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July 18, 2005

More Needs to be Done

Arwa Mohamed Al-Rabea, Kawther Badri and Shaheena Manzoor had never met before coming to the United States this month, but they have been battling the same problems in each of their countries for most of their professional lives. Until recently, Yemen, Sudan and Pakistan saw their populations increasing, as did the maternal and neonatal mortality rate. The countries lacked family planning educational programs and education on and distribution of contraceptives. Not until they came to a two-week seminar in Baltimore, sponsored by the Bloomberg School’s Bill and Melinda Gates Institute for Population and Reproductive Health, did the three Islamic women meet. They now share a common vision after realizing the similarities of their countries’ reproductive health issues.

Shaheena Manzoor

Shaheena Manzoor

The three all agreed that their countries have begun to make reproductive health—the concept of physical, mental and social reproductive well-being, with not only the absence of disease, but also access to safe, effective, affordable and acceptable methods of family planning—a priority. However, more needs to be done. 

“Things are improving, but I think it can be improved further. We need to increase manpower and redesign the reproductive health programs,” said Manzoor, the dean of the Institute of Public Health in Lahore, Pakistan.

Pakistan, she said, hopes to increase, before the end of 2006, the number from 60,000 to 100,000 of Lady Health Workers, who are women that are assigned to different rural communities and provide contraceptives and health care education. The Pakistani government has also made reproductive health, especially decreasing the population growth rate, a priority. Pakistan also runs advertisements about contraceptives and increasing the time in between pregnancies on national television, radio and newspapers.

Yemen has a high illiteracy rate and one of the fastest growth rates in the world, and Yemeni health workers are doing what they can to place health care workers where they are needed most, said Al Rabea, the Yemen Deputy Minister of Public Health and Population. Almost 80 percent of births take place at home and the country does not have a referral system for emergency obstetric care. Sending mobile teams to rural areas, where 75 percent of the population lives, and establishing functioning health care facilities, which didn’t exist previously due to a lack of staff or equipment, are key components of Yemen’s new reproductive health plan. Creating functioning emergency obstetric care and a referral system, as well as family planning and health education are a priority.

Arwa Mohamed Al-Rabea

Arwa Mohamed Al-Rabea

“The area of reproductive health needs more work and we are now working with community and interest groups and government ministries to integrate reproductive health into educational and religious messages. The government also created a unit that focuses on women’s health,” said Al Rabea.

Kawther Badri

Kawther Badri

Sudan, which is recovering from 20 years of war, has many families moving back into the country and the process of rebuilding is a challenge to the post-war period. The country’s population is also spread throughout the country, making it difficult to reach everyone, according to Badri, director of Policy and Programs of the National Population Council of Sudan. 

She also noted that female genital cutting is widespread in Sudan. “There is confusion between cultural and religious issues. Most of the people are illiterate, so they think the cultural issues are Islamic issues. As more people are being educated, they begin to understand [the difference between the two] and everything improves and changes,” she said.

The use of contraceptives is not received well by some religious groups in Yemen and Pakistan. Some of the religious groups think that discussing the topic will encourage extra marital relationships and promiscuity. Language barriers within each country and illiteracy also make it difficult to educate populations about family planning, sanitation and other topics. “I think if you talk to the people in their own language, it would be easy to reach the community and educate them,” said Pakistan’s Manzoor.

The women returned home to continue removing the barriers that hinder each of their country’s reproductive health progress, with plans to implement some of the strategies they learned and share their knowledge with the colleagues they work with and students they teach.

Al-Rabea, Badri and Manzoor were in the United States July 5-15 to attend the 2005 Summer Institute in Reproductive Health and Development. A total of 55 participants, from 26 countries, participated in the Institute, which is in its third year. —Kenna L. Lowe

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To read more about public health in Islamic countries, read “The Muslim Mosaic: Islam and Public Health” in the spring 2005 issue ofJohns Hopkins Public Health.