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Women’s Rights and Access to Maternal and Reproductive Healthcare

As someone who has worked on international development issues from my desk in Washington, I was excited to participate in the 2013 Women Deliver Conference last week in Kuala Lumpur, Malaysia.

The conference afforded me an amazing opportunity to listen and talk to a variety of people from 149 countries about their experiences and views related to the health and well-being of women and girls. A recurring theme that emerged from the week was the issue of women’s sexual and reproductive health. I have never written about reproductive health before, but I’ll credit that up to never spending a week at a conference focused on maternal and reproductive health before this experience.

Since returning home, I have spent a lot of time thinking about the issue of reproductive health and I firmly believe that we need to start thinking about this issue in a different way – through the lens of a woman or a young girl in a developing country, and with an eye on equality.

In the U.S., we all face the reality that a majority of young adults engage in sexual relations outside marriage, and we educate our kids to wait to have sexual relationships – preferably until marriage. But as parents, we also want to ensure that they know how to protect themselves when they decide to engage in such activities.

This was a key part of the international dialogue I participated in; however, on the international front, in many poor or developing countries, access to reproductive health includes a very different reality.

That reality is that girls and women’s rights are systematically violated in too many places around the world today. (I would encourage anyone reading this or interested in this issue to check out the trailer, and the movie called Girl Rising, an innovative new feature film that highlights the struggles of women and girls around the world). In some cultures, it is still considered acceptable for a husband to beat his wife for not having sex. In too many places, girls are forced into marriage at far too young an age. HIV disproportionately impacts women. In many cultures, when reproductive health options are available, a woman’s male partner often vetoes her decision to use those options.

Women and girls in developing nations are more likely to become mothers at a young age. We know that pregnancy during adolescence has serious health impacts for girls and their babies. There are complications from pregnancy and childbirth – which is the leading cause of death among girls, aged 15-19 in developing countries.

Approximately one in three women will experience gender-based violence in her lifetime. In some pacific countries, more than 60% of women and girls experienced violence at the hands of their partners.

I met a woman from the Congo at the conference. We were discussing access to female contraception and she explained to me that access to female condoms in her village have been transformative because women and girls are now using these resources when walking miles to the wells to get water. The incidence of rape is so great, that these women and girls have decided to use female condoms to avoid unwanted pregnancies.

In developing countries, desire for smaller families and the motivation for healthy spacing of births has steadily increased. Yet, 222 million women in developing countries do not have the ability to determine the size of their families, or have a say in the planning of their families.

MDG 5 — Improve Maternal Health — has two sub targets. Target 5A set a target of reducing maternal mortality by three-fourths by 2015, while Target 5B set a target of universal access to reproductive health.

The achievement of the MDGs is strongly underpinned by the progress that the world makes on sexual and reproductive health. It is a pillar for supporting the overall health of communities, in particular, that of women. Ill health from causes related to sexuality and reproduction remains a major cause of preventable death, disability, and suffering among women. Apart from the health consequences, poor sexual and reproductive health contributes significantly to poverty, inhibiting affected individuals’ full participation in their own social and economic development.

I was surprised to learn that the world has not made as much progress on this front as is needed to meet MDG5 by 2015. Many countries in sub-Saharan Africa and South Asia have shown little progress in recent years; some have even lost ground. Globally, the rate of death from pregnancy and childbirth declined between 1990 and 2005 by only 1% per year. In order to be on track to achieve MDG 5, a 5.5% annual rate of decline was needed from 2005 to 2015.

During my week at the conference, our group was fortunate enough to have a conversation with Melinda Gates. We were all enlightened and her comments during our conversation were extremely helpful to me. Mrs. Gates stated that when she talks about health with women from developing countries, they explain to her that their job is to feed the children. They explain that if they cannot space out their births, they cannot work or properly care for and feed the other children. In many places, Melinda explained that while condoms might be readily available, women – due to cultural perceptions – couldn’t even fathom negotiating the use of condoms because it means they are suggesting that their partner might have AIDs or that she is trying to say she has AIDs.

The Gates Foundation does not fund abortions, and has it right when they state that we need to put girls and women at the center of this debate. We need to start trusting one another and realize that “family planning” is not code for anything else in this debate.

As the week progressed, I became certain that the only way for the world to begin to correct this problem is for us to start trusting one another and to look at this issue as an equality rights one, not something else. Advancing equality among boys and girls and men and women is a goal we can all support.

I am confident that if we are successful in achieving equality, many other aspects of this problem begin to fall into place. Perhaps, once achieved, we might even begin to have a significant impact on achieving MDG5.

Just think of all the good that could come from advocating for ensuring that women and girls have the right to access maternal and reproductive health care. Treating women and girls all around the world equally might eradicate early and forced marriage, keep girls in school, give women a say in their family planning, and end gender-based violence.

One of my take-aways from the conference was that women’s rights and access to maternal and reproductive healthcare must be a highlight of our global development agenda. The issue is too important to ignore, or be mired in obtuse political innuendo. With the right focus and attention, we can ensure that sexual and reproductive health is readily available and sustainable for all women.

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Visiting Kuala Lumpur

Visiting the City…

Or how to kill yourself your first day in KL after a twenty hour flight! I think our group should receive an award for making the most out of 7 hours of free time in Kuala Lumpur. After a fast turn around this morning, we set out on our adventure through the city, hitting all of the city’s key attractions, all while facing what felt like 100 degrees and higher humidity than I’ve ever felt before.

Any perceived notions I may have had about Kuala Lumpur were shattered today. This is a vibrant, modern city with a vast infrastructure and bustling neighborhoods. Kuala Lumpur has an estimated population of 1.6 million. The population’s diversity is amazing. Which is the key reasoning for the incredibly mix of ethnic and cultural influences you find here.

From the “just because I thought you might like to know” files, Malaysia’s constitution declares Islam the state religion while protecting freedom of religion. The government system is closely modeled on the Westminster parliamentary system and the legal system is based on English Common Law. The head of state is the King, but he is known as the Yang di-Pertuan Agong. He is an elected monarch chosen from the hereditary rulers of the nine Malay states every five years. The head of government is the Prime Minister. In 1957, the Federation of Malaya gained its independence from British rule. Kuala Lumpur remained the capital through the formation of Malaysia on September 16, 1963.

The geography of Kuala Lumpur is characterized by a huge valley known as Klang Valley. The valley is bordered by the Titiwangsa Mountains in the east, several minor ranges in the north and the south and the Strait of Malacca in the west. Kuala Lumpur has a tropical rainforest climate, which is warm and sunny and complete with regular rainfall. Temperatures tend to remain constant with maximums between 88 and 91 °F and minimums ranging between 72 and 74 °F. Apparently, the temperatures have never gotten higher than 103 degrees and have never fallen below and have never fallen below 58 degrees. My kind of weather!!

Since the 1990s, Kuala Lumpur has played host to many international sporting, political and cultural events including the 1998 Commonwealth Games and the Formula One Grand Prix. And this week they are hosting the third international “Women Deliver” conference with 5,000 delegates from all over the world, including me and my colleagues from the Congress. Kuala Lumpur is also home to one of the tallest twin buildings in the world, the Petronas Twin Towers, which have become an iconic symbol of Malaysia’s futuristic development.

Malaysia is a relatively open state-oriented and newly industrialized market economy. Since independence, Malaysia has had one of the best economic records in Asia, with GDP growing an average 6.5% for almost 50 years. The economy has traditionally been fueled by its natural resources, but is expanding in the sectors of science, tourism, commerce and medical tourism. In 2011 the GDP (PPP) was about $450 billion, the 3rd largest economy in ASEAN and 29th largest in the world. In 1991, former Prime Minister of Malaysia, Mahathir bin Mohamad outlined his ideal, called Vision 2020, in which Malaysia would become a self-sufficient industrialized nation by 2020. And several independent sources confirm that Malaysia not only has all of the right ingredients to become a developed nation, but they are also well on their way to meeting the Vision 2020 goals outlined by the government. After touring around yesterday, I cannot believe that they will not do so!

Exploring the city was wonderful, and we decided to do so using the Hop Off Hop On bus, which costs RYM 38 or about $13.00, for a two and a half hour drive around the city with 28 different stops. We decided as a group to hit some of the highlights and began our journey around 10:45 with our first stop in Kuala Lumpur (KL as the locals call it) at Petaling Street, KL’s very own Chinatown! As you might imagine, Petaling Street was a hive of sound and activities. The street seemed to be a bargain hunter’s paradise, with stall after stall of what started to seem like the same stuff….but you know what I mean! I did see Chinese herbs, food specialities, and tons of imitation goods. I understand that at night, Petaling Street transforms into a lively and vibrant night market.

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We decided to walk to two other sites, the Sri Mahamariaman Temple and Central Market. The Sri Mahamariamman Temple is the oldest and richest Hindu temple in Kuala Lumpur. Founded in 1873, it is located at edge of Chinatown. In 1968, a new structure was built, featuring the ornate ‘Raja Gopuram’ tower. From the temple’s inception, it provided an important place of worship for early Indian immigrants and is now an important cultural and national heritage. The temple catches your eye on an otherwise crowded and busy street. It is the most elaborate Hindu temple in the country and its gate tower is adorned with ornate sculptures of Hindu deities. The floors and walls inside are marbled with Italian and Spanish tiles. Outside and all around the temple, we found multiple street stalls with hand crafted flower tributes for believers to purchase and place in the temple.

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After the temple, we continued our journey and found our next destination – The Central Market. Its an old building – built in 1928 – but it had air-conditioning, a by pleasant surprise on this warm and muggy day!

The building has won awards for its architectural design and was founded in 1888 and originally used as a wet market. It has since been classified as a Heritage Site by the Malaysian Heritage Society and it is now a landmark for Malaysian culture and heritage. Today, Central Market is arranged in a stall concept, representing the traditional market that has existed in Kuala Lumpur since the 1800s.

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After Central Market, it was back on the bus! Our next stop, Little India! Ok, this was just a drive by, but this block was a huge project unveiled by Indian Prime Minister Manmohan Singh and Malaysia’s PM. Little India is an area that caters to KL’s Indian community and includes shops and stores that carry Indian specialities and goods. There’s a 35-foot fountain at the center of this part of town, an information kiosk at Jalan Thamby Abdullah and a three-story Indian bazaar at the end of Jalan Tun Sambanthan. The brick-paved Jalan Tun Sambanthan is lined with white street lamps and creamy-yellow arches with purple embellishments to match the newly painted purple buildings along the street.

Our next stop was also a drive-by…we saw the Istana Negara or National Palace. This was the official residence of His Majesty, the Yang di-Pertuan Agong (King) of Malaysia. It stands on a 28 acre site, located on the slope of a hill of Bukit Bintang overlooking the Klang River, along Jalan Syed Putra. The Yang di-Pertuan Agong is the head of state of Malaysia. The office was established in 1957 when the Federation of Malaya gained independence. The Yang di-Pertuan Agong is one of the few elected monarchs in the world.

The 14th and current Yang di-Pertuan Agong is Sultan Abdul Halim of Kedah. His reign began on December 13, 2011 after his election by the Conference of Rulers. He previously served as the fifth Yang di-Pertuan Agong from 1970 to 1975. He is the first ruler to hold the position twice, as well as the oldest elected to the office at 83 years old. The installation of the new Yang di-Pertuan Agong was held on 11 April 2012, at the new Istana Negara at Jalan Duta. This building is now used a museum.

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We also visited the National Museum. It is a palatial structure built in the style of Minangkabau architecture. Located atop a hill on Jalan Travers, it provides an introduction to the history and culture of Malaysia.

Our next stop, Lake Gardens, is Kuala Lumpur’s first large-scale recreational park. It is located in the heart of the city and established in 1888. Lake Gardens served as place of refuge from the hustle and bustle of the city during colonial times. It contains large sculpted and manicured gardens and a host of attractions. Among the tourist attractions located here are the National Monument, deer park, Hibiscus garden, Orchid Garden, Kuala Lumpur Bird Park and Kuala Lumpur Butterfly Park. Lake Gardens, we learned, is also the where the Malaysian House of Parliament is located. So, hopping off at this location was a must! The Malaysian Parliament is divided into three components: Yang Di-Pertuan Agong, Senate and House of Representatives.

We spent some time visiting the Orchid Garden, which has over 800 species of exotic Malaysian orchids. The orchid is truly exotic and special flower and i have never seen so many of them in one place at one time. Despite how beautiful this park was, everyone told us a must see was the bird park and we needed to visit that before our at ran out! Across the street from the Orchid Garden is the KL Bird Park, a fascinating and slightly uncomfortable park that puts people inside a giant aviary.

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I must admit, I felt like I was entering that scene in Jurassic Park! The KL Bird Park is a 20.9-acre public aviary in the city. It is a popular tourist attraction in the country, receiving an annual average of 200,000 visitors. The Bird Park houses more than 3000 birds representing more than 200 species in an enclosed aviary. 90% are local birds and 10% were imported from overseas. Feeding time at the Eagle enclosure was frightening when the other birds got all excited about the eagles getting lunch.

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One the way back to our hotel, we passed the Masjid Negara, the national mosque of Malaysia. It has a capacity of 15,000 people. Originally built in 1965, it is a bold and modern approach in reinforced concrete, symbolic of the aspirations of the newly-independent Malaysia.

Our last stop for the day was the Petronas Twin Towers, the world’s tallest twin buildings. A mix of offices and commercial, the towers are huge and a part of the KL skyline. As we cut through the building to get to our hotel, we saw the famous mall inside the towers.

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After a quick shower, we all ran to our dinner and briefing to discuss the week’s goals. At 9:00 pm, an extremely long, exhausting, but productive day finally came to an end!

 
 

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