31 women is likely to die as a consequence of pregnancy or childbirth (WHO, 2010). In developed countries, that chance is one in 4,300. Outside of Africa, Afghanistan is the riskiest place on earth to become pregnant and bear children, with a one in 11 lifetime chance of dying from pregnancy-related causes.<\/p>\n<p class=\"indent\">Millions of women suffer physical injuries or long-term disabilities, such as incontinence or ruptured organs, resulting from lack of proper care during pregnancy and childbirth. Many of these disabilities go unreported because women in developing countries consider them normal. The technology and knowledge to prevent needless deaths and injuries has long been available, but geography, substandard health systems, gender bias and political inertia all create barriers to making motherhood safer.<\/p>\n<p class=\"indent\">The HIV\/AIDS pandemic also threatens women\u2019s health in poor countries and communities. Where the virus is spread through heterosexual contact, women are more vulnerable to infection than men for physiological and social reasons, such as women\u2019s economic dependence on men, their lack of power to ask male partners to practice safer sex and \u2014 too often \u2014 coerced sex. According to a 2009 UNAIDS report, \u201cAn estimated 50 million women in Asia are at risk of becoming infected with HIV from their intimate partners \u2026 men who engage in high-risk sexual behaviours.\u201d<\/p>\n<h3 id=\"over2\" class=\"section\">Recent Trends Encouraging<\/h3>\n<p class=\"nonindent\">The good news is that today women are marrying later throughout the developing world. They are delaying first births and having fewer children than their mothers did. These trends reflect the fact that more girls are staying in school and more women and couples are practicing family planning. But there still is a large unmet need for family planning: According to a 2009 report from the Guttmacher Institute, more than 200 million women worldwide who want to avoid pregnancy do not use modern contraception. This contributes to tens of millions of unplanned births and unsafe abortions annually, often among the poorest women, who are least able to obtain and use the health services they need.<\/p>\n<p class=\"indent\">Estimates from WHO in 2010 revealed that maternal deaths dropped by about one-third globally from 1990 to 2008, thanks to a number of factors such as increased availability of contraception, prenatal care and skilled assistance during childbirth. Countries as diverse as Bolivia, China, Eritrea, Iran, Romania and Vietnam have made remarkable progress. Much more work remains to be done, however, for all countries to meet the Millennium Development Goal to reduce maternal deaths by three-fourths (compared with 1990 levels) by 2015.<\/p>\n<h3 id=\"over3\" class=\"section\">More to be Done<\/h3>\n<p class=\"nonindent\">Where countries have prioritized women\u2019s health in national policy, great progress has been made. Women should be encouraged to recognize and speak out about their health care needs, so policymakers may learn and take action. Concern about women\u2019s issues, including health care, prompted President Obama to appoint Melanne Verveer the first ambassador-at-large for women\u2019s issues, to help address such problems. Secretary of State Hillary Rodham Clinton has made global women\u2019s issues a high priority of the U.S. State Department. In 2009 President Obama designated $63 million \u2014 to be spent over six years \u2014 for the Global Health Initiative, a partnership among U.S. agencies to boost health care in the developing world, particularly for women and children. HIV\/AIDS treatment projects such as mothers2mothers, which is highlighted in this chapter, are funded by the U. S. Agency for International Development and the U.S. President\u2019s Emergency Plan for AIDS Relief.<\/p>\n<div class=\"page\">\n<figure style=\"width: 706px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/opentextbc.ca\/womenintheworld\/wp-content\/uploads\/sites\/183\/2017\/04\/43-1.jpg\" alt=\"\" class=\"\" width=\"706\" height=\"438\" \/><figcaption class=\"wp-caption-text\">Figure 3.3: Partnerships between local groups and international organizations provide health care and counseling for pregnant women and new mothers in Madagascar<\/figcaption><\/figure>\n<\/div>\n<p class=\"indent\">Improving women\u2019s health starts by recognizing that women have different needs from men and unequal access to health care. Focusing a \u201cgender lens\u201d on health services is necessary to reveal and address the inequalities between men\u2019s and women\u2019s care. This means paying more attention to girls, adolescents and marginalized women who suffer from poverty and powerlessness and changing the attitudes and practices that harm women\u2019s health. Also, men should be partners in promoting women\u2019s health, in ensuring that sex and childbearing are safe and healthy and in rearing the next generation of young leaders \u2014 both girls and boys.<\/p>\n<p class=\"bio\"><strong>Lori S. Ashford,<\/strong> a freelance consultant, has written about global population, health and women\u2019s issues for 20 years. Formerly with the Population Reference Bureau (PRB), she authored the widely disseminated PRB \u201cWomen of Our World\u201d data sheets and \u201cNew Population Policies: Advancing Women\u2019s Health and Rights\u201d for the <em>Population Bulletin,<\/em> among other publications.<\/p>\n<h2 id=\"prof\" class=\"chapterr\"><span class=\"gray\">PROFILE: <\/span>Salwa Al-Najjab &#8211; <span class=\"gray\">Palestinian Health Care Activist<\/span><\/h2>\n<p class=\"subchapter1\"><strong><span class=\"gray\"><em>By<\/em> Naela Khalil<\/span><\/strong><\/p>\n<figure style=\"width: 445px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/opentextbc.ca\/womenintheworld\/wp-content\/uploads\/sites\/183\/2017\/04\/44-1.jpg\" alt=\"\" width=\"445\" height=\"555\" \/><figcaption class=\"wp-caption-text\">Figure 3.4: Overcoming gender bias in male-dominated hospitals wasn\u2019t easy for Salwa Al-Najjab, but her success has inspired other Arab women. Her Juzoor Foundation brings medicine to poor and underserved communities.<\/figcaption><\/figure>\n<p class=\"nonindent\"><span class=\"dropcapsr\">S<\/span>alwa Al-Najjab was the best female math student in her class, and her passion for mathematics would have led her to study at the College of Engineering, but for her Russian math teacher\u2019s advice to study medicine: \u201cWith your intelligence and your strong personality, you will be of more benefit to the women of Palestine as a doctor than as an engineer,\u201d the teacher said. Salwa Al-Najjab followed her teacher\u2019s advice, and today she is changing medical care in the Palestinian Territories.<\/p>\n<p class=\"indent\">The hospital environment stirred Al-Najjab\u2019s curiosity and her love of knowledge. She hadn\u2019t realized that her medical career also would show her that many women lived in very different circumstances from her own. Al-Najjab admits: \u201cThe hospital and the medical profession opened my eyes wide to conditions which I hadn\u2019t realized were as bad and as difficult as they were.\u201d Her lifelong professional and personal battle to support women\u2019s rights and to help provide better health care for women started when she began practicing medicine in 1979 at Al-Maqasid Hospital in Jerusalem.<\/p>\n<p class=\"indent\">She expanded her efforts to create better conditions for women in the mid-1980s. Carrying her physician\u2019s bag and instrument case, Al-Najjab visited Palestinian villages and refugee camps to give women medical check-ups and treatment. She volunteered her time under the most difficult and complex conditions. She was creating change on the ground.<\/p>\n<p class=\"indent\">Today, after more than 30 years of work in hospitals and clinics in different parts of the Palestinian Territories, Al-Najjab heads the <em>Juzoor<\/em> (Roots) Foundation for Health and Social Development, based in Jerusalem. She continues to enthusiastically pursue her dream, although now, she says, it is more difficult \u201cto influence health care policy decisionmakers to improve and develop the level of health care services provided to women, and to bridge the gap between service providers and recipients.\u201d<\/p>\n<p class=\"indent\">Al-Najjab\u2019s optimism is infectious. She maintains her smile despite the challenges she has faced in her life. During her early school years, she attended eight different schools in Ramallah, Hebron and Jordan. Her father worked first at the Jordanian Ministry of Education, then at UNESCO, so her family moved frequently. This meant she and her three siblings often changed schools, making it difficult to maintain long-term friendships. However, it was always easy for her to maintain her academic excellence.<\/p>\n<p class=\"indent\">Al-Najjab traveled to Russia to attend Moscow University in 1971. After one year of Russian language study, she enrolled at Kuban Medical School in Krasdnada. Dealing with her fellow students was more difficult than learning a new language or other demanding subjects. Some Arab students looked at her disapprovingly; others underestimated her ability to succeed because she was a woman. She persevered in her studies, defying those who doubted her, and became a model of academic success. She became a mentor to Palestinian women studying abroad.<\/p>\n<p class=\"indent\">Her first job at Al-Maqasid Hospital presented her with major challenges. She was the only female resident doctor, and she began working in the obstetrics and gynecology section. It was difficult for the male doctors to accept a female colleague and professional competitor. The hardest thing for Al-Najjab was that the female nurses did not accept her either, because they were accustomed to dealing with male doctors. They believed that a male doctor was more competent and professional than his female counterpart. The atmosphere at the hospital reflected this masculine bias in the way they divided the work: Al-Najjab would do routine examinations of female patients at the hospital clinic, while the male doctors would perform surgical operations and circumcisions. They did not expect that this quiet, beautiful young woman would resist this arrangement, nor that the section head would support her.<\/p>\n<p class=\"indent\">Al-Najjab says: \u201cI refused to accept their masculine [-biased] division of labor, and I stuck to my position: \u2018I will participate in surgical operations, and I will perform circumcisions on boys.\u2019 This didn\u2019t please them, and they nicknamed me \u2018the rooster.\u2019\u201d<\/p>\n<p class=\"indent\">Al-Najjab says that the first time she experienced discrimination against women was at the hospital: \u201cI grew up in a family that offered the same opportunities to both sexes. Even my grandfather, back in the 1960s, allowed my aunts to study in Britain, to work outside of the house and to spend the night away from home. Therefore, the attitude that I faced from my colleagues at the hospital astonished me.\u201d<\/p>\n<div class=\"page\">\n<figure style=\"width: 725px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/opentextbc.ca\/womenintheworld\/wp-content\/uploads\/sites\/183\/2017\/04\/46-1.jpg\" alt=\"\" width=\"725\" height=\"567\" \/><figcaption class=\"wp-caption-text\">Figure 3.5: A nurse in a West Bank community clinic examines patients. The clinic is part of USAID\u2019s Health Flagship Project to improve community health care.<\/figcaption><\/figure>\n<\/div>\n<p class=\"indent\">Al-Najjab also learned about the unequal status of women. She says, \u201cI felt that I was getting to know my society for the first time. I would feel distraught when I delivered the baby of a girl who was no older than 15, or when I heard women affirming to me, unprompted, that men had a monopoly over decisions regarding who their daughters would marry, whether or not to use contraceptives or how many children they would have.\u201d Al-Najjab adds, \u201cWomen don\u2019t have the right to defend their own right to an education \u2026 It\u2019s a cycle that must be broken.\u201d<\/p>\n<p class=\"indent\">Al-Najjab\u2019s family valued knowledge. Her father defied convention by sending her to study in Russia. Although her mother hadn\u2019t completed her studies, she encouraged her four children, girls and boys alike, to continue their education. All of them graduated from college.<\/p>\n<p class=\"indent\">\u201cUnlike other mothers, mine never talked to me about marriage. Instead, she would always talk to me about the importance of education for a woman\u2019s life,\u201d Al-Najjab recalls.<\/p>\n<p class=\"indent\">After seven years at Al-Maqasid Hospital, during which time she helped establish several high-quality clinics in Jerusalem and its suburbs, Al-Najjab left the hospital to work in the field. \u201cI discovered that only a small number of people go to hospitals, either due to poverty or ignorance,\u201d she says. \u201cIf I wanted to provide health care to women, I had to go to them, wherever they were.\u201d<\/p>\n<p class=\"indent\">In 1985, Al-Najjab and a group of health professionals began visiting villages and refugee camps to provide health care. People\u2019s reactions were positive, but some doctors criticized her for damaging doctors\u2019 \u201cprestige\u201d by going to the patients rather than insisting that people come to the doctor.<\/p>\n<p class=\"indent\">By breaking this rule of prestige, Al-Najjab and her colleagues found conditions that they did not encounter in well-organized clinics equipped with winter heating and summer fans. They met people in far-flung places who suffered from a severe lack of health care compounded by the complex political conditions resulting from the Israeli-Palestinian conflict. Al-Najjab says, \u201cI treated women who had no bathrooms in their homes and others living in homes unfit for human habitation. I came into contact with a bitter reality that overturned all of my convictions regarding the concept of health: I realized that it wasn\u2019t only a question of physical well-being, but that health is also related to economic, social and psychological conditions, and to the environment.\u201d<\/p>\n<p class=\"indent\">She has fought many battles and continues to do so. Her convictions and her decisions are sometimes contrary to social traditions that limit women\u2019s rights. Al-Najjab is an activist who gets things done. She co-founded the Women\u2019s Social and Legal Guidance Center in Ramallah. The center shelters women who are victims of violence, offers them legal assistance, refers their cases to the police and refers them to a safe house for their protection.<\/p>\n<p class=\"indent\">\u201cI used to believe that as the years went by, change for the better would take place. But what I am noticing today is the opposite. In this social environment of political frustration and poverty, fundamentalist movements have strengthened and are actively working to move society backwards at every level. Women and women\u2019s rights are the most prominent victims,\u201d she says.<\/p>\n<p class=\"indent\">Besides leading the Juzoor Foundation, which seeks to influence health care policies, Al-Najjab heads the Middle East and North Africa Health Policy Forum, where she continues to strive for change. She was nominated by the U.S. Consulate General in Jerusalem for the U.S. Department of State\u2019s 2010 International Women of Courage award.<\/p>\n<p class=\"indent\">With a husband and three children, in addition to her medical practice and activism, Dr. Salwa Al-Najjab has a full life. Her prescription for success is this: \u201cWe cannot but be optimistic about life.\u201d<\/p>\n<p class=\"bio\"><strong>Naela Khalil<\/strong> is a Palestinian journalist. She won the 2008 Samir Kassir Award for freedom of the press.<\/p>\n<h2 id=\"proj\" class=\"chapterg\"><span class=\"gray\">PROJECT: <\/span>Mothers2mothers &#8211; <span class=\"gray\">Help for HIV-Positive Women<\/span><\/h2>\n<p class=\"subchapter1\"><strong><span class=\"gray\"><em>By<\/em> Maya Kulycky<\/span><\/strong><\/p>\n<div class=\"block\">\n<p class=\"nonindent\">HIV\/AIDS is the scourge of Africa, but in Kenya, the nongovernmental organization mothers2mothers enables HIV-positive women and their families to live full lives despite the disease.<\/p>\n<\/div>\n<p class=\"nonindent\"><span class=\"dropcapsg\">T<\/span>eresa Njeri, a single mother in Kiambu, a northern suburb of Kenya\u2019s capital, Nairobi, has a dream. She wants to build a home for herself and her six-year-old son. Recently, Teresa bought a plot of land. When she looks out over it she pictures the house she plans to build, with three bedrooms, a \u201cbig kitchen\u201d and a yard where her son can play. Teresa is confident and optimistic. But planning for a bright future, and having the means to make it a reality, is a big change for her. Ten years ago Teresa was convinced that she and her son were going to die.<\/p>\n<p class=\"indent\">In 2001, Teresa was diagnosed as HIV-positive when she was five months pregnant. \u201cThe first thing that came to my mind was death,\u201d says Teresa. \u201cAll of my hopes were shattered.\u201d The nurse at the clinic told Teresa she could protect her baby from HIV, but the nurse \u201cwasn\u2019t convincing, she was not very sure.\u201d Regardless, Teresa joined a prevention of mother-to-child transmission (PMTCT) program. Meanwhile, she disclosed her status to her husband, who also tested HIV-positive. Like others who were afraid of the stigma associated with HIV, the couple hid their status. They separated shortly after the birth of their son, who is HIV-negative.<\/p>\n<p class=\"indent\">A few months later, Teresa was hospitalized and told she had AIDS. When her father discovered her status from the hospital staff, he told her family, who isolated her and took her son away to live in the family\u2019s village. \u201cSo I was left alone, all alone in the world,\u201d Teresa remembers.<\/p>\n<p class=\"indent\">Teresa fled, sought treatment and volunteered to speak to others with AIDS. But she says she still \u201cdidn\u2019t have any focus in life. I didn\u2019t have any hope. I didn\u2019t know what to do.\u201d Then Teresa found mothers2mothers, thanks to nurses in the hospital where she volunteered. They told her that mothers2mothers was seeking to hire women trained in PMTCT. Teresa applied and became a mothers2mothers mentor mother.<\/p>\n<div class=\"page\">\n<figure style=\"width: 452px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/opentextbc.ca\/womenintheworld\/wp-content\/uploads\/sites\/183\/2017\/04\/49-1.jpg\" alt=\"\" width=\"452\" height=\"564\" \/><figcaption class=\"wp-caption-text\">Figure 3.6: Mathakane Metsing carries her daughter at their home in Khatleng, Lesotho. She was helped by \u2014 and now works for \u2014 mothers2mothers as a peer educator.<\/figcaption><\/figure>\n<\/div>\n<div class=\"page\">\n<figure style=\"width: 758px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/opentextbc.ca\/womenintheworld\/wp-content\/uploads\/sites\/183\/2017\/04\/50-1.jpg\" alt=\"\" width=\"758\" height=\"557\" \/><figcaption class=\"wp-caption-text\">Figure 3.7: Ntsiuoa Ralefifi (center) at a mothers2mothers support group at Mafeteng hospital in Lesotho. When she learned she was HIV positive, she enrolled in the transmission prevention program.<\/figcaption><\/figure>\n<\/div>\n<h3 id=\"proj1\" class=\"section\">International Partnerships<\/h3>\n<p class=\"nonindent\">Mothers2mothers \u2014 funded by USAID, PEPFAR (U.S. President\u2019s Emergency Plan for AIDS Relief) and the CDC (U.S. Centers for Disease Control), the Elton John AIDS Foundation, Johnson &amp; Johnson and other corporate and foundation partners \u2014 trains and employs HIV-positive mothers to be \u201cmentor mothers\u201d to provide counseling, education and support to newly diagnosed HIV-positive pregnant women and new mothers. It is an innovative, sustainable model of care at the forefront of prevention of mother-to-child HIV transmission. Mothers2-mothers operates 680 sites in nine sub-Saharan African countries, reaching about 85,000 new pregnant women and new mothers a month.<\/p>\n<p class=\"indent\">The African continent is struggling under the burden of HIV\/AIDS. Of the 33 million people carrying HIV worldwide, 22 million live in sub-Saharan Africa. Ninety percent of HIV-infected babies are born in the region and 75 percent of the world\u2019s HIV-positive pregnant women live in 12 African countries, according to studies done by AVERT (<a class=\"hlink\" href=\"http:\/\/www.avert.org\">www.avert.org<\/a>), the UNAIDS Regional Support Team for Eastern and Southern Africa (<a class=\"hlink\" href=\"http:\/\/www.unaidsrstesa.org\/unaids-priority\/2-preventing-mothers-dying-and-babies-becoming-infected-h\">http:\/\/www.unaidsrstesa.org\/unaids-priority\/2-preventing-mothers-dying-and-babies-becoming-infected-h<\/a>) and the <em>World Health Organization Universal Access Report 2010<\/em>. Meanwhile, the region is desperately short of doctors and nurses.<\/p>\n<p class=\"indent\">Mothers2mothers fills a gap by enlisting HIV-positive mothers to counsel pregnant women about how testing and treatment can ensure their babies are born healthy and that, if necessary, they can get medication. Mentor mothers work beside doctors and nurses in health care facilities, helping patients understand, accept and adhere to the interventions that are prescribed. They are paid members of the medical team.<\/p>\n<h3 id=\"proj2\" class=\"section\">Empowering Women, Protecting Children<\/h3>\n<p class=\"nonindent\">The results are clear. In Lesotho, data collected by mothers2mothers show that 92 percent of pregnant women who attended the organization\u2019s instruction sessions three or more times took antiretroviral (ARV) medication during pregnancy, compared to 71 percent of those who attended once. Adhering to the ARV regime is critical to decreasing mother-to-child transmission of HIV. Furthermore, 97 percent of frequently-attending mothers2mothers clients get CD4 tests, which determine the number of T-helper cells with which the body combats infections. A CD4 test shows how advanced an HIV infection is and is a first step toward receiving the life-saving highly active antiretroviral treatment (HAART).<\/p>\n<p class=\"indent\">Women are empowered by the support they receive in mothers2mothers programs. They become peer educators who are role models in their communities, while earning a salary and gaining valuable work experience.<\/p>\n<p class=\"indent\">Teresa credits mothers2mothers with giving her a sense of purpose. Her mothers2mothers colleagues encouraged her to pursue her college degree. She is studying community health and development. \u201cI feel like God created me \u2026 to talk to these women, and help them, empower them, encourage them,\u201d she says.<\/p>\n<p class=\"indent\">Teresa points to her success in helping a pregnant woman from the traditional African religion of Wakorino, whose adherents often eschew professional medical care. \u201cI saw her when I was coming to work,\u201d she says. She gave the woman her telephone number, and \u201cthe following day she called me and said, \u2018I am here at the [hospital] gate.\u2019\u201d The woman tested HIV-positive. \u201cI told her, \u2018Don\u2019t worry, because you are going to live a very long time.\u2019 I disclosed my status to her.\u201d Teresa convinced her to adhere to PMTCT treatment and deliver in the hospital. The woman gave birth to an HIV-negative child. \u201cI feel like a star,\u201d Teresa laughs.<\/p>\n<p class=\"indent\">Mothers2mothers is working to expand its reach to women in more countries and in countries where it currently operates. The impact is clear and the method is simple \u2014 a woman talking to another woman can help prevent mother-to-child transmission of HIV.<\/p>\n<p class=\"bio\"><strong>Maya Kulycky<\/strong> is the global communications manager at mothers2mothers. She also lectures in political journalism at University of Cape Town, South Africa. She previously reported for ABC News and CNBC. A graduate of Johns Hopkins University, she received a master\u2019s degree from the University of London, Goldsmith\u2019s College, and a law degree from Yale Law School.<\/p>\n<div class=\"textbox exercises\">\n<h3 id=\"ques\" itemprop=\"educationalUse\">Multiple Choice Questions<\/h3>\n<h4>Questions<\/h4>\n<ol>\n<li>The following factors are major contributions to gender inequalities in health\u2026\n<ol>\n<li>Biological differences (Women are unhealthier by nature)<\/li>\n<li>Poverty and gender discrimination<\/li>\n<li>Adolescent marriage and childbearing<\/li>\n<li>Cultural preferences for sons over daughters<\/li>\n<li>All except for A<\/li>\n<\/ol>\n<\/li>\n<li>The vast majority of the world\u2019s maternal deaths occur in\u2026.\n<ol>\n<li>South Asia<\/li>\n<li>Sub-Saharan Africa<\/li>\n<li>South-East Asia<\/li>\n<li>Latin America<\/li>\n<li>Both A and B<\/li>\n<\/ol>\n<\/li>\n<li>The riskiest country on earth to become pregnant is\u2026\n<ol>\n<li>Malawi<\/li>\n<li>Cambodia<\/li>\n<li>Lesotho<\/li>\n<li>Afghanistan<\/li>\n<li>None of the above<\/li>\n<\/ol>\n<\/li>\n<li>Existing technologies and knowledge that make pregnancy and childbirth safer do not reach some populations due to\u2026\n<ol>\n<li>Geography<\/li>\n<li>Sub-standard health systems<\/li>\n<li>Gender bias<\/li>\n<li>Political inertia<\/li>\n<li>All of the above<\/li>\n<\/ol>\n<\/li>\n<li>The WHO estimates that maternal deaths dropped one-third globally from 1990 to 2008 thanks to\u2026\n<ol>\n<li>Contraception<\/li>\n<li>Prenatal care<\/li>\n<li>Skilled assistance during childbirth<\/li>\n<li>Abstinence<\/li>\n<li>Answers A, B, and C.<\/li>\n<\/ol>\n<\/li>\n<li>President Obama designated $63 million towards global health through\u2026\n<ol>\n<li>The Bill and Melinda Gates Foundation<\/li>\n<li>Mothers2mothers<\/li>\n<li>The Global Health Initiative<\/li>\n<li>U.S. President\u2019s Emergency Plan for AIDS Relief (PEPFAR)<\/li>\n<li>None of the above<\/li>\n<\/ol>\n<\/li>\n<li>Encouraging recent trends in women\u2019s health globally <strong>DO NOT<\/strong> include:\n<ol>\n<li>More girls are staying in school longer<\/li>\n<li>Girls are delaying their first births<\/li>\n<li>More women and couples are practicing family planning<\/li>\n<li>Many women have insufficient access to contraception<\/li>\n<li>All of the above<\/li>\n<\/ol>\n<\/li>\n<li>_____________ founded the Women\u2019s Social and Legal Guidance Center in Ramallah, Palestine.\n<ol>\n<li>Maya Kulycky<\/li>\n<li>Teresa Njeri<\/li>\n<li>Salwa Al-Najjab<\/li>\n<li>All of the above<\/li>\n<li>None of the above<\/li>\n<\/ol>\n<\/li>\n<li>Salwa Al-Najjab started which Jerusalem-based institution?\n<ol>\n<li>Juzoor (Roots) Foundation for Health and Social Development<\/li>\n<li>Kuban Medical School<\/li>\n<li>Al-Maqasid Hospital<\/li>\n<li>All of the above<\/li>\n<li>None of the above<\/li>\n<\/ol>\n<\/li>\n<li>The most difficult aspect of practicing medicine for Al-Najjab was:\n<ol>\n<li>Performing circumcisions on boys<\/li>\n<li>Being the only female doctor<\/li>\n<li>Male doctors not accepting a female colleague<\/li>\n<li>Not being accepted by female nurses, who were used to working with male doctors.<\/li>\n<li>None of the above<\/li>\n<\/ol>\n<\/li>\n<li>Al-Najjab stated that she first experienced discrimination\u2026\n<ol>\n<li>Growing up at home with her family<\/li>\n<li>At Kuban Medical School in Russia<\/li>\n<li>When she began practicing at Al-Maqasid Hospital in Jerusalem<\/li>\n<li>Working in Palestinian refugee camps<\/li>\n<li>None of the above<\/li>\n<\/ol>\n<\/li>\n<li>The factors of Al-Najjab\u2019s upbringing that empowered her to pursue a career in medicine include\u2026\n<ol>\n<li>Her family valued knowledge<\/li>\n<li>Her family included boys and girls to go to school alike<\/li>\n<li>Her mother never spoke about marriage<\/li>\n<li>She observed her aunts moving abroad to study<\/li>\n<li>All of the above<\/li>\n<\/ol>\n<\/li>\n<li>By seeing patients within conflict zones, rather than being confined to the hospital, Al-Najjab realized\u2026\n<ol>\n<li>The importance of the economic, social, and psychological determinants of health<\/li>\n<li>The value of privatized pharmaceutical research<\/li>\n<li>The importance of technology in treating neglected tropical diseases<\/li>\n<li>All of the above<\/li>\n<li>None of the above<\/li>\n<\/ol>\n<\/li>\n<li>The Women\u2019s Social and Legal Guidance Centre performs the following functions\u2026\n<ol>\n<li>Shelters women who are victims of violence<\/li>\n<li>Offers them legal assistance<\/li>\n<li>Refers their cases to the police<\/li>\n<li>Refers them to a safe house for their protection<\/li>\n<li>All of the above<\/li>\n<\/ol>\n<\/li>\n<li>Mothers2mother is <strong>NOT<\/strong> funded by\u2026\n<ol>\n<li>USAID<\/li>\n<li>PEPFAR<\/li>\n<li>Centre for Disease Control (CDC)<\/li>\n<li>Bill and Melinda Gates Foundation<\/li>\n<li>Elton John AIDS Foundation<\/li>\n<\/ol>\n<\/li>\n<li>Of the 33 million people carrying HIV worldwide, how many live in sub-Saharan Africa?\n<ol>\n<li>10 million<\/li>\n<li>25 million<\/li>\n<li>22 million<\/li>\n<li>15 million<\/li>\n<li>30 million<\/li>\n<\/ol>\n<\/li>\n<li>Mothers2mother\u2019s service provision includes\u2026\n<ol>\n<li>Enlisting only nurses who are mothers<\/li>\n<li>Recruiting only female doctors<\/li>\n<li>Enlisting HIV-positive mothers to counsel pregnant women about how testing and medication can ensure that babies are born healthy<\/li>\n<li>Providing foreign women health practitioners to carry out capacity-building workshops<\/li>\n<li>All of the above<\/li>\n<\/ol>\n<\/li>\n<li>Mothers2mothers program participants experience the following outcomes:\n<ol>\n<li>Experience a sense of purpose<\/li>\n<li>Participate in a community with other HIV-positive mothers<\/li>\n<li>Assume leadership roles amongst their peers<\/li>\n<li>Earn a salary and work experience<\/li>\n<li>All of the above<\/li>\n<\/ol>\n<\/li>\n<li>What percentage of women who attend mothers2mothers instruction sessions over three times per week begin antiretroviral treatment?\n<ol>\n<li>82%<\/li>\n<li>75%<\/li>\n<li>99%<\/li>\n<li>92%<\/li>\n<li>63%<\/li>\n<\/ol>\n<\/li>\n<li>What percentage of mothers frequently attending mothers2mothers trainings decide to receive CD4 tests?\n<ol>\n<li>60%<\/li>\n<li>70%<\/li>\n<li>100%<\/li>\n<li>97%<\/li>\n<li>90%<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<h4>Answers<\/h4>\n<ol>\n<li>Answer E (all except for A) is correct. The chapter states that biological differences (answer A) are lesser determinants of health inequalities. Instead, poverty and gender discrimination (B), adolescent marriage and childbearing (answer C), and cultural preferences for sons (D) are listed as factors that exacerbate gender inequality in health.<\/li>\n<li>The correct answer is E. The vast majority of the world\u2019s maternal deaths take place in South Asia and sub-Saharan Africa (both A and B are correct).<\/li>\n<li>The correct answer is Afghanistan (answer D).<\/li>\n<li>The correct answer is all of the above (answer E).<\/li>\n<li>The correct answer is E (answers A, B, and C).<\/li>\n<li>The correct answer is the Global Health Initiative (answer C). The Bill and Melinda Gates Foundation is a private foundation (answer A), and mothers2mothers (answer B) was funded by the Global Health Initiative. PEPFAR (answer D) was the response to HIV\/AIDS initiated by President George W. Bush in the year 2000.<\/li>\n<li>The correct answer is D (insufficient access to contraception). While staying in school (answer A), delaying first births (answer B), and practicing family planning (answer C) all illustrate progress in women\u2019s health, many women still do not have access to contraceptives (answer D).<\/li>\n<li>The correct answer Salwa Al-Najjab (answer C). Maya Kulycky (answer A) is the global communications manager at mothers2mothers and Teresa Njeri (answer B) was a participant in the mothers2mothers program.<\/li>\n<li>The correct answer is the Juzoor (Roots) Foundation for Health and Social Development (answer A). The Kuban Medical School (answer B) is where Al-Najjab earned her medical education in Russia and the Al-Maqasid Hospital (answer C) is a Jerusalem-based hospital where she began practicing medicine.<\/li>\n<li>According to Al-Najjab, the hardest thing about practicing medicine at Al-Maqasid hospital was also not being accepted by female nurses who were used to dealing with male doctors (answer D). Discrimination experienced by being the only female doctor (answer B) and being seen as less professional by her male colleagues (answer C) were also significant challenges, but not having the support of female nurses was especially difficult.<\/li>\n<li>Al-Najjab first experienced discrimination when she began practicing at the Al-Maqasid Hospital (answer B).<\/li>\n<li>The correct answer is all of the above (answer E).<\/li>\n<li>Al-Najjab realized the importance of the economic, social and psychological determinants of health (answer A).<\/li>\n<li>The correct answer all of the above (answer E).<\/li>\n<li>Answer D is correct. Mothers2mothers is not funded by the Bill and Melinda Gates Foundation. The funders for the mothers2mothers program include USAID (answer A), PEPFAR (answer B), the CDC (answer C), and the Elton John Aids Foundation (answer E).<\/li>\n<li>22 million is correct (answer C).<\/li>\n<li>Mothers2mothers enlists HIV-positive mothers to counsel pregnant women about how testing and medication can ensure that babies are born healthy (answer C). The program does not enlist only nurses who are mothers (answer A), recruit only female doctors (answer B), or recruit international women health practitioners to run capacity-building workshops (answer D).<\/li>\n<li>The correct answer is all of the above (answer E).<\/li>\n<li>The correct answer is 92% (answer D).<\/li>\n<li>The correct answer is 97% (answer D).<\/li>\n<\/ol>\n<\/div>\n<div class=\"textbox exercises\">\n<h3 itemprop=\"educationalUse\">Discussion Questions<\/h3>\n<ol>\n<li>What are some of the structural health factors influencing the differing levels of poor health among men and women? How is women\u2019s health issues affected by politics and culture?<\/li>\n<li>How do gender norms influence the way health is viewed and discussed?<\/li>\n<li>What encouraged Salwa Al-Najjab to pursue a career in medicine?<\/li>\n<li>What did Salwa Al-Najjab realize about health during her tenure at the Al-Maqasid Hospital?<\/li>\n<li>How does the mothers2mothers campaign build community and support among HIV-positive women?<\/li>\n<li>What are the connections between health and economic growth? What are the benefits and drawbacks of using economics and rights-based perspectives in the context of women and health?<\/li>\n<li>If technologies and knowledge to treat and prevent maternal deaths and injuries are available, why are they not reaching certain populations?<\/li>\n<li>Scholars and practitioners in the public health field have begun using the term \u201cvertical transmission\u201d instead of \u201cmother-to-child transmission.\u201d What could be the reasons for this evolution in terminology?<\/li>\n<li>Salwa Al-Najjab stated that it was \u201cdifficult to influence health policy decision makers\u201d while she was providing medical services in Jerusalem. What does this statement demonstrate about the differences between service provision and policy advocacy? Further, what are some challenges in influencing policy change that are particular to the Palestinian context?<\/li>\n<li>The chapter states that while 75% of the world\u2019s HIV-positive pregnant women live in 12 African countries, sub-Saharan Africa is desperately short of doctors and nurses. What are the reasons for this? (You will have to look outside of the text.)<\/li>\n<\/ol>\n<\/div>\n<div class=\"textbox exercises\">\n<h3 itemprop=\"educationalUse\">Essay Questions<\/h3>\n<ol>\n<li>To what extent should health fall under the responsibility of the individual, and to what extent should it be under the purview of the state?<\/li>\n<li>Under which presidency was the U.S. President\u2019s Emergency Plan for AIDS Relief (PEPFAR) implemented? (You will have to look outside of the text.) What, if any, were some challenges or oversights of the program and what were their implications in terms of gender and sexual orientation?<\/li>\n<\/ol>\n<\/div>\n<div class=\"textbox examples\">\n<h3 id=\"add\" itemprop=\"educationalUse\">Additional Resources<\/h3>\n<p><strong>Bill &amp; Melinda Gates Foundation.<br \/>\n<\/strong>More information about the Bill &amp; Melinda Gates Foundation.<\/p>\n<p><a href=\"http:\/\/www.gatesfoundation.org\/\">http:\/\/www.gatesfoundation.org\/<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Courtenay, W.H. <\/strong>\u201cConstructions of Masculinity and their Influence on Men\u2019s Well-Being: A Theory of Gender and Health.\u201d <em>Sco Sci Med.<\/em> (2000). 50(10): 1385 \u2013 1401.<br \/>\nPaper on the linkages between masculinity, social status, economics, and sexual orientation influence men\u2019s health outcomes.<\/p>\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10741575\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/10741575<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Diaz-Tello, F. <\/strong>Invisible Wounds: Obstetric Violence in the United States.<em> Reproductive Health matters 24<\/em>(47), 56 \u2013 64. (2016).<br \/>\nContributes to the growing attention to coercion of pregnant women by health care personnel in the USA.<\/p>\n<p><a href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0968808016300040\">http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0968808016300040<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Institute for Health Metrics Evaluation.<\/strong> \u201cGlobal Health Data Visualizations.\u201d<br \/>\nDatabase with graphics and visualizations allowing the user to compare illnesses, causes, and demographics across states, regions, and globally.<\/p>\n<p><a href=\"http:\/\/www.healthdata.org\/gbd\/data-visualizations\">http:\/\/www.healthdata.org\/gbd\/data-visualizations<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Hickel, J.<\/strong> \u00a0\u201cNeoliberal Plague: AIDS and Global Capitalism.\u201d <em>Al Jazeera.<\/em> (2012).<br \/>\nA critical piece on the impact of structural adjustment policies, privatization, and border security on global health, particularly the HIV &amp; AIDS crisis.<\/p>\n<p><a href=\"http:\/\/www.aljazeera.com\/indepth\/opinion\/2012\/12\/201212685521152438.html\">http:\/\/www.aljazeera.com\/indepth\/opinion\/2012\/12\/201212685521152438.html<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Ramjee, G. &amp; Daniels, B. <\/strong>\u201cWomen and HIV in Sub-Saharan Africa.\u201d <em>AIDS Research &amp; Therapy<\/em> <em>10<\/em>(30): (2013).<br \/>\nArticle expanding on the particular vulnerabilities of women to HIV &amp; AIDS in Sub-Saharan Africa.<\/p>\n<p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3874682\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3874682\/<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>The World\u2019s Women 2015.<\/strong> \u201cHealth.\u201d (2015).<br \/>\nAnnually updated data and analysis on the gendered dimension of health, with indicators including HIV rates, STIs, access to information, antenatal care, and non-communicable diseases.<\/p>\n<p><a href=\"http:\/\/unstats.un.org\/unsd\/gender\/chapter2\/chapter2.html\">http:\/\/unstats.un.org\/unsd\/gender\/chapter2\/chapter2.html<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Wood, S. Abracinskas, L. Correa, S. &amp; Pecheny, M<\/strong>. Reform in Abortion Law in Uruguay: Context, Process and Lessons Learned. <em>Issues in Current Policy<\/em>: (2016).<br \/>\nExamines the strategies and actors that led to passing Uruguay\u2019s \u201cVoluntary Interruption of Pregnancy\u201d bill through a feminist lens.<\/p>\n<p><a href=\"http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0968808016300428\">http:\/\/www.sciencedirect.com\/science\/article\/pii\/S0968808016300428<\/a><\/p>\n<\/div>\n","protected":false},"author":17,"menu_order":3,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-58","chapter","type-chapter","status-publish","hentry"],"part":3,"_links":{"self":[{"href":"https:\/\/opentextbc.ca\/womenintheworld\/wp-json\/pressbooks\/v2\/chapters\/58","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opentextbc.ca\/womenintheworld\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/opentextbc.ca\/womenintheworld\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/opentextbc.ca\/womenintheworld\/wp-json\/wp\/v2\/users\/17"}],"version-history":[{"count":13,"href":"https:\/\/opentextbc.ca\/womenintheworld\/wp-json\/pressbooks\/v2\/chapters\/58\/revisions"}],"predecessor-version":[{"id":338,"href":"https:\/\/opentextbc.ca\/womenintheworld\/wp-json\/pressbooks\/v2\/chapters\/58\/revisions\/338"}],"part":[{"href":"https:\/\/opentextbc.ca\/womenintheworld\/wp-json\/pressbooks\/v2\/parts\/3"}],"metadata":[{"href":"https:\/\/opentextbc.ca\/womenintheworld\/wp-json\/pressbooks\/v2\/chapters\/58\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbc.ca\/womenintheworld\/wp-json\/wp\/v2\/media?parent=58"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbc.ca\/womenintheworld\/wp-json\/pressbooks\/v2\/chapter-type?post=58"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbc.ca\/womenintheworld\/wp-json\/wp\/v2\/contributor?post=58"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbc.ca\/womenintheworld\/wp-json\/wp\/v2\/license?post=58"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}