Tanzania has pledged to improve access to education for pregnant girls after receiving a controversial $500m (£402m) World Bank loan, but has stopped short of readmitting them to mainstream classrooms.
The World Bank has been accused of undermining human rights and has faced criticism from local and international civil society groups over the Tanzania secondary education quality improvement programme loan. Campaigners say approval should not have been given without first securing a commitment from the government to reverse its discrimination towards pregnant girls and end compulsory pregnancy tests.
A public notice released earlier this week by Tanzania’s education minister, JoyceNdalichako, said: “The target [of the loan] is to reach more than 6.5 million secondary school students across the country, without discrimination and shall include girls who drop out of school for various reasons, including pregnancy.
“The government is committed to ensure that they continue with their education as prescribed in the project.”
Of the 60,000 students who drop out of secondary school every year in Tanzania, 5,500 leave due to pregnancy according to World Bank data.
Tanzania’s ban on pregnant schoolgirls dates back to the 60s. Amid renewed criticism, it was reaffirmed in a 2017 speech by Tanzania’s president, John Magufuli, who stated that “as long as I am president … no pregnant student will be allowed to return to school. We cannot allow this immoral behaviour to permeate our primary and secondary schools.”
Success! You’re on the list.
Whoops! There was an error and we couldn’t process your subscription. Please reload the page and try again.
Human rights lawyer Judy Gitau, regional coordinator at Equality Now, welcomed Ndalichako’s declaration and said she was “cautiously optimistic” about “the first time the government of Tanzania has publicly announced in an official state document that it will include pregnant girls in secondary school education”
But Elín Martinez, senior researcher at Human Rights Watch, said the Tanzanian government’s positionremained unchanged. She referred to a recent tweet in Swahili from Tanzania’s chief government spokesperson that indicated the government has set up parallel systems for pregnant girls.
“Tanzania will continue to arbitrarily deny pregnant girls the right to study in formal public primary and secondary schools – and they will only have an option of studying in a parallel system, which will now be built using the World Bank’s loan,” said Martínez, adding that the “alternative education pathways” only offer a condensed version of the curriculum, and at a cost.
The World Bank has “undermined its own commitment to non-discrimination and to improving the lives of ‘marginalised groups,’” she said.
Gitau condemmed the parallel system and called for the “reintegration of all pregnant girls to mainstream education”.
In a factsheet about the programme released last week, the World Bank said the Tanzanian government “has reaffirmed that pregnant girls who enrol in AEP [alternative education pathways] can sit for national secondary school examinations. Once they pass, they will be eligible to enrol in the next cycle of the public school system, similar to children who undertook their education in public or private schools.”
It also stated that the government has “agreed to assess the prevalence of pregnancy testing and develop an approach to address this practice” and that the World Bank will “advocate a halt to all involuntary pregnancy testing in schools in Tanzania”.
The World Bank and the Tanzanian ministry of education were unavailable for comment.
Adolescents with heavy menstrual periods may find it impossible to get through the school day without getting blood on their clothes, or wake at night to find blood on the sheets. Beyond the inconveniences, those with heavy or prolonged menstrual periods can lose a lot of blood, month by month.
In a review published in the journal JAMA Pediatrics at the end of December, Dr. Claudia Borzutzky, an adolescent medicine specialist at Children’s Hospital Los Angeles and Dr. Julie Jaffray, a pediatric hematologist at the same institution, reviewed the issue of heavy menstrual bleeding in adolescents. Both of them are faculty members at Keck School of Medicine at the University of Southern California.
“We have a lot of patients who are missing school, who leave school to be home-schooled, who are leaving sports activities, because of their really crazy heavy periods,” Dr. Borzutzky said. “Someone’s menstrual period should not be impairing them from leading a normal life, because we have really good treatments for pain and for heavy bleeding.”
Rather than defining a heavy period in terms of milliliters of blood, the doctors said it is important to take it seriously if it impairs a teenager’s functioning.
And although some teenagers may find this a difficult topic to address head-on with parents, parents will often be aware, Dr. Jaffray said, not only that their daughters may be missing school, but that they are having to wash bedsheets, or that they are going through sanitary products much faster than expected.
In the first year or two after menarche, the most common reason for heavy or prolonged periods is what is called anovulatory bleeding, reflecting a cycle in which no ovulation has actually occurred, but hormones cause continued bleeding. Over time, cycles should become more regularly ovulatory, and the bleeding should decrease, but in the meantime, the heavy periods can be treated, Dr. Borzutzy said.
Most people who have heavy periods will not actually have bleeding disorders, but about 20 percent of them will, and since some of these disorders are inherited, it is not uncommon to start by diagnosing the problem in the adolescent and move on to finding the same problem in a parent or other family member. “A mother may not recognize her daughter’s heavy menstrual bleeding because it’s just like hers,” Dr. Jaffray said. “Many times we diagnose a young girl and have to go back and encourage the mother or the father to be tested.”
These mothers may have given birth and had difficulties with blood loss, may even have had hysterectomies for their own heavy menstrual bleeding, all without finding out the underlying diagnosis, she said. The Foundation for Women and Girls with Blood Disorders works to raise awareness of these issues and increase the likelihood that medical providers make these diagnoses and treat them appropriately.
In a study published in November in the Journal of Pediatric and Adolescent Gynecology, researchers looked at 258 adolescents who came into the emergency room for heavy menstrual bleeding. Forty-four (17 percent) were admitted to the hospital, and almost a third of those had a bleeding disorder. The mean age of the girls who were hospitalized was 15, and most of them received blood transfusions or other blood products, like platelets or plasma.
Dr. Monica Woll Rosen, an assistant professor of obstetrics and gynecology at the University of Michigan Medical School who was the lead author on the study, said that in addition to the signs of heavy or prolonged menstruation, parents should watch for symptoms of anemia, such as fatigue and dizziness.
Even young women who don’t have bleeding disorders can lose enough blood through heavy menstrual periods to become significantly — and sometimes dangerously — anemic. “It’s very important especially in teenagers to have normal iron levels, to help them with growth and development, energy, intellectual function,” Dr. Jaffray said.
If a girl is passing large clots — anything from the size of a quarter on up — that’s concerning. Parents should pay attention if a daughter can’t make it through a class at school without going to the bathroom to change her pad or her tampon, if she’s taking changes of clothing to school because of accidents, if she’s regularly doubling up pads and tampons, or having periods that last longer than seven days.
The most common bleeding disorder among these young women is Von Willebrand disease, a genetic clotting defect, which can occur in more or less severe forms. These girls may also bruise easily and may have nosebleeds, or bleed from their gums when they brush their teeth. Von Willebrand disease may be inherited from either parent.
Various platelet disorders can also result in heavy menstruation, including immune thrombocytopenia, or ITP, a platelet deficiency that can occur after a viral infection. And there may be some subtle bleeding disorders that we cannot yet detect.
The American College of Obstetricians and Gynecologists recommends thinking of the menstrual period as a vital sign. Dr. Borzutzky said: “Just as important as your blood pressure and your heart rate is your menstrual period and the pattern of it.”
But because doctors were not necessarily trained to think this way, they don’t always assess this particular vital sign, and some patients may find that doctors dismiss their concerns, telling them that early on, the menstrual cycle can be irregular in various ways. “Irregular periods, be they absent or frequent or heavy, are common, but that doesn’t mean normal,” Dr. Borzutzky said. “It warrants evaluation if it’s affecting the patient’s life.”
Doctors may prescribe oral contraceptives to regularize periods without looking for bleeding disorders or other problems, Dr. Jaffray said. “I would love to say to the parents, to the patients, to really advocate for yourself if you really think you’re bleeding more than your peers.” A full evaluation is important, especially if there’s any family history to consider.
The primary treatments for heavy menstrual periods are hormones — that is to say, the medications we think of as contraceptives. “Birth control pills for hormonal benefits, a patch, a ring, a shot, an implant or an I.U.D. are all options we give these girls,” Dr. Rosen said. “Our cycles are regulated by hormones, namely estrogen and progesterone, and to decrease the amount of menstrual bleeding someone has, you can use hormones, albeit synthetic hormones, to regulate the hormones your own body is making.”
Some parents have strong objections to their daughters taking hormones, Dr. Borzutzky said, for a broad range of reasons, many connected to historical experiences with hormone therapy. Some have had bad experiences themselves, others worry about possible future effects on their daughters’ fertility or other complications, and some may be concerned that giving young women contraceptive medications will increase the chances of early sexual activity, though there is no evidence that this is true.
“There are very few patients in whom we cannot find a safe hormonal medication,” Dr. Borzutzky said. “We have to take each method one by one and talk about the safety, the benefits, the risks of each one and really go through what science we have — it’s not perfect, but we have quite a bit of safety evidence.” In addition, girls with bleeding disorders may need hematologic medications, and anyone who is anemic will need iron.
So parents should discuss this with adolescents, Dr. Borzutzky said, “when they start their menstrual life,” and make sure that their periods are not causing them a lot of discomfort. Ask if there’s anything they’ve stopped doing because of their periods, she suggested. “We say this all the time, try to just normalize discussion, give context, use humor — say, I know it feels funny to talk about this sometimes,” but emphasize that it’s a completely normal part of life, and keep on checking in.
“Say that the pediatrician has asked me to check in two or three times a year about periods,” Dr. Rosen suggested. “Say, because this is your health, I need to ask you a few questions about what’s going on with your period.”
Discrimination against girls is still entrenched in the laws of many African countries. Shocking examples are easy to find.
by Violet Odala, African Child Policy Forum
I love my job, but it can be pretty depressing. I’ve spent the past year researching and writing the first-ever continental report of the routine, blatant discrimination suffered by African girls.
The fact that girls and women are treated as inferior citizens is hardly news, except that this report reveals the extent to which gender discrimination is frequently state-sanctioned – embedded into the laws, policies and practices of many African nations. We’re talking about legal, institutional discrimination with its roots in a deeply gendered and patriarchal society. We are also talking about the denial of respect for the dignity of the African girl.
Millions of African girls face exclusion, exploitation and subjugation on a daily basis. In school, at home, out shopping, in hospitals and courts, online and offline, girls are valued and respected far less than boys. During my research I have come across numerous shocking examples, such as teenagers in Tanzania who were kicked out of school – legally – because they were pregnant.
And an HIV-positive man in Malawi, locally known as a ‘hyena’ (responsible for taking young girls through a rite of passage to prepare them for married life by having unprotected sex with them) who slept with more than 100 women and girls and escaped a charge of “defilement” for a variety of unacceptable reasons.
Then there was the foreign charity volunteer in Kenya who recruited young girls, subjected them to pornography and sexual violence, and took them to his tourist friends. He was only charged for “defiling” and committing indecent acts against them, and not under the relevant trafficking legislation.
Again in Kenya, in a recent “defilement” case, the courts exonerated an accused man who claimed in defence that he reasonably believed that a 13 year-old girl was over the age of 18 and that she was enjoying the relationship, and behaved like an adult.
In Malawi, in a similar case, a convicted male nurse was discharged after spending one month in prison because the court considered the girl was not injured, and the accused had learnt his lesson by losing his job and being imprisoned.Advertisement
Don’t miss latest stories again. Sign up!
Success! You’re on the list.
Whoops! There was an error and we couldn’t process your subscription. Please reload the page and try again.
Then there were cases in Ethiopia where underage girls have been forced by “traditional justice” to marry men who kidnapped, raped and got them pregnant.
I found that in many countries, the law discriminates against girls and fails to uphold their rights.
Laws and justice systems frequently perpetuate deeply ingrained political, social and cultural beliefs and practices designed to subjugate girls. The invisibility of girls in laws and policies has inevitably resulted in a lopsided legal pendulum tipped in favour of boys.
Ironically, some international human rights instruments may have had the unintended consequence of further marginalising girls. The Convention on the Elimination of All Forms of Discrimination against Women is child blind and the Convention on the Rights of the Child is gender blind. These treaties tend to talk in terms of “women” and “children” as distinct entities. International law seldom mentions girls as a specific group, and their rights are rarely explicitly addressed. As a result, when governments do enact legislation based on these international standards, girls can slip through the net.
There are exceptions of course, especially at the regional level. The Protocol to the African Charter on Human and People’s Rights on the Rights of Women, better known as the Maputo Protocol, and the African Charter on the Rights and Welfare of the Child (ACRWC) expand legal protection to various specific aspects of girls’ rights.
Today, after nearly 30 years of the ACRWC, gender discrimination is still embedded in the laws of many African countries – even those which are party to international agreements.
Even where laws and policies aimed at protecting and promoting the rights of girls do exist, they are frequently poorly implemented or even ignored.
Nairobi — “I think that even for the decision of female circumcision, a woman can make that decision. And once she has made that decision, she should be able to access the best medical care to have it done.”
A Kenyan doctor is seeking to legalise female genital mutilation (FGM), arguing that a ban on the internationally condemned practice is unconstitutional and that adult women should be allowed to do what they want with their bodies.
Tatu Kamau filed a petition in the Machakos High Court in eastern Kenya on Wednesday claiming that women are being harassed and arrested for undergoing FGM.
“If women can decide to drink, to smoke, women can join the army, women can do all sorts of things that might bring them harm or injury, and yet they are allowed to make that decision,” Kamau told Kenya Television News (KTN).
“I think that even for the decision of female circumcision, a woman can make that decision. And once she has made that decision, she should be able to access the best medical care to have it done.”
An estimated 200 million girls and women worldwide have undergone FGM, which usually involves the partial or total removal of the female genitalia and can cause a host of serious health problems, say health experts.
The ancient ritual – practised in at least 27 African countries and parts of Asia and the Middle East – is usually carried out by traditional cutters, often using unsterilised blades or knives.
In some cases, girls can bleed to death or die from infections. FGM can also cause fatal childbirth complications later in life, add health experts.
Kenya outlawed the practice in 2011, but it continues as communities believe it is necessary for social acceptance and increasing their daughters’ marriage prospects. One in five women and girls between 15 and 49 years in Kenya have undergone FGM, says the United Nations.
Kamau’s petition has sparked criticism from women’s rights campaigners who said overturning the ban would be a regressive step, setting back decades of gains made to improve the sexual and reproductive health of Kenya’s women and girls.
“I actually think it’s one of the worst ideas I’ve ever heard, and it’s even more shocking that it is coming from a medical doctor,” said Njoki Njehu from the charity Daughters of Mumbi Global Resource Center.
“Everything we know about FGM is that it has no benefit and causes a great deal of harm. We also know the majority of those who undergo FGM are young girls, not adults. We – all women’s rights groups – are ready to fight this if it comes to that.”
The petition is expected to heard by the court on Feb. 26.
– Reporting by Nita Bhalla @nitabhalla, Editing by Ros Russell