Archive for the womens reproductive healthcare Category

Planned Parenthood Global- Youth Peer Providers

Posted in Documentary | Photography, Ecuador, Ethiopia, Peru, teenage pregnancy, Uncategorized, womens reproductive healthcare on July 9, 2012 by tuschman

Last year, I had created a library of images for Planned Parenthood Global, which works in rural and urban areas of Guatemala, Nicaragua, Ecuador, Peru, Ethiopia, and Kenya. In all of these countries, rates of unintended pregnancy and unsafe abortions remain very high.

This post describes how Planned Parenthood has used a very innovative “Youth Peer Provider” model. This program trains young teenagers to teach and empower their peers with the knowledge that they need to prevent unwanted pregnancies and sexually transmitted diseases. These young people assume the role of health educators and contraceptive counselors. In countries where talking to young people about sex remains taboo, Youth Peer Providers help their counterparts to delay pregnancy, stay healthy, and stay in school.

The images of teenagers earnestly educating their peers, with explicit demonstrations of the proper use of condoms, are scenes that one does not normally see here in the US. Using peer counselors to educate their fellow adolescents has proven very effective in reducing rates of unintended pregnancy, and empowering teenagers to control their lives and pursue their dreams.

Below, Ofelia is a peer counselor who has been trained  by Planned Parenthood. She is pictured outside her parents guesthouse in Cusco, Peru. She is explaining the proper use of condoms to a high-school student who lives in a rural area and boards at the guesthouse.

Planned Parenthood peer counselors distributing condoms and safe-sex information to young men and sexually active teenagers in a plaza in Jinotega Nicaragua

In Riobamba, Ecuador, another demonstration to a young couple on proper condom use.

In Cajabamba, Ecuador, an indigenous teenagers instructs her peers on the proper use of birth-control pills.

In Cajabamba Ecuador, Lourdes instructs a group of teenagers on safe sex and birth-control methods. Lourdes is employed by CHEMOPLAF, an Ecuadorian NGO who has partnered with Planned Parenthood.

In Awassa Ethiopia a young peer counselor demonstrates proper use of a condom.

A group of peer mothers gathering together for their weekly coffee ceremony in Awassa, Ethiopia. They use this time to discuss their experiences in delivering family planning information to members of their communities.

A peer mother discussing safe sex and contraception to a very interested 14 year old

In Adama Ethiopia an instructor for the Forum on Sustainable Child Development instructs a group of young girls on basic sexual reproductive health and contraception.

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Teenage Pregnancy in Guatemala

Posted in Documentary | Photography, Global Health, Guatemala, Non Profit, teenage pregnancy, womens reproductive healthcare on May 2, 2012 by tuschman

In Guatemala, half of all young women marry before the age of 20. Only five percent of them use an effective method of birth control.
Forty-four percent of women become mothers before they reach 20; the proportion of young mothers is even higher among women without education (68 percent) and among indigenous women (54%). By the time they turn 30, many of these women have seven or eight children.
Although there is a federal mandate to provide universal reproductive-health education and healthcare , entrenched cultural norms and the
influence of the Catholic Church mean that very few young people receive it.

Early motherhood is recognized throughout the world as a factor that negatively impacts the physical, emotional, and reproductive well-being of young women, as well as the pace of a country’s development. In Guatemala, scarce economic resources limit the lives of most young people; an unplanned pregnancy adds further weight to their burden. Thus, it is imperative that young people have access to education regarding the additional social, psychological, and health consequences of teen pregnancy.
Stuart Schear, the former Vice President of Communications for Planned Parenthood, has written about a very innovative program that is directed at teenagers.
To quote from his blog, funding and technical assistance from Planned Parenthood supports “Tan Ux’il, a local youth organization active in the rural northern region of Petén. Tan Ux’il seeks to ensure that young people between the ages of 12 and 19 have accurate information about sexual health and birth control. The organization also advocates for health services for pregnant women.”  TanUx’il’s young activists also created a friendly clinic in a local hospital that caters to young pregnant teenagers.

The full waiting room of a prenatal clinic in a regional hospital in Peten Guatemala. The youth activist of Tan Ux’il lobbied for this youth friendly clinic and suggested that it be painted in bright colors.

A young pregnant teenager  waiting for her pre-natal exam.

This pregnant young girl is only 16 years old.

Her boyfriend was 24.

Gomber, a young DJ for Sexo Tips Radio, who shares tips about sexual health and birth control with her audience in Guatemala between playing pop songs.

Elmer, a founder of Sexo Tips Radio,  plays  popular music and answer questions from their peers about sex and puberty.

Some of the other teenagers of Tan Ux’il broadcasting their Sexo Tips radio program.

Educating Child Brides in Rajasthan India

Posted in child brides, Documentary | Photography, Girls Education, India, Non Profit, poverty, womens reproductive healthcare on April 6, 2012 by tuschman


This past January, I had another opportunity to work with EducateGirls India, an NGO that works in Rajasthan, where gender inequality is especially high. EducateGirls has intensive programs to educate as many girls as possible. Their goal is to encourage them to pursue education beyond the 6th grade. In Rajasthan, 68 percent of girls are child brides, out of which 15 percent are married below the age of ten. Educate Girls works in the Pali and Jalore districts, where a lack of education for girls is a serious problem. Both districts have alarmingly high rates of child marriage, out-of-school children, and some of the lowest literacy rates in Rajasthan.

First, a bit of background information on the issue of child brides.

 

Child Brides

“Every year, an estimated 10 million girls worldwide are married before they turn 18, usually with no say in when or whom they marry. That’s more than 25,000 girls every day, or 19 every minute. In the developing world, one in seven girls is married before her 15th birthday and some child brides are as young as eight or nine.

Neither physically nor emotionally ready to become wives and mothers, these girls are at far greater risk of experiencing dangerous complications in pregnancy and childbirth, becoming infected with HIV/AIDS and suffering domestic violence. With little access to education and economic opportunities, they and their families are more likely to live in poverty.”

from www.girlsnotbrides.org a global partnership to end child marriage

Causes of Early and Child Marriage

“Parents who cannot provide for the basic needs of their children may give a young daughter in marriage so they have one less mouth to feed and to ensure she is supported.

In parts of India, culture dictates that the bride’s family pay the groom’s family a dowry, the value of which is lower when the girl is young. This custom reinforces the idea that it’s best to hand over a girl child early, before she becomes a greater economic burden. In these circumstances, poor parents consider it a waste to invest in daughters, who are expected to leave at marriage and serve in another’s home whereas sons are expected to look after aging parents.

Illiteracy and lack of education mean many girls and their families see few alternatives for the future.

Uneducated parents are most likely to be ignorant of laws prohibiting child marriage and of the serious health risks that early sexual debut and pregnancy pose for girls. They are also more likely to see the education of females as wasteful rather than a sound investment.

Without educated females to serve as role models in a community, the multiple, proven benefits of educating girls aren’t readily apparent.”

From the World Vision report “Before she’s ready:Fifteen places girls marry by 15”.

Educate Girls in Rajasthan India

Education has proven to be an effective tool in delaying the transition of young girls into married life. Empowering and educating girls yields positive returns to individuals, families, and societies both now and for generations to come.

These four young girls are all attending school. Only Kala, on the right side, is a child bride. They are preparing for a dance performance for their mothers, whom they still live with until they reach an age determined by their families, when they have to leave and reside in their husbands’ home.

This is Devika, who is 12 years old and in the 6th grade.

Practicing for her dance performance:

Manju 13 years old and also in the 6th grade:

Manju practicing for the dance performance:

This is Kala, who is13 years old and in the 7th grade. She was married when she was three months old.

Kala preparing for the dance:

We visited Kala at home. Her parents are both manual laborers and not at home when we visited.

Here are photos of her cleaning, studying and another portrait. She had a certain elegance and brightness, and I could not help but feel saddened by the fact that her destiny was determined at three months.

This is Munni, Kala’s neighbor. She never enrolled in school. She is 16 years old and became a widow eight months ago. Now she is considered a widow for life.

This is Poonam, also 13 years old and in the 6th grade.

This is Meena, a 15 year old child bride, who dropped out in the 6th grade.

This is Chumki, 17 years old child bride who dropped out after the 6th grade.

Chaddi, who is 16 years old, with her mother Vimla.  Chaddi is pursuing her education. She is in the 10th grade,  studying at home in a long distance education program.

Vimla, who is 32 years old, is also in the same program in the 12th grade.

Mohini, a child bride is 17 years old and  is shown here with her mother. She dropped out after the 8th grade.

Pooja, a child bride with her mother. Pooja is 12 years old and in the 6th grade.

Chaddi a 14 years old child bride is in the 7th grade. She is  reading to her mother, who never had an opportunity for any education.

Sobha, in the turquoise sweater, is 21 years old and has completed her B.A. She is part of Educate Girls  “Team Balika” , girls who have had the good fortune to get an education and are employed to tutor young girls in school. EducateGirls is building a cadre of village based youth leaders to work as champions for girls’ education and catalysts for school reform. Six Hundred Twenty “Team Balika” members have been trained and are actively working to support all the programs of EducateGirls.

Payal is 13 years old and  is in the 6th grade.She is not a child bride.

Sunita is 7 years old and in the 2nd grade. Her eagerness to learn is quite clearly evident by the intensity of her concentration.

A class of 2nd graders in the village of Chitariya.

A second grader learning to read:

A seventh grader  learning intently.

A village elder looks into the classroom, perhaps wondering what it would have been like to have received more schooling:

The above examples clearly show that there is a great deal of variation in the extent that girls are getting educated. Many of the child brides will not continue school past the 6th grade. The fortunate girls who have graduated from high school and perhaps even gone on to college (i.e., the members of “Team Balika”) will provide positive role models for the community. Many School Management Committees have been formed with parents sitting on their local school boards, encouraging girls to stay in school. It is hard work to change traditions and culture, but hopefully the elders of the communities will appreciate the value of educating their girls.

Below are photos from a “Team Balika” training session. Nooreen Dossa, on the right from EducateGirls is leading a session with some of the high school graduates.

For more information about about Educate Girls programs in India, please visit:

                                                                     http://www.educategirls.in    

Dowry Abuse in India- Action India Women’s Support Group

Posted in Global Health, India, Non Profit, Recent Projects, Uncategorized, womens reproductive healthcare on March 15, 2012 by tuschman

This January, I documented the work of Action India, a grantee of the Global Fund for Women. Action India is involved in many aspects of women’s empowerment; one aspect of their work in particular, however, moved me the most: supporting women who have been victims of dowry abuse.
The Global Fund’s Anasuya Sengupta gave me the following overview:
“Dowry-related violence and death are simply one form of domestic violence that happens in India and around the world. Yet dowry abuse is a particularly pernicious form of violence, because it is closely linked to culture and religion. When they marry, women in many Indian communities take into their marital home ‘stree dhana’, or ‘women’s wealth’, which often consists of jewelry or clothes from her family. The value of the dowry has actually increased over the last few decades (in parallel with India’s economic liberalization) as a means of rapid economic gain. And the custom has even spread into communities that did not traditionally practice any form of dowry. For example, the dowry can now be found in some Muslim and indigenous (adivasi) communities, where the groom’s family traditionally paid a mehr or a bride-price. These trends have occurred despite the fact that the giving and receiving of dowry is technically illegal in India, although rarely enforced.”

The stories that I documented in India include horrific cases in which husbands and their family burnt women alive for not paying an ‘adequate’ dowry. One victim of dowry abuse whom I met was Nazia. She told her story to a women’s support group. We are in a tiny room no larger than 10 feet wall to wall. Women fill almost every inch of floor space. Most of them appear to have suffered physical abuse, and they have now gathered to support Nazia. It is hard for Nazia to speak; she is on the verge of tears, as if she has already used up all of her courage simply to come here. The support group is very important and encouraging, yet it’s hard not to feel disturbed by all the stories of mistreatment and violence.
Many perpetrators are literally getting away with murder. I asked an Indian woman who was traveling with me how this can be possible. She explained that people just make up excuses to make it seem as if the abuse and murders are all self-inflicted. For example, the family that hung their daughter-in-law could claim that the victim had felt suicidal and hung herself. Or if they badly burnt a daughter-in-law, people could claim that her sari caught fire.


Nazia is 21 years old. She has been married for two years. Her husband’s family demanded a motorcycle as part of the dowry, for which her parents gave 50,000 rupees(US$10,000) for the motorcycle. But this wasn’t enough, so the husband demanded a car. But the cost of a car was far beyond what Nazia’s parents could afford.  One day when Nazia was riding with her displeased husband on the new motorcycle, he pushed her off. His intent was clearly to kill her and cover up the murder as a traffic accident. She was seven months pregnant at the time.

After Nazia survived the “accident,” her husband tricked her into taking some medicine to help her recover. Instead of feeling better, she felt ill and went to the hospital, where she delivered a stillborn child. After Nazia was discharged from the hospital (which required her husband to sign some papers, apparently) he left without her. Nazia has been living with her mother for the past five months. She wants a divorce and the return of her dowry. She broke into tears shortly after I photographed her.


Shanthi had only one daughter named Kavita. When Shanthi marrid, her in-laws demanded 5,000 rupees. But she could only afford 3,000. For lack of 2,000 rupees (US$40) Shanti’s in-laws hanged and murdered her daughter, Kavita.


Kamalesh is a woman with a very abusive husband (note the scar underneath her eye). He is a drunkard and regularly beats her. She still lives with her husband but on a different floor of the house. The husband does not take care of her or her children, and Kamalesh has nowhere else to go.


A mother and daughter in a rural village, 70 km outside of Delhi. I believe the mother’s name is Indu and her daughters is Tinko. Tinko had suffered through five years of abuse. She is living with her mother now, who is very supportive.
Here is a recent article by a very well-known Indian journalist, Kalpana Sharma, which gives a strong analysis and overview of dowry-related violence and homicide in India:
http://www.thehindu.com/opinion/columns/Kalpana_Sharma/article2856945.ece

To quote from the article:
“The official figures of dowry deaths are obviously just the tip of the iceberg. A truer picture would emerge if we added the cases of young married women registered as having committed suicide.
Dowry has not disappeared. It has morphed. Seema Sirohi, in her interesting and relevant book Sita’s Curse, Stories of Dowry Victims (HarperCollins, 2003), gives this humorous yet apt description of dowry as it has come to be today: Dowry has become a bribe paid to a husband to keep the bride’s body and soul together. A woman is a mere conduit to a ‘good’ dowry – the
definition of ‘good’ being flexible and expandable. The boys are on sale and
there are few discounts in the marriage market. There is no ‘buy one, get
one free’ here. It is a transaction weighted against the woman. In fact, it is a sale where even after the price is paid, satisfaction is not guaranteed. And ironically, the sale is never complete with marriage – the buyer is expected to keep paying in cash and in kind during festivals, to celebrate childbirth, and to mark ritualistic occasions. Any excuse is good enough to keep the one-way street laden and moving with gifts.
The fact that women are still being burned for dowry in modern-day India should enrage us. Why are we accepting of this outrage, this insult to the sensibilities of all women? We should be burning dowry, not women.”

Planned Parenthood Global and Soccer in Kenya

Posted in Africa, Documentary | Photography, Girls Education, Global Health, Kenya, Non Profit, Recent Projects, Uncategorized, womens reproductive healthcare on February 22, 2012 by tuschman

(The following text has several contributors- primarily Joyce Ho, a Graduate Media Fellow from the Stanford School of Medicine and Leila Darabi from Planned Parenthood Global).

In Kenya, Planned Parenthood Global (PP Global) works with several local soccer leagues to integrate sexual and reproductive health education and services into their programs.

For many, expectations for their educational and career success do not extend beyond completing primary school. Some are already mothers. Joining an athletic league provides these young women with the chance to exercise, become part of a team, and have some fun. Evidence shows that young women who participate in team sports are more confident, stay in school longer, and set more ambitious career goals than those who never get to run across a field or score a goal.

Using their Youth Peer Provider model, PP Global’s partners train young people to become health educators and contraceptive counselors in their own right. Youth Peer Providers work closely with local clinics and are trained by public health experts to teach their peers how to avoid unwanted pregnancy and sexually transmitted infections, and to provide contraception to young people who need it. This peer-to-peer model circumvents the stigma and barriers that surround adolescent sexual and reproductive health services. In countries where talking to young people about sex remains taboo, Youth Peer Providers help their counterparts delay pregnancy, stay healthy, and stay in school.

We will follow two girls: Sylvia, who lives on in the Kilifi district on the coast of Kenya and Anne, who lives in an urban slum in Nairobi (names changed to protect their privacy).

In the Kilifi District on the coast of Kenya, HIV and teen pregnancy trap some of the world’s poorest and most disadvantaged adolescent girls in a relentless cycle of poverty. A local community organization called Moving the Goalposts (MTG) sought to address this issue by organizing a young women’s soccer league. By engaging these young women in physical activities that promote camaraderie, MTG helps its players build self esteem and leadership skills. The framework for MTG represented a unique entry point for reproductive health initiatives for these young women, to give them the knowledge and tools to protect their sexual health.

In 2011, MTG and Planned Parenthood formed a collaboration to build a sexual health youth peer provider program into the soccer league. Sylvia, age 22, is one of the first peer providers trained through the MTG and Planned Parenthood program in Kilifi. She plays on the older girls’ soccer league and teaches sexual health classes to her peers before games.

The unique quality of the peer provider program lies in increased access to the target population. Young people are hard to reach, especially in areas where enrollment in school is limited. Sometimes adults speak different languages from the younger generation, and oftentimes, youth shy away from asking questions about sexual health out of embarrassment or discomfort. Peer providers know exactly how to reach the ones they are trying to help – they know how to communicate effectively and lessons are safe places where girls can ask any sort of question and not feel embarrassed. Here, Sylvia demonstrates the proper way to use a condom while her teammates listen and learn.

A young woman in Kenya knows that if she gets pregnant, she will probably be forced to drop out of school and the course of her life will be unalterably changed, leaving her with very limited options.  Through MTG and Planned Parenthood, these soccer players are becoming empowered to take their health needs into their own hands. Sylvia, a star player on her team, understands the importance of this program, and thus devotes many hours a week to peer counseling and soccer practice.

The girls don’t live close to the soccer fields. Many players walk miles from the slums to the more well-kept neighborhoods where the soccer games are held, demonstrating their true dedication to the program.

Sylvia lives at home with her mother, the head of the household, who is proud to have such a responsible daughter who spends time volunteering to help her community. Sylvia has an older sister who is currently married with children, and Sylvia  wants to finish her education first before embarking on a similar life path.

Next year Sylvia plans to start classes at the local university. After finishing secondary school, she took time off to work and save up money, all the while debating whether college was within her reach. Sylvia’ experience with the team and the Youth Peer Provider program helped build up her confidence and plan for her future. This is in stark contrast to the future in store for many of her peers who haven’t finished secondary school and are already mothers. Sylvia has truly broken the mold, and unlike most of the young women who grew up in her neighborhood, she will make it to that next level of education. It is our hope that Moving the Goalpost and Planned Parenthood Global can continue to work together to inspire other similar girls to take ownership of their futures.

In Nairobi, PP Global partners with the Bravilian Queens, a nonprofit that organizes several teams in the newly established Nairobi Girls Soccer League. The program takes advantage of team practices, a time when a group of young women are gathered together, to provide basic sex education and answer any questions about puberty, sex, relationships and contraception.

Anne lives in one of the urban slums of Nairobi. To reach her home, one has to walk past an open latrine and then walk about 400 meters over a hill on a path littered with trash.

Here she is pictured with her parents and her younger sister.

Anne is not a Peer Counselor but one of the girls whose self-esteem is greatly benefited by her athletic prowess on the soccer field and her knowledge of her own reproductive health care needs.

Anne participates with great enthusiasm even though she does not have the funds to buy a pair of soccer shoes. She either borrows a spare pair when available or, in most cases, plays in knee socks and sandals.

A few 2011 highlights

Posted in Awards, Documentary | Photography, Global Health, Kenya, Malaria, News, Non Profit, Recent Projects, womens reproductive healthcare with tags on December 28, 2011 by tuschman

I had the privilege of working on some very satisfying and rewarding projects this past year. I documented the Novartis Malaria Initiative and a few of my photos were recently used in an ad for Novartis in the Dec. 19th issue of the New Yorker. Here is the ad and I have also included the two images uncropped.

I also had the privilege  of photographing a library of images for Planned Parenthood Global and here are a few images that were used in their Annual Report:

To see the full Annual Report, here is a link: (All the large double paged photos are mine with the exception of the one taken in the US).

http://www.tuschmanphoto.com/pdf/International_Brochure.pdf

On the local level I photographed an Annual Report for the Palo Alto Medical Foundation focusing on their oldest patients. Despite the stereotypes of old age, these people were very inspirational. The youngest person, in their late 80’s was a ballroom dancer and the oldest- and this was hard for me to believe- was 105 years old, lived in her own home, had just come back from a cruise and wanted me to help her buy a new computer!

Here is a link to a pdf of the PAMF AR.

http://www.tuschmanphoto.com/pdf/PAM035_Annual2011_lowres.pdf

Several of the images from this past year received awards in photography competitions.

The image of the Ecuadorian women below was awarded a fifth place award in the APA Something Personal Exhibit in SF this past January.

One of my portraits was nominated among the best in the portrait category of the

INTERNATIONAL COLOR AWARDS PHOTOGRAPHY MASTERS CUP. Photo is below:

And finally the following image was accepted into the One Life International Photography Competition. It was taken while I was documenting a girl’s education program in Rajasthan.

I also was fortunate to collaborate wit Gayle Peterson, a philanthropic consultant, on her new venture.

Click here to see the full muti-media presentation:

http://tuschmanphoto.com/Partners_for_Change_.mov

I will be posting stories from the work I did for Planned Parenthood and the Novartis Malaria Initiative. My next post, however, will be on the problem of third world urban slums, in particular, the slum of Kibera in Nairobi, which I had the occasion to visit twice this past year.

7 Billion Unique Stories

Posted in Documentary | Photography, education, News, Non Profit, Recent Projects, Uncategorized, womens reproductive healthcare on July 15, 2011 by tuschman

A new report from the UN comes just ahead of a demographic milestone: the world’s population is expected to pass 7 billion in late October, only a dozen years after it surpassed 6 billion. The UNFPA (United Nations Population Fund) is about to release a new campaign urging each individual and organization to take creative action to solve the immense problems we face as global interconnected community. To quote from the brochure, “every day one billion of us go hungry, two billion of us are surviving on less than $1 a day, one billion of us don’t have access to clean water and more than one thousand women die in pregnancy or during childbirth each day.”

“In a world that is more interconnected than ever before, challenges such as poverty, inequality, women’s rights, aging and the environment belong to all of us.”

“These are problems that can, and must be solved. Thankfully, significant strides are being made by committed organizations and impassioned individuals all over the world. Working together, incremental actions will create exponential results.”

I am very proud that many of my images are being used to highlight this call to action. Below are ten posters featuring the campaign. Other photographs will also be used in a National Geographic insert, a multi-media web presentation and an exhibit in Copenhagen.

For those not familiar with UNFPA, the “United Nations Population Fund is an international development agency that promotes the right of every woman, man and child to enjoy a life of health and equal opportunity. UNFPA supports countries in using population data for policies and programmes to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect. UNFPA – because everyone counts.”

For the remainder of the year I will be posting stories on some of the issues that I have documented this past year, including a girl’s education project in Rajasthan, India and family planning programs in Latin America for Planned Parenthood. I also will be working in Kenya and Ethiopia, documenting malaria treatment and prevention and women’s reproductive healthcare.