Friday, 07 March 2014 11:04

Women’s Roles in Achieving MDGs

Oleh : Laksmi Amalia
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Fourteen years after Millennium Development Goals (MDGs) were launched, there are some goals that are not easy to achieve. Although almost two hundred countries prepare strategy and innovative finance to achieve these goals, they could not combat poverty which is the main problem in many developing countries. Based on Ban Ki-moon’s statement, reducing child and maternal mortality are the most difficult goals to achieve globally. In Indonesia, reducing maternal mortality, combating HIV and malaria, and making clean water available fail to be reached. To achieve these goals, women have significant roles in implementing strategy from government so that empowering women is the key to reach the goals in 2015.

Seventy percent of poor people in the world are women. It means that they do not have the right to live properly because poor people could not access nutritious food, good sanitation and health care access. This condition leads to difficulty in achieving women’s health and shows the high women’s mortality rate. In Indonesia, maternal mortality rate is 228/100.000 live births based on Indonesia Health and Demography Survey 2007 and it should be decreased to 102/100.000 live births in 2015. Until June 2010, there were 21.770 AIDS cases in Indonesia based on Ministry Health Report. Infant and child mortality rate are still high because they decrease slowly. In 2015, infant mortality rate should decrease until 23/100.000 live births and child under five years mortality rate should decrease until 32/100.000 live births.

Reducing by three quarters maternal mortality ratio is one of the target among 18 targets in MDGs. The indicators of this target are maternal mortality ratio and proportion of birth attended by skilled health personnel. There are many causes that make high maternal mortality rate in Indonesia such as severe bleeding, sepsis, unsafe abortion, eclampsia caused by gestational hypertension, and obstructed labor. Routine antenatal care is the key to solve these problems because women could monitor her pregnancy condition and health personnel such as doctor or midwife could give the suggestion to the mother about her problems related to her pregnancy. For example, if the mother has hypertension during pregnancy, she is suggested to deliver the baby in the hospital so that her delivery process is safer without eclampsia.

Health care and referral access should be available especially during the delivery process. Skilled health personnel could decrease the incidence of obstructed labor and sepsis caused by unsafe delivery. If there is bleeding in delivery process, the women should be referred to the hospital which make the blood available so that the transfusion could be done. The access of women to get contraception is important to prevent unwanted pregnancy which could make the women to have unsafe abortion. Unfortunately, most of women have weak position in a family especially the women living in rural area so that their husbands and their big family would decide where they deliver without concerning the women’s condition. The women also do not get her reproductive right because sometimes their husbands prohibit them to get contraception and delay the pregnancy. Indeed, strong women’s roles could make safe motherhood realized.

The high rate of infant mortality rate is caused by unsafe delivery which is usually done at home by unskilled birth attendant, low birth weight, and neonatal infection. Women could prevent these conditions by doing antenatal care during pregnancy in order to avert low birth weight baby. They could also deliver baby with asking help to skilled health personnel in order to have safe delivery and prevent neonatal infection such as neonatal tetanus.
The women’s knowledge about healthy nutrition is very substantial to prevent malnourished children. Besides that, if the women could have strong financial ability they could buy their children nutritious food to make their children healthier. Preventing malnutrition could decrease infectious disease rate in children because infectious disease is the main cause of child mortality. In fact, the children’s health depends on their mother’s effort.

In addition to safe motherhood and children’s health, women could decrease the spreading of HIV and AIDS. Nowadays, the number of housewives infected with HIV increase because of the increasing evidence of heterosexual HIV transmission. Their husbands who are usually injected drug users or prostitute client’s could spread HIV and AIDS. Women could encourage their husbands to do Voluntary Consulting and Testing (VCT) and support them to disclosure their status to their wives if their husbands are at risk of getting HIV. Women must also suggest their risky husbands to use condoms as a protection device. Women should know about HIV and AIDS and do VCT in order to prevent unwanted transmission to their babies if they have planned to have children. Prevention of Mother to Child Transmission (PMTCT) program which consists of giving antiretroviral drugs to the mothers and babies, doing caesarean operation to deliver the baby, and preventing breastfeeding is the most important step to decrease the number of children infected with HIV and AIDS.

However, all those steps achieving MDGs could not succeed without strengthening women’s roles and position. Low number of women’s participation in education reflects gender inequality and failure of women empowerment. Uneducated women could not have the power to improve their life. They could not work and earn money so that they could not get their independency and freedom to claim their rights to live healthy. If the government wants to correct the women’s quality of life, the government could give the easy access to get high education level for women. Educated women are expected to participate more to achieve safe motherhood, children healthy, and decreasing the number of HIV infected people.

It is clear that achieving MDGs could be done with high participation of women. Promoting gender equality and empowering women as stated in goal 3 of MDGs could be a basic foundation to reach the other goals. Furthermore, implementing the real action with appropriate policy should be done immediately so that these goals are not only the promises from almost 200 countries in UNO.

Wednesday, 05 March 2014 14:12

Women’s Fight against HIV and AIDS

By : Laksmi Amalia
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The number of women living with HIV and AIDS are increasing sharply since Luc Montaigner first found this disease in the early 80’s.  Based on the report from UNAIDS which was published in 2009, there was 15,7 million women living with HIVand AIDS in 2008. Ministry of Health reported that in 2009, out of 19.973 people living with HIV and AIDS in Indonesia, a third of them are women. Unfortunately, these women do not know that they are infected with HIV because in the early stage of infection, the patients are asymptomatic. Sometimes, they just have flu-like symptoms, but when they meet the doctor, they are diagnosed as having a common cold. Moreover, the women do not take an early detection of HIV and AIDS because they do not feel that they have the deviant behavior.  However, in fact, many women living with HIV and AIDS are infected from their couple because of changing sexual partners a lot or sharing needles.  Then, the women usually realize that they are infected in the late stage when an infection such as oral candidacies and pulmonary tuberculosis appear.

The increasing number of women living with HIVand AIDS probably could increase the number of infected children because the pregnancy, the delivery, and the breastfeeding process could raise the chance of the babies to be infected by HIV and AIDS. In addition, when women have the HIV and AIDS, many problems are related with their status such as the discrimination and the reproductive right. Even, their role and right as a mother could be disturbed because they suffer from this disease. Therefore, nowadays, there should be special attention to the women’s problems related to HIV and AIDS that could be overcome by the preventing program, early detection, and appropriate treatment of this disease.

Women are prone to be infected by HIV virus type 1 and 2 which could attack their immunity system from blood transfusion, sharing needles, and sexual intercourse. Whether the women are housewife or sexual workers they are more prone to be infected from unsafe sexual intercourse because they are in the receptive side. It means that in anal, vaginal and oral intercourse the women have the higher risk to get the infected semen and this fluid could penetrate easily because the mucosa of vagina and anus of women are thinner than the skin of penis. Unfortunately, many housewives do not know about the sexual and consumption drug history of their husbands, so when the couple does sexual intercourse they do not use the condom to protect themselves. In addition to housewife’s problem, the sexual workers could not force their sexual partners to use the condom in every sexual intercourse because their clients sometimes refuse to use this protection device.

Therefore, every woman is prone to be infected by this disease nowadays. In Yogyakarta, the number of housewives infected by HIV increased 14 % and their husbands infected them. This fact makes the handling of the disease from the prevention until the treatment stage should be done in the wider area, not only limited in the localization but also in the urban and rural area where the population live. This appropriate approach is very important because there are many problems that the women should face when they are infected with this disease.

First, their problem is discrimination. They are prone to lose their jobs or find difficulties to get them. Furthermore, they are also discriminated when they seek medical service because of their status. For example, when they are pregnant and want to do the antenatal care, some doctors and midwives sometimes refuse them. Second, the women living with HIV and AIDS could get the bad stigma from the people around her because some people suppose that this disease is related to deviant behavior. Third, when a woman has AIDS they are prone to get the opportunistic infections, which relapse easily.  Therefore, they sometimes could not do their role as a mother responsible to take care of her children. The last and the most important problem are about the reproductive problem because the women are usually infected in their reproductive age.  The women living with HIV and AIDS still have the right to have a child, but they have greater responsibility. Besides that, the couple should think about their children owing to the risk of spreading the infection and possibility of their children to be orphans. The physicians should suggest the husband who has HIV and AIDS to do sperm washing since this procedure could choose the healthy sperm from the infected semen (Djauzi, 2010).  Then the sperms meet the ovum by in vitro fertilization or the sperms are injected into the fallopian tube of the woman by the insemination process. Furthermore, women living with HIV and AIDS should consume the ARV (Anti Retroviral Drug) without considering their CD 4 counts, which describe their immunity status, and they should prevent the infection when they are pregnant. They also deliver the baby with caesarian section to reduce the direct contact between the vaginal mucosa and the baby. Even though this process could spend much time, money, and sometimes both physical and psychological burden, it is the most effective way to reduce the risk of baby to be infected HIV from their parents.

Nevertheless, it is better for the couple living with HIV AIDS not to have children to reduce the likelihood of children to get HIV and AIDS. This pregnancy prevention program is also complicated as only the condom that could be the most effective contraception for the couple with HIV and AIDS due to the bad effect of contraception pill and IUD (Intra Uterine Device) which could disturb the effect of ARV. Condom could prevent the unwanted pregnancy, decrease the risk of sexual transmitted disease related with AIDS, and prevent the unwanted mutation between the HIV viruses. Moreover, in fact, some ARVs could affect the normal menstruation cycle of the women.
Therefore, there should be enough reproductive information, education, and counseling for the women, so when they know that their husbands or  themselves are in the high risk to be infected with HIV and AIDS, they could do VCT (Voluntary Counseling and Testing) individually or together with their partners. In addition to the counseling program, the women should be encouraged to examine their reproductive health to the gynecologist routinely if they are sexually active. For the women living with HIV and AIDS who decide to have children they should do the PMTCT (Prevention of Mother to Child Transmission) with appropriate concern from their physicians. Furthermore, there should be enough support from their family and people around them to combat the stigma in order to provide the opportunity of empowering women with HIV and AIDS.
In summing up, the prevention, early detection, and appropriate treatment programs are the keys to solve the problems of women living with HIV and AIDS. There should be also enough information, education, and counseling programs that are related to HIV and AIDS. The right approaches might help Indonesian government to combat HIV and AIDS as stated as one of the Millennium Development Goals.

By : Ratnasari Nugraheni
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Rifka Annisa participated in ACICIS NGO Fair (Australian Consortium for ‘In-Country’ Indonesian Studies) on Friday, February 28, 2014, in Inculs Building, Room D-114, Cultural Science Faculty of UGM. The event was supposed to take place on February 14, 2014.  However, the city of Yogyakarta experienced disaster emergency as Mount Kelud had erupted hours before the scheduled time.

Putting aside the cloud of ashes, enthusiasm was still building up for the NGO members, particularly in taking part in the event “NGO information and NGO voluntary in Yogyakarta”. Such enthusiasm was proven by on-time attendance, at 10.00 AM (GMT+7).

The event drew the attention not only from NGO members, but also from other participants. In the two-hour event, 21 out of 30 participants visited Rifka Annisa’s counter. Most of them are students, stating to be interested in an internship at Rifka Annisa.

“I am really interested in some issues related to gender and women’s violence since I want to do a thesis research about this,” said Tamasin Young, a law faculty student from Australia. Rifka Annisa has been hosting another Australian student Yula Bardo since January.

An ACICIS NGO Fair aims to encourage ACICIS participants, all of which are students of 24 universities in Australia, New Zealand, England, and Netherland. They are to join and contribute in some NGOs in Yogyakarta. Upon joining and contributing to the assigned NGO, the students will also perform several non-academic activities, such as translating, conducting research, collecting data, and teaching English.

Rifka Annisa realizes that foreign students are interested in some issues related to gender and violence. Through this event, Rifka Annisa expects more ACICIS participants joining the organization as interns or volunteers.

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