The Quiet Crisis of Europe’s Pregnant Refugees

This article first appeared on the Women & Girls Hub from News Deeply

Around one in 10 women refugees traveling through Europe is pregnant. Better coordinated approaches from states and NGOs are urgently needed to keep women and their newborn babies safe and well.

More mobile clinics and specialist services are needed for pregnant refugees crossing Europe

Tehmina was traveling through Greece from Syria when she went into labor. However, the first-time mother was determined to continue her journey and have her baby once she reached Germany. Finally, her family convinced her to go to the hospital and she agreed to give birth in Greece. Just hours later, Tehmina and her newborn left the hospital and continued to walk.

Her story is by no means unique. For the first time since the refugee and migrant crisis hit Europe, there are now more women and children on the move than male adults. Women and children account for 60 percent of refugees and migrants.

Every day, some 500 women die in pregnancy or childbirth in humanitarian settings. Sixty percent of preventable maternal deaths and 53 percent of under-five fatalities take place in countries affected by, or prone to, conflict, forced displacement or natural disaster.

The situation prompted 13 countries to announce at the first World Humanitarian Summit on May 23-24 their commitment between now and 2030 to increase their support for sexual and reproductive health services and supplies.

The plight of pregnant refugees is illustrated by a recent joint field assessment from the United Nations refugee agency (UNHCR), its Population Fund (UNFPA) and the Women’s Refugee Commission (WRC). Researchers looking into the risks for refugee and migrant women and girls in Greece and Macedonia heard from humanitarian agencies that women often left hospitals less than 24 hours after giving birth, some having had a Caesarean section.

Pregnant and lactating women, even those with health problems, are reluctant to access services or visit hospitals for fear of delaying their journey, losing their baby or being separated from their family. Most of the women seen in Greece and Macedonia had suffered severe physical and psychological stress while traveling. Even if they were otherwise healthy, they were at higher risk of complications, premature delivery or even death.

Deni Robey, the WRC’s director of strategic communications, says assessments show very little readily available sexual and reproductive health care: “Pregnant women were waiting until the last possible moment to go to a hospital to deliver and then were back out walking within a day.”

These expectant and new mothers receive no cards or flowers. As they make their way through Europe on foot, with numerous stops and practically nonexistent antenatal or postnatal care, they will be lucky to have a bed for the night or collect basic supplies such as diapers and formula.

Many will experience fatigue from walking, heavy bleeding or other complications related to pregnancy or recent birth. Others may be weak from dehydration and poor nutrition. Some are already caring for one child or more.

The report from UNHCR, UNFPA and WRC highlights single women traveling alone or with children, pregnant and lactating women, and early-married children – sometimes with newborn babies – as among those who are particularly at risk of extortion and exploitation, including multiple forms of sexual and gender-based violence (SGBV).

The E.U.-Turkey deal that came into effect March 20 only exacerbates the situation for women. Doina Bologa, the UNFPA representative for Bosnia and Herzegovina, was assigned in mid-May as the organization’s senior emergency coordinator for Europe. She says: “Currently, the migration flow through the Balkans has practically halted, with only an estimate of 200-300 illegal or irregular migrants being counted by UNHCR in transit towards the Western European countries. Some 50,000 refugees or migrants are reported to be currently stranded in Greece and accommodated in some 40 camps.”

In an open letter this month to E.U. member states and institutions, Médecins Sans Frontières international president Joanna Liu brands the official welcome offered by Europe to those stranded in Greece as “shameful,” and says camps on the Greek islands have “virtually no safeguards” in place. “Women fear to go to the toilet once darkness falls, mothers beg for milk formula to feed their babies,” she wrote.

But care and services for pregnant women are slowly starting to improve. In the last few months, UNFPA has introduced four mobile health clinics with ultrasound equipment in Serbia and Macedonia, although border closures now limit women’s access to these.

Meanwhile, UNHCR is rolling out 20 Blue Dot centers: Child and family support hubs located at strategic sites (such as border entry or exit points) that will provide a package of services including mother and baby/toddler spaces, counseling, psychosocial first aid and social workers.

Providing information in a language that pregnant women understand and having female translators at transit centers remain challenges, as does access to contraception and family planning advice, says Bologa at UNFPA.

Signatories to the 13-state WHS pledge will ensure that financing for humanitarian action includes access to sexual and reproductive health. The group also backs a rollout by 2017 of the Minimum Initial Services Package (MISP) within 48 hours of an emergency. This series of crucial actions includes an objective to prevent maternal and newborn illness and death.

Sandra Krause, director of the sexual and reproductive health program at WRC, says: “We want the commitment from all humanitarian actors to implement the MISP from the onset of every humanitarian emergency, and to comprehensive sexual and reproductive health care for all women and adolescent girls as soon as the situation stabilizes.”

Krause would like to see more mobile clinics serving this itinerant refugee population, and emergency response training for local health workers.

Bologa at UNFPA says there is a need for “more systemic and sustained attention” to gender-based violence issues, given that some of these women are pregnant because they have been involved in trafficking, transactional sex or domestic violence: “This migration is quite unprecedented, and the international community is still struggling to come to terms with these problems.”

From conflict to California: a journey through cooking and food

This article first appeared on the Women & Girls Hub from News Deeply

Sharing food from their homeland is helping the San Francisco Bay Area’s women refugees to resettle in a new country, while raising awareness of migration and its difficulties.

As a single mother living in the world’s largest refugee camp for 21 years, Somali-born Halimo supported her family by running her own small restaurant. From 7 a.m. until 6 p.m. each day, the mother of three fed more than 100 residents of Kenya’s Dadaab camp, serving up her signature dish of malawah – a sweet Somali pancake.

It’s a recipe Halimo shares – along with her story of resettling to the U.S. in 2011 – in “Between Meals,” a cookbook celebrating the food and lives of California’s refugee women.

Welcoming some 1,400 refugees each year, the San Francisco Bay Area is home to people fleeing conflict or deprivation across the globe, from Afghanistan and Burma to Nepal and Sri Lanka. And for more than 30 years, Bay Area nonprofit Refugee Transitions has been supporting newcomers through education, family engagement and community leadership programs.

The “Between Meals” cookbook project grew out of Refugee Transitions’ home-based tutoring program – a core plank of its work that connects low-income, high-need newcomers with community volunteers who teach them English and life skills. Through sharing meals with their host families and new communities, refugee women share their traditions and much-loved foods but also talk about the experiences that have brought them to their new home.

From Halimo’s Somali malawah pancakes to Naw Htoo’s coconut chicken soup from Thailand, from Arezo’s Afghan meat dumplings to Devi’s goat curry from Nepal, every single recipe tells a story.

Arezo and her family arrived in California from Afghanistan in 2010, when it was no longer safe to live in their native Kabul. Arezo misses her homeland, and the feeling of being surrounded by a large community. So she cooks to remember home and creates meals to connect with new friends. Her meat dumplings (mantu) are made with Japanese gyoza skins from a Mexican market in San Jose in California.

“Mantu is special to me because my mother made it for me the day I found out I was pregnant with my first child,” says Arezo. “I make mantu in California, especially when I miss Kabul and my family in Afghanistan.”

Laura Vaudreuil, executive director at Refugee Transitions, says food plays a significant part in the refugee journey: “Culinary traditions are a thread that connects these women to their homeland, to the personal and cultural history. ‘Between Meals’ is our contribution to preserving these (often disappearing) traditions, and highlighting refugee women’s experiences and expertise, which are so often undervalued.”

To create the cookbook, the volunteer tutor would spend between two and four hours a week with their student to hear their story, cook together and turn their dish into a recipe. Volunteers are trained in the “language experience approach,” which uses familiar subjects such as a food to accelerate language learning.

“Between Meals” author Lauren Markham says the process of recipe and story gathering led to “deepening connections” between volunteers and their students. “When Refugee Transitions matched refugee students with a new volunteer, families were often really excited to have visitors and met them with tea, snacks or even a four-course meal,” says Markham.

“The food was so delicious and the gestures so loving. [Refugee] women may not have worked in their home country so they don’t think of cooking as a skill. In an age of celebrity chefs, all of these wonderful home chefs are under-recognized.”

One of the hardest parts of the cookbook project was turning the student’s instinctive process of creating a familiar dish into a more precise process of measuring ingredients and cooking times. “You have to see the techniques for yourself and a lot of them were new to the volunteers,” explains Markham.

Another challenge was sourcing ingredients for these traditional dishes – from locating a goat farm an hour’s drive from Oakland to make goat curry to tracking down galangal root ginger in a Chinatown market for a Burmese chicken stew.

Vaudreuil says cross-cultural bonds like those created through the cookbook project are hugely beneficial to newcomers seeking to become self-sufficient and integrate into their adopted communities.

But it’s a two-way street. “Often, volunteer tutors tell us that they have benefited as much from the partnership as their students did. After all, tutoring exposes one to new knowledge, intelligence and perspectives that newcomers bring with them to the U.S.,” says Vaudreuil.

The project has been supported by Cal Humanities, an independent nonprofit state partner of the National Endowment for the Humanities. All profits from sales of “Between Meals” are distributed among the women who contributed to the cookbook, which has just printed its second edition.

“‘Between Meals’ boldly strikes new ground by centralizing the stories of the powerful women featured and elevating them as historians, keepers of culture and preservers of food traditions, as well as cooks,” says chef, educator and author Bryant Terry.

Arezo learned to make jalebi – a deep-fried syrupy sweet served at birthdays, weddings and other special occasions – from her mother at the age of 13. “In our religion, Islam, it says to eat together – to talk, to enjoy. This goes, too, for cooking … Everyone loves jalebi. When I make it in California, it reminds me of many happy times.”


Girl power to the people

This article first appeared on the Women & Girls Hub from News Deeply

Aware Girls co-founder Saba Ismail explains how her organization is helping young women in Pakistan to shape politics and the peace process

Women with their children attend a special service to mark Mother’s Day at Cathedral Church in Lahore, Pakistan. Photo by AP/K.M. Chaudary

Saba Ismail’s lightbulb moment came the day her 12-year-old cousin was told she had to drop out of school to marry a man 15 years older than her. Saba, also 12 at the time, recalls being outraged that her cousin would never finish her education or fulfill her dream of becoming a pilot.


“I realized then that education – which should be a basic human right for everyone – was actually accessible to only a very few in Pakistan,” she says.

Saba and her older sister Gulalai, 16, mobilized a handful of like-minded school friends from the girls’ hometown of Peshawar in northwest Pakistan. Their mission was to volunteer for human rights organizations and work with women’s rights activists. However, they soon realized that something vital was missing from the picture.

“At that time, there was no platform for young girls to come out and share their ideas – particularly where we were, near the border with Afghanistan, where it is a very feudal, tribal and conservative society,” says Saba.

So in 2002, at the age of 15, Saba, along with Gulalai, cofounded Aware Girls – Pakistan’s first organization run by girls, for girls, to promote women’s empowerment, gender equality and peace. “We had no real expertise, just our thoughts,” says Saba. “But there were no other organizations actually led by young women so this is what we wanted to do.”

Over the past 14 years, the Ismail sisters have grown their small group into an internationally lauded organization whose work has earned them seats at the table with the likes of First Lady Michelle Obama and U.N. General Assembly President Mogens Lykketoft.

Aware Girls has developed several award-winning themes, ranging from leadership training to HIV/AIDS awareness and peace building. Achievements include setting up over 40 Girls’ Power Clubs in schools and universities to teach more than 1,200 girls key leadership skills, and a helpline to support survivors of domestic abuse that serves more than 2,000 people every year.


Gulalai and Saba (right) Ismail, co-founders of Aware Girls (Photo: Angela Catlin)

For Saba, now 28 and executive director of Aware Girls, a key outcome has been getting more girls and young women to engage in the political process. “We come from a part of the country where, in certain areas, it’s not allowable for women to come out and cast votes,” she says.

In 2013, Aware Girls led a team of 100 young women (the first such group in Pakistan’s history) to monitor the general election. In the 2015 local elections, the organization trained 42 young women to run for office and three won seats.

Saba is also heartened by the reaction of boys taking part in Aware Girls initiatives such as its peace activist program. “Sometimes it is the first time that they have had training from a young woman, or the first time they’ve see a woman not covering her head,” she says. “They see that there’s nothing wrong with this and they tell us that they want to send their sisters on the program so that ‘they can be like you.’ We see real transformation in those boys.”

In December 2015, the U.N. Security Council adopted Resolution 2250 – groundbreaking guidance that calls on member states to increase youth representation in peace talks and conflict resolution amid “the rise of radicalization to violence and violent extremism among youth, which can be conducive to terrorism.”

Saba is passionate about seeing more young women in Pakistan included in such work, and contributed to a high-level U.N. debate on peace and security in May 2016. Aware Girls has set up a network of 200 youth peace activists in northwest Pakistan, who are trained in conflict-resolution skills and are reaching more than 1,000 young people each year through peer education and community exchanges.

Like her fellow human rights activist and compatriot Malala Yousafzai, Saba has faced danger because of her beliefs and work. In 2014, her family was threatened at home by armed men posing as security officers; the Aware Girls abortion advice helpline has received many threatening calls; and the organization has had to move office twice because of safety concerns.

“We have become refugees in our own country because of the work that we’re doing,” says Saba. “But we are still working with strength and commitment because this is our country.”

Looking ahead, Saba wants Aware Girls to expand its work and build more bridges between young women in Pakistan and Afghanistan. It is also engaging with young women to help them use digital communication more safely: “Women face a lot of harassment online so we’re working with students on how to securely use social media.”

Saba is currently in the process of setting up a New York office for Aware Girls, to improve networking and build connections that will strengthen its work to involve more young women in the political process.

“Activism is in my blood. I cannot imagine myself without this job,” she says. “But we have a long way to go. Patriarchy is everywhere and we have to continue to work on this. We are not anti-men; we are focused on equality.”

Reducing child marriage in Bangladesh

This article first appeared on the Women & Girls Hub from News Deeply

A new four-year study has found that programs that educate girls, teach them about their rights and build their career skills reduce child marriage by up to one third.

Amena (not her real name) had had several marriage proposals by the time she reached 15, but she rejected every one. The schoolgirl, who lives with her parents in southwest Bangladesh, wants to continue her studies and avoid becoming a child bride like many of her friends. While Amena knows her parents will most likely pick her future husband, she is, according to a report recently released on child marriage, one of the lucky girls in Bangladesh who hasn’t been married off before the age of 15.

Young Bangladeshi girls gather round to use a laptop. Photo by Population Council/Lachmin

Two out of three girls in Bangladesh marry before the legal age of 18 and a third will wed before their 15th birthday. Most become mothers while they themselves are still children. But targeted educational support and skills training could see child marriage in Bangladesh drop by up to a third, according to the findings of a four-year study by the Population Council.

Bangladesh has the fourth highest rate of child marriage in the world, and is second only to India in terms of absolute numbers. It’s a practice driven largely by cultural and religious beliefs, poverty and the perceived need to protect girls from harm, including sexual harassment. Research shows that the prevalence of child marriage increases at times of natural disasters, as parents worry about their daughter’s future or struggle to meet basic needs. And, while illegal, the custom of dowry (requiring a bride’s family to pay significant sums to the groom) can result in the youngest adolescent girls being married off, as often they require smaller dowries.

The United Nations Population Fund (UNFPA) maintains that child marriage is a human rights violation, which threatens girls’ lives and health and limits their future prospects. It says child marriage often leads to girls becoming pregnant while still adolescent, increasing the risk of complications in pregnancy or childbirth – a leading cause of death among older adolescents in developing countries.

The Population Council’s Bangladeshi Association for Life Skills, Income and Knowledge for Adolescents (BALIKA) project began in 2012 and has involved more than 9,000 girls aged between 12 and 18 in the rural communities of Khulna, Satkhira and Narail, where child marriage is most prevalent.

Girls across 72 communities in the northwest and southwest of Bangladesh took part in one of three skills-building interventions: educational support through tutoring in math and English (in-school girls) and computing or financial skill training (out-of-school girls); life skills training on gender rights, critical thinking and decision making; or livelihood training in entrepreneurship, mobile phone servicing, photography and basic first aid.

The girls received 100 hours of training, support and mentoring over 18 months, meeting weekly with peers and mentors in safe, girl-only locations – called BALIKA centers – that were housed in their local primary school. In addition to broadening their skills, the aim was for the girls to build their confidence, demonstrate their achievements and raise their profile within the community.

Another 24 communities served as a control to the study, with no such services, education or training provided in these locations. The girls who received educational support or life skills training were 31 percent less likely to be married while still children at the end of the study than girls in the control communities. Those who received livelihood training were 23 percent less likely to be married.

BALIKA infographic - Web Version JPEG

In Bangladesh, efforts to prevent early marriage have focused on the enforcement of laws and policies – so-called “marriage busting” – but little research has been done until now into other interventions. Sajeda Amin, a senior associate who leads the Population Council’s work on livelihoods for adolescent girls, says the BALIKA findings clearly demonstrate the impact of programs on delaying marriage age.

“Now we have not one, but three approaches that are proven to work,” she says. “The BALIKA results show that programs that build girls’ skills and knowledge and elevate their visibility and status in their families and communities while keeping them safe can significantly reduce the average child marriage rate in the community.”

Girl-centered program design was critical to the project’s success, explains Amin. Each center employed a local young woman and a local female schoolteacher to deliver training and education support.

Another key factor was community involvement: “Recruiting two local people was really critical to anchoring the program in the community,” says Amin. “The field staff also met with communities to explain critical points and engaged with them to continue the work.”

Feedback from BALIKA participants indicates greater awareness of rights and more self-confidence. One girl from Pankhali said: “I learned from BALIKA that I can say ‘No’ to a marriage proposal. I learned that if a proposal comes and I am too young to marry, I am able to express my opinion to convince my parents. If I couldn’t convince them, then I would seek out someone in the family who would understand me or else I would consult with my friends.”

The BALIKA project was delivered with a range of partners, including the Dutch government, local NGO The Population Services & Training Center, ICT group mPower and the Center for International Development Issues Nijmegen. Around 38 centers produced a viable plan to follow up the programs, the most sustainable strategy being to use the preexisting local government budget for women and children to fund the centers’ staff salaries.

The findings are cited in a recent report on child marriage in conflict from the Women’s Refugee Commission. The report suggests that child marriage can be reduced when girls have access to education, and recommends that donors and policymakers should support the piloting of child marriage interventions and learning documentation.

Bangladesh has set 2041 as the target date to eliminate child marriage, and the prime minister, Sheikh Hasina, has stated that she wants to outlaw marriage among under-15s by 2021. But a 2015 report by Human Rights Watch claimed the government is not doing enough to reach its targets, while proposals to lower the marriage age for girls to 16 have been vigorously opposed by civil society activists.

Amin at the Population Council concludes: “If we want to effectively reduce child marriage in Bangladesh, we must employ new approaches that empower each girl, engage her family and her community so she is seen as an asset, not as a liability.”