Monday, June 07, 2010

Africa’s Maternal Care: Draw-back To World Health!

Complications and deaths associated with pregnancy are assuming alarming dimensions in Africa and not a few people are agitated by this situation. Pregnancy which normally brings joy to couples is gradually becoming a nightmare to many. Reports show that the average maternal mortality ratio in the African region has jumped from 870 deaths per 100,000 live births in 1990 to 1000 deaths per 100,000 live births in 2001 and to 1500 per 100,000 live births in 2004. Of the estimated 529,000 maternal deaths that occur globally every year, 48% occur in Africa, a region that constitutes only 12% of the world population and 17% of all births in the world. Poor women in the region are especially vulnerable. In many countries in the African region between 25% and 33% of all deaths of women of reproductive age are as a result of complications of pregnancy or childbirth whereas in industrialised countries the risk of maternal death is very low. The estimate is just 1%.

Recent statistics also show that 80% out of every 100 would-be mothers are afraid of pregnancy and childbirth while another huge 95 cannot bear the horror of childbirth. The statistics also revealed that for every 100 childbirth, at least 65% of women came out with Post Traumatic Stress Disorder as a result of fear and stress before the childbirth. The statistical report in question therefore lamented that more than 15 years following the launching of the Safe Motherhood Initiative (SMI), the maternal and prenatal mortality levels in Africa have sadly continued to rise instead of declining. High fertility rate and low contraceptive use in Africa contributes to this high risk. The lifetime risk of maternal death in the African region is estimated at 1:16 compared to 1:3500 in North America, 1:2400 in Europe, 1:160 in Latin America and the Caribbean and 1:100 in Asia. For every maternal death there are at least thirty women who suffer short or long term disabilities, says the African Regional Reproductive Health Task Road Map for Accelerating the Attainment of the Millennium Development Goals Related to Maternal and New-born Health in Africa.

Approximately 13% of all maternal deaths occur among adolescents mainly as a result of complications of unsafe abortion. The majority of the disabilities especially obstetric fistulas are also more prevalent in the adolescent age group. Averagely, in Africa a woman has had her first pregnancy by the age of 19. Fourteen million adolescents aged 15 to 19 years in the world give birth annually, the majority-12.8 million-in developing countries which includes Africa. In spite of this, little attention is paid to married or pregnant adolescents when it has been proved that compared with women in their twenties, adolescents are twice more likely to die during childbirth and those that are 14 years and younger are five times more likely to die. The new-borns of adolescents also have a higher incidence of low birth weight and neonatal mortality. There is no doubt then that Africa has the highest new-born mortality rate estimated at a ratio of 45 deaths per 1000 live births compared with 34 in Asia, 17 in Latin America and five in developed countries. Given ineffective and gross under-reporting system and wide variations within the continent, these figures are without doubt much higher. However the Road Map quoted earlier was vocal in indirectly attributing the high maternal deaths at the moment in the continent to the three co-joined epidemics of HIV/AIDS, TB and Malaria. This is in addition to other factors that are peculiar to each country.

“Increasing numbers of maternal deaths in the region are due to indirect causes such as HIV/AIDS, TB and Malaria. Many pregnant women in Africa are being diagnosed with HIV. In regions of Southern, Eastern and Central Africa, 20-30% of all pregnant women are infected. HIV infection transmission rates from mother to child range from 25% to 40% in some countries. Tuberculosis kills over 1 million women from the age range of 18-45 years annually of which 600,000 of these deaths occur in the African region. Malaria is a major cause of maternal anaemia, low birth and neonatal death”, says the Road Map

In Nigeria the story is the same. In fact stakeholders in the health sector are of the opinion that the maternal and prenatal mortality has reached an embarrassing situation. Nigeria’s maternal mortality statistics have been cited as one of the highest in the world. While the maternal mortality ratio of 704 maternal deaths per 100,000 live births was obtained from a 1999 National Survey, a similar survey three years later indicated a figure of 948 maternal deaths per 100,000 live births. In the year 2004, it was 1,500 deaths per 100,000 live births. Analysis of the 1999 national survey revealed that there are wide geographical disparities with respect to maternal mortality incidence within the six geo-political regions of Nigeria with the rate in the North-East zone (1,549 deaths per 100,000 live births) almost ten times that of the South-West zone (165 deaths per 100,000 live births). That of North-West was 1,025 while South-East recorded 165. It identified the leading medical causes of maternal mortality in Nigeria as haemorrhage (23%), sepsis (17%), unsafe abortion (11%), anaemia (11%), malaria (11%), eclampsia (11%) and obstructed labour (11%) and added regrettably that effective medical approaches that would have managed each of these conditions currently do not exist.

“There is a dire and urgent need to effectively address the high maternal mortality situation in Nigeria in the interest of human development, social justice and poverty alleviation”, the report noted.

The number five of the Millennium Development Goals aims at reducing by 2015 maternal mortality rate by three-quarter. Maternal mortality has also been included as one of the key issues to be addressed under the new Nigerian national development initiative known as the National Economic Empowerment Development Strategy (NEEDS). From the pictures we are getting from the Nigeria health sector, it seems that the dream would never come true. In terms of Primary Health Care services only 49.8 percent of PHC facilities in Nigeria provide antenatal care services while 42.9 and 43.9 percent respectively provide delivery and postnatal services. Meanwhile only a third of PHC facilities in the country which is about 34.6% provide treatment for sexually transmitted infections.

“In respect of obstetric care services, less than a fifth (18.5%) of facilities offering maternal health care services in Nigeria met standards for Essential Obstetric Care (EOC) nationally. In the public sector, only 4.2 percent of facilities met the EOC criteria (1.2% for basic EOC and 3.9 for comprehensive EOC) while 32.8 percent of private sector facilities met the criteria (5.3% for basic EOC and 27.5% for comprehensive EOC)”, says a report from the Community Development and Population Activities Department of the Nigerian Federal Ministry of Health.

It also noted that among the 12 states involved in national EOC study, only one state which is Lagos, met the availability criterion of four basic EOC per 500,000 population and noted that on the whole, the proportion of pregnant women that delivered in EOC facilities was estimated at 5.9 percent. This indicates a high level of unmet need for EOC services. Approximately 15 percent of pregnant women are generally expected to develop complications, which require EOC services. The report titled the Maternal Mortality Situation and Determinants in Nigeria observed that a NEEDS assessment survey of the Primary Health Care system indicated that 5.9% of 679 PHC facilities sampled nationally did not have any of the 26 equipment described as minimum equipment package for use in a generic PHC facility. Also none of the sampled facilities had all the 26 equipment in the list even as it revealed that less than a quarter of government-owned hospitals sampled in all the geo-political zones of the country lack equipment as basic as Sphygmomanometer. It described the nation’s health facilities as poor in terms of medical supplies and related logistics and very poor the technical competence of its health workers in the area of various service delivery activities. However it noted that the poor funding of the sector is a major contributing factor to the poor quality service discovered and advised that reduction in maternal mortality should begin from the Primary Health Care sector which is the first point of call for the rural dwellers who are the major victims of the maternal mortality rate.

The report noted that efforts deployed since the launching of the Safe Motherhood Initiative seem not to have yielded the expected results due to the many challenges confronting the Maternal and New-born Health (MNH) programmes in the region.

“Most of the countries in the African region are poor and highly indebted. This limits the allocation of resources to health and in particular MNH programmes. The growing poverty especially amongst women is a great obstacle limiting women’s access to highly needed services. The situation is further aggravated by dwindling donor resources. Besides, numerous man-made and natural disasters in the region, such as civil conflicts, disease outbreaks and floods that rapidly destroy infrastructures, disrupt services and divert resources erodes gains made in the past”, said the Road Map for Accelerating the Attainment of the MDGs.

The Road Map also noted that some of the reasons for failure to significantly reduce maternal and neonatal mortality in the region include:
• Lack of national commitment and financial support
• Poor co-ordination amongst partners
• Inadequate male involvement coupled with low status of women with poor decision making power
• Growing poverty particularly among women
• Lack of access to, availability and use of quality skilled care during pregnancy, childbirth and the immediate postnatal period
• Focus on ineffective interventions such as the risk approach
• Poorly functioning health systems with weak referral system, especially during obstetric and neonatal emergencies
• Weak national human resource development and management, including the continuing brain drain of skilled personnel within and outside Africa and from public to private
• Negative impact of the HIV pandemic on human and financial resources for MNH care
• Poor logistic for management of drugs, family planning commodities and equipment
• Unclear policies concerning practice regulation and
• Harmful socio-cultural beliefs and practices.

Giving a note of warning the Road Map added that if nothing is done to effectively address the above challenges, there will be at least 2.5 million maternal deaths and 49.0 million maternal disabilities resulting in 7.5 million child deaths over the next ten years.

Nigeria therefore has a great lesson to learn from this. For instance, local councils which are supposed to be the first point of call for these pregnant women, indeed the seat of Primary Health Care, are not helping matters. The health sector is characterised by low sector funding, poor staff motivation, which is a major reason for the huge migration of health workers to Europe and America and the highest brain drain recorded by the sector. For instance, at the federal level, budgetary allocation for health has varied between 1.5 percent and 3.1 percent of total government budget between 1985 to date; short of the World Health Organisation (WHO) recommended level of 5 percent of national budgets. Budgetary allocations at state level vary considerably. At the council level a recent analysis of their expenditure showed that budgetary allocation to the health sector was between 12.94 and 12.6 percent in 1998 and 1999 respectively. The pattern of health expenditure at this level of government is very much skewed towards personnel cost, with the result that very little amount is actually available for the health activities and infrastructure development. This leads to undue dependence on donor funding.

In the same way lack of budgetary release and tampering with the council allocations by the state governors is a rampant occurrence, thus making it impossible for meaningful planning and execution of programmes to take place at the local level without undue dependence on donor funding with its attendant complications. Interventions are highly needed in reducing the number of pregnancies, the number of complications and the likelihood that a complication will result in death. According to Eyitayo Lambo, a professor and former Nigerian Minister for Health, “Effective knowledge and tools exist to reduce suffering and deaths. In order to make a real difference, the interventions must reach mothers and children who need them. Experience has shown that known interventions are affordable and can be delivered. For maternal deaths to be reduced dramatically, women need access to quality obstetric care, with at least three key elements viz skilled care at birth, emergency obstetric care in case of complications and a functioning referral system which ensures access to emergency care, if needed. Another key solution is helping women to avoid unwanted pregnancies and births since only pregnant women die of pregnancy-related complications”.

Finally it is worth noting that the well being of societies is directly linked to the health and survival of mothers and their children. When mothers and children live in a healthy atmosphere and thrive, the society in which they live prospers.

The End.

*The original of this article titled 'Africa's Maternal Care As Draw-back To World Health' was first published by the Guardian Newspapers of Nigeria on Thursday April 7, 2005.

Tuesday, May 18, 2010

The Ever Grim Story of Brain Drain

Latest statistics on emigration of health workers from Africa, particularly Nigeria, to other continents is, indeed, grim. A report from the World Health Organisation noted that in Africa alone, where health needs and problems are greatest, around 23,000 qualified academic professionals emigrate annually to Europe and North America in search of better life opportunities. The report also revealed that as many as 18,000 nurses from a particular African country work abroad, while in another African country, an entire graduating nursing class was recruited by a European country immediately after graduation. That is obviously not good news for Africa. Presently, there are an estimated 750,000 health workers in the African continent who serve 682 million people. By Comparison, the ratio is 10 to 15 times higher in Europe and North America. To achieve the Millennium Development Goals, the minimum level of Health Workforce Density according to WHO should at least be 2.5 health workers per 1,000 people. Out of 46 countries sampled in Africa, only 6 have a workforce density of up to 2.5 per 1000 population.

Mohammed Yaro Budah, a pharmacist and Fellow of the Pharmaceutical Society of Nigeria (PFN) captured the scenario: "I dare say that the health sector has suffered the greatest brain drain compared to other sectors. This has led to a dearth of specialists in the various fields."

Indeed, Africa's Health Workforce Density averages 0.8 workers per 1000 population; significantly lower than the other regions of the world and the world median density of 5 per 1,000 populations, observed the High Level Forum on Millennium Development Goals that met in Abuja in December of 2004. From the North to the South and the East to the West of Africa, the problem is the same. It is said that roughly 50% of the total population of doctors in Ghana are practising in the USA alone; while between 70 and 100 doctors emigrate from South Africa every year. The story is the same in Nigeria. Having the highest population in the continent, Nigeria alone looses more health workers compared to other African countries. Some estimates put the number of Nigerian doctors outside at one out of every five black doctors in the United Kingdom. In the US it is about one out of every 10. The story is also not different in other European and American countries. The migration is already causing a lot of havoc to the country and the growth of its health sector. Indeed, without urgent action, there is a big risk that the financial support to Africa through the new Global Health Fund to combat AIDS, Tuberculosis and Malaria may suffer setbacks because of this trend. In the recent years, there has been a sharp reduction in the number of newly registered doctors from 1750 in the year 2000 to 800 in 2002, a 60% reduction with dire consequences for the health sector. By 2002, Nigeria had a nurse population ratio of 1 to 20,700 people compared with the WHO recommended 1 to 1,000. Even the distribution of qualified medical doctors in the nation’s health sector is frightening. About 8% of doctors in Nigeria work in private hospitals, 9% are resident doctors, 10% in public hospitals, 55% are not in the profession, while about 18% work abroad.

A 2003 statistics of registered nurses in the UK showed that Nigerian nurses topped the list. In the United States of America, the Nigerian doctors registered with the American Medical Association by specialty for the same year were 15% paediatricians, 12% general practitioners, 10% surgeons, 7% psychiatrists, 6% obstetricians and gynaecologists, 3% pathologists and 47% for other branches of medicine. Stakeholders in the health sector have noted that the main reasons for this migration of health workers to Europe and North America include poor remuneration, poor working conditions, inadequate incentive systems compounded by outdated regulations and management approaches. Furthermore, "challenges like political, social or economic crisis are undermining optimal utilisation of available health workforce. Structural adjustment policies have had major effects on development of human resources for health as some conditions for loans led to the lay-off of personnel including health staff, freezing of positions and non-recruitment of new personnel in the civil service", said the WHO.

Consequent upon the above reasons, the migration of health workers to Europe and North America is today a major health disaster in Africa. For instance, it is alarming and pathetic that Malawi, a small poor African country has more of its doctors practising in Manchester, England, than in all of Malawi. Other examples abound, noted the High Level Forum. The future is even grimmer, said the Forum. It noted that "there are ‘demand’ issues which encourage the exodus of African health workers to wealthy countries. The investment in health in the western world is predicted to increase ten-folds in the next 50 years. It is estimated that England will need 25,000 doctors and 250,000 nurses more than it did in 1997 by 2008. It is also estimated that a further one million nurses will be needed over the next ten years to meet the shortfall in the United States.

"There are also 'supply' issues which encourage African health workers to look for more promising work opportunities abroad. The biggest would have to be the low level of compensation provided to most health workers in Africa. Cost of living adjusted wages indicates that a registered nurse makes about $489 a month in Malawi. By comparison, monthly pay for a nurse in the UK's National Health Service is about $2576. In Ghana and Zambia, the average monthly salary for a doctor is just over $400," says the Forum.

The World Health Assembly through resolutions WHA 48.8 in 1996, WHA 49.1 in 1996 and WHA 54.12 in 2001, urged member states to undertake co-ordinated health systems reforms, including reforms in medical education and practice. It also suggests government-to-government agreements to set up health-personnel exchange programmes as a mechanism for managing their migration and to establish mechanisms to mitigate the adverse impact on developing countries of the loss of health personnel through migration. Receiving countries were also urged to support the strengthening of health systems especially in human resources development in the countries of origin. Similarly, at the Sixth Ordinary Session of the OAU Conference of African Ministers of Health held in October 1999 in Cairo, Egypt, the issue of brain drain and its impact on the health sector was extensively debated. The conference stressed the need to carry out research on the scope of the problem and its repercussion on the health budget even as it called upon member states to ensure better utilisation of human resources in the health sector. Also, the Abuja Declaration and the Abuja Framework Plan of Action on HIV/AIDS, Tuberculosis and other related infectious diseases in Africa adopted in 2001, called for acceleration of human resources development in the continent and the improvement of conditions of service of health personnel through the use of incentives to prevent brain drain and promote the return of health professionals.

How far these resolutions can go in the light of economic realities of the African countries remains to be seen. A Nigerian born American computer guru, Philip Emeagwali in a speech on how to reverse the problem of brain drain in Africa painted the picture graphically: "I also speak from my family experiences. After contributing 25 years to Nigerian society as nurse, my father retired on a $25 per month pension. By comparison, my four sisters each earn $25 per hour as nurses in the United States. If my father had had the opportunity my sisters had, he certainly would have immigrated to the United States as a young nurse. The 'brain drain' explains in part why affluent Africans fly to London for their medical treatment”. Continuing, Emeagwali opined that, "Because a significant percentage of African doctors and nurses practice in the US hospitals, we can reasonably conclude that African medical schools are de facto serving the American people, not Africans." He therefore advised African governments to ensure that those with skills are encouraged and rewarded to stay, work and raise their families in Africa. At the long run he pointed out, it would ensure large middle class families thereby reducing the conditions that give rise to civil war and corruption and ultimately promote revitalisation and renaissance. "It will be impossible to achieve a renaissance without the contributions of the talented," he affirmed.

The contributions of the African practitioners to the economy of Europe and the Americas are enormous. According to the WHO report cited at the outset, a typical Nigerian health professional in the US contributes about $150,000 per year to the US economy in terms of human cost. Today it is widely believed that Africa's insufficient health workforce will continue to be a major handicap in attaining the Millennium Development Goals for reducing poverty and diseases. Recently the Minister of Health, Professor Eyitayo Lambo, raised an alarm that African health development faces a double-edged crisis 'namely that its health systems are fragile and its human capacity is inadequate'. He noted that while Africa has 25 per cent of the global burden of disease, its share of the global health workforce is just 1.3 per cent thereby limiting its ability to deliver qualitative health care especially in the public sector. Lambo observed that the situation calls for more drastic actions by government and the people. But as Emeagwali posited earlier, there might be an urgent need for the United Nations to impose what he called 'Brain Gain Tax' on all the benefiting countries in Europe and North America. He said: "I believe controlling emigration will be very difficult. Instead, I recommend the United Nations impose a 'Brain Gain Tax' upon those nations benefiting from the 'Brain Drain'. Each year, the United States creates a brain drain by issuing 135,000 HI-B visas to 'outstanding researchers' and persons with 'extraordinary ability'. The US Internal Revenue Services (IRS), allows US taxpayers to make voluntary contributions to election funds. Similarly, it could allow immigrants to voluntarily pay taxes to their country of birth instead of to the United States."

However, the war to reverse the ugly trend may not end up in vain. The WHO regional office in Africa believes that a lot can still be done. It is of the opinion that the tide can be reversed with improved systems performance, better remuneration packages, adequate work incentives, better training of health workforce, prompt and constant payment of their salaries and arrears and others. It also recommended that countries should urgently develop retention strategies to prevent the brain drain especially in the area of ensuring peace and security for their work and creation of an enabling environment for the provision of health services. "Countries should value their health workers and demonstrate this by paying them a salary in keeping with what is expected of them. Countries should, in addition, tap into the skills, expertise and resources of their nationals in the Diaspora. Moral and ethical considerations in the recruitment by developed countries of health workers from developing countries should be put on the international agenda," the office said.

The right atmosphere to make these professionals abide in Nigeria, for instance, is still an issue, some say. "A great number of Nigerian health professionals abound in the Diaspora who has acquired great knowledge and skills and many are willing to return home to share and invest in healthcare delivery once the enabling environment is provided", said Mohammed Yaro Budah.

Perhaps, some day, given the right conditions, the brain drain will turn to brain gain.

*This article won an Honourable Mention Award-World Level-under the Category of the International Award for Excellence in Journalism in 2007 edition of the UCIP Awards.

Wednesday, May 05, 2010

In Defence Of The Right Of The Girl Child To A Quality Education

"There can be no significant or sustainable transformation in societies and no significant reduction in poverty until girls receive the quality basic education they need to take their rightful place as equal partners in development”
Carol Bellamy, Former Executive Director, UNICEF.

Despite the wide clamour for delay of early marriage amongst the girl child and an increased commitment towards girl child education, latest findings by various organisations indicates that the sub-Saharan Africa is yet to come to terms with the need to delay early marriage of the girl child and channelling of resources towards their proper education. Though it has become a household cliché in the sub-Saharan Africa that the education of the girl child is akin to educating the whole world and therefore the surest investment any country can make to safeguard its future, records from different countries in the sub-Sahara Africa shows that the education of the boy child is by far more valued than that of her girl child counterpart. It was therefore not a surprising statement when British Department for International Development (DFID) came up with a shocking revelation which says that going by the available statistics and progress reports of different countries, no fewer than 75 countries would meet up with the United Nations Millennium Development Goal target of gender parity in primary and secondary school enrolments by 2015.

The numbers two and three of the Millennium Development Goals seeks to achieve universal primary education and to promote gender equality and empower women by eliminating gender disparity in primary and secondary education preferably by 2005 and at all levels by 2015. Also an existing partnership between the Federal Government of Nigeria and the United Nations Children Fund Nigeria called Strategy for Acceleration of Girls’ Education in Nigeria (SAGEN) seeks to achieve gender parity in access, retention and completion of Basic Education. SAGEN also intends to expand and improve comprehensive early girl childhood care and education, ensuring that by 2015 all children particularly girls have access to and complete free and compulsory primary education of good quality as well as eliminating gender disparities in primary and secondary education and ensuring gender equality in education by 2015.

According to DFID, one-third of these countries that are not likely to meet up with the Goal are in sub-Saharan Africa. Nigeria is on top of the list. DFID is also of the opinion that at least 40 percent of all countries in the world are at risk of not making the target at primary, secondary or both levels of education by 2015. The reason sub-Saharan African countries could not meet up with the Goals has been attributed to some cultural and traditional beliefs prevalent in the region. In some parts of sub Sahara Africa, it is traditional and customary for the girl child to marry early-before age 18-so that the money could be used for the education of the boy child, support the dwindling business fortune of the family or to send the boy child abroad to search for greener pastures. As a result of this unfortunate situation, experts have predicted that about 82 million girls in developing countries who are now aged 10 to 17 will be married before their 18th birthday. Girl child marriage is still the norm in some countries where majority of girls marry before age 18. Some of these countries include Nepal where about 60 per cent marry before age 18, 76 per cent in Niger Republic, 50 per cent in India and 80 per cent in Nigeria. In Nigeria about four million girls of school age are not enrolled in school.

The statistics of girl child school dropout rate as a result of early marriage round the world is heart breaking. In sub-Sahara Africa about 40 countries had about 23 million of their girls out of school. 22 million girls who are out of school in South and West Asia are concentrated in India and Pakistan. In Niger Republic less than one-third of all school aged girls are enrolled in primary school while in Rwanda four out of every five girls are enrolled in primary school. A recent publication of DFID revealed that about 58 million girls worldwide are not in school whereas their male counterpart recorded just about 45 million. Part of the reason for this situation, it noted is the high rate of early marriage amongst the girl child. The United Nations Children Fund affirming that girls and boys have the same right to a quality education however regretted that the gender gap amongst them quickly demonstrates that more girls than boys are kept out of school. UNICEF in its 1990 Year Report noted that of 20 percent of the world’s primary school-aged children who were out of school, two-thirds of them are girls. Even though the numbers of children out of school were brought down to about 120 million worldwide by the year 2000, most of these, about 70 million were girls. In Nigeria, a 12 percent gender difference in primary Gross Enrolment Rate (GER) was recorded in 2001 compared to 7% in 1990. Also, of about 3.9 million primary school-aged children that are out of school, 71 percent are girls. “Today there are more children than ever in the world’s primary schools but the majority of those who are not are still girls”, UNICEF said.

The Nigerian scenario is very peculiar with girls more likely to be in the school in the southern part than in the northern part. Part of the reason is because of the high prevalence of early marriage and poverty in the north compared to the south. A girl child in the north is by far more likely to be married off before age 18 than her counterpart in the south. This has resulted in great imbalance in the life of women in the two regions. An average married woman in the south has at least a basic education. She is married at a later age and has fewer children. She sends her kids to school and is likely to have more access to reproductive health care, lives a healthy life and has a very high potential of reproducing healthy and educated children. Her counterpart in the north is less likely to achieve that. She is married before age 15 with little or no education. She has more children and has more chances of dying as a result of complications of pregnancy and childbirth. Her children are not likely to benefit from basic education because she herself never received one and therefore cannot know or cherish the importance of education. She is also more likely to live unhealthy life due to the accumulation of stresses of pregnancy and childbirth and would eventually reproduce unhealthy and uneducated children. This is in compliance with the fact that poverty begets poverty; and the cycle continues.

The former President of Nigerian, Olusegun Obasanjo in an address to commemorate the 2005 Children’s Day, blamed the diverse nature of Nigerian society and its different socio-cultural beliefs as being a cog in the wheel of streamlining the opportunities of the girl child. “The girl child is often faced with discriminations from the early stages of her life. She is assigned roles in the home that are gender discriminatory, and further confronted with social and cultural obstacles to her future life such as early marriage and genital mutilation”, he said. “In many cases, girls that are educated are carefully and deliberately guided away from professions that are male dominated. The result is that many girls and women slip into the margins of national development activities”, he added.

According to experts other factors responsible for early marriage and drop out of the girl child from the school especially in the northern part of the country has been traced to poverty, parental desire to ensure sexual relationship within marriage, a lack of educational or employment opportunities for girls, the sense that girls’ main value is as wives and mothers and dowry systems. Findings also suggest that the most important and biggest factor discouraging parents from sending girls to school is the fear of high rate of physical and sexual harassment women face in some societies. As a result some parents would rather keep their children at home or just marry them off at a young age rather than have them defiled. “This aptly describes the situation in northern Nigeria, where for religious and cultural reasons, girls are not allowed to go to school at all or at most not beyond the elementary”, said a woman from the region who does not want her name in the press.

Also in some cultures parents still believe that women education ends in the kitchen and since it ends in the kitchen it would be pointless sending them to school in the first place. In relation to that they also believe that educating a girl is not important and very useless since a man would later come to marry her off with her education. As a result they would prefer sending their male child to school leaving the girl child as ‘burden’ that would eventually be disposed of. UNICEF quoted a 15 year old Indian girl as saying: “I had never been to school before because my father didn’t think girls should be educated. Even my mother thought the same; she never went to school either. My brothers went to school because they would become ‘working hands’. My father said I would just get married”. One writer put it this way: “In relation to the above point is the weak position of women in the society. Girls have very limited control over their futures that they are often forced to drop out of school for one reason or the other or forced into early marriage. To put it succinctly, girls are made to “make sacrifices” for other family members at their own peril”.

The issue of security is also another reason the girl child is denied access to basic education. In times of emergency, the girl child is more likely to be withdrawn from the school than her male counterpart. During these emergencies they are naturally prone to sexual abuse and unequal access to schooling especially in countries without security or in conflict. According to DFID, 37 million children that are not in primary school globally of which majority are girls, reside in fragile states. The war torn Sudan has one of the lowest girls’ enrolment rates in the world. Worried by this ugly scenario and the dwindling enrolment of the girl child in the school, experts believe that young girls in the developing world who are denied education due to early marriage and other factors are denied much of what their young colleagues elsewhere take for granted. These include good education, good health and access to basic healthcare and economic opportunities and the right to associate with their peer.

DFID was of the opinion that education makes an enormous difference to a woman’s chances of finding a well paid job, raising a healthy family and preventing the spread of diseases such as HIV/AIDS. “Women with at least a basic education are much less likely to be poor proving that girls with one extra year of schooling beyond the average can boost their eventual wages by 10 to 20 per cent. Also, an infant born to an educated woman is much likely to survive until adulthood”, said UNICEF. It has also been established that in the sub-Saharan Africa children of mothers who receive at least five years of primary education are 40 per cent more likely to live beyond age five while an educated woman is 50 per cent more likely to have her children immunised against childhood diseases. For instance an interview conducted by the Guardian Newspapers of Nigeria in Yabo Local Government Area of Sokoto State during the state National Immunisation Days Campaign revealed that majority of mothers who came to immunise their wards and children are literate. One of the mothers Hajia Fatima Abubakar said that it has been her tradition to immunise all her children at the appropriate time. She told the Guardian that being a literate woman she knows the importance of immunisation to children. “Though am not a graduate, am educated enough to know the importance of immunisation. Every reasonable mother knows the importance of immunisation in fighting the childhood killer diseases. Because of my children happy future, I owe them a duty to immunise them today. I think it is only illiterate mothers who will believe any story they hear and refuse to immunise their children”, she said.

Stakeholders have also passed a verdict that it is no more in doubt that early marriage almost inevitably disrupts education of the girl child and reduces her chances for future independence through work. They were of the opinion that married girls are rarely found in schools and girls who are not in school rarely have much contact with their peers or people outside their families. The implication is that she will lack the necessary interaction and experience that will carry her to the future as a mother. The consequences of early marriage for adolescent girls’ sexual and reproductive health and rights are significant. Their exposure to Sexually Transmitted Diseases and HIV and AIDS is very high compared with their counterparts who are educated and married later. Young uneducated married girls are generally unable to negotiate the use of contraceptives or to refuse sexual relations and are more likely to be married to older men with more sexual experience who are more likely than single men to be HIV positive. Indeed recent research sponsored by the United Nations Children Fund indicates that young uneducated married girls are more likely to be HIV positive than their educated unmarried counterparts.

It is also an established fact that young uneducated married girls often cannot seek health care without the permission of their husbands or other family members, generally cannot pay for health care independently and may experience periods of depression. Husbands and families also apply pressure on young wives to have a child soon after marriage thereby increasing their risk of maternal death or injury and hampering efforts to prevent Sexually Transmitted Diseases and HIV and AIDS through regular use of the contraceptives. Experts are therefore unanimous in their conclusion that such early childbirth often goes hand in hand with high rates of poverty, lower levels of education, less mobility and fewer attended births which has been linked to high maternal mortality rate amongst young mothers.

In addition, young uneducated girls’ relative lack of power is often linked to violence in marriage which is associated with unwanted pregnancy and Sexually Transmitted Diseases. Young brides have very little ability to leave abusive partners and many live in isolation with little chance to secure social or legal support to remedy their situation. While on tour of the three southern states of Edo, Delta and Akwa Ibom, the former Nigerian Minister of Women Affairs, Hajia Inna Maryam Ciroma told the stakeholders in the states that quality education targeted at girls and women, could be the most powerful weapon in the nations quest for socio-economic development and fight against poverty. The contribution of girls' education, she told Obong Victor Attah, the former Governor of Akwa Ibom State could as well directly lead to sustainable development saying that it has been established that educating girls and women is the single most important investment that yields maximum returns for development of any nation. She also told James Ibori, the former Governor of Delta State that educated women are more likely to become better income generators thereby increasing their economic power. She was strongly of the opinion that education of girls goes with decrease in maternal and infant mortality rates while children of educated women have a higher probability of getting good education, which increases their knowledge towards socio-political development of society. Ciroma also addressing Lucky Igbinedion, the former Governor of Edo State posited that the positive gains of educating the girl child are enormous and therefore opined that it was because of the enormity of the gains that world leaders at the Education Forum in Dakar, Senegal agreed to eliminate gender disparities in primary and secondary education and achieve gender equality in education by 2015.

“It is also within the same context that, two out of the eight Millennium Development Goals (MDGs) to end world poverty, have laid emphasis on Education for All and especially the girl-child”, she said.

Tuesday, May 04, 2010

Playing God With The Rights Of The Girl Child

Almost two decades after the passage of the United Nations Convention on the Rights of the Child and six years after its domestication in Nigeria, some of the federating states especially the northern states are still reluctant to pass the Convention into law. In the north of Nigeria where the Convention received the stiffest opposition on the grounds of religion, the atmosphere is still looking gloomy for the future of the children especially for the girl child. Nigeria is a federation of 30 states and one Federal Capital Territory and by the provisions of the terms of the federation the states are allowed to review the Convention and adapt it to their cultural and religious milieu or to reject it entirely. The Nigerian population is basically divided along two lines of the north and south. The north is predominately Islam hence the huge success of the boycott called by the Council of Ulamas there against the legalisation of the Convention in the region. The reason behind this is religious. Recently some Council of Ulamas-Muslim scholars well versed in Islam and Sharia legal system-in the north asked their governments to boycott the Convention citing some provisions that they claimed ran contrary to Islamic faith and the Sharia legal system as their reason.

Article 32 of the Convention on the Rights of the Child recognises the right of the child to be protected from economic exploitation and from performing any work that is likely to be hazardous or interferes with the child’s physical, mental, spiritual, moral or social development. Contrary to these provisions, children in the north are engaged in works that are exploitative and hazardous. It is estimated that about 8 million Nigerian children are trapped in child labour and child trafficking. This situation has worsened as poverty continues to deepen. Lately the Nigerian government committed huge human and financial resources on education and awareness programme to persuade the states to pass the Convention into law to safeguard the future and the welfare of the children. The efforts made so far proved abortive and the more the campaign gathers momentum, the more it is opposed.

One of the specific provisions in the Convention responsible for this huge negative reaction is that which prohibits the marriage of girls below the age of 18, a trend very common in the north that girls as young as 13 are forced in the name of religion to marry men old enough to be their fathers. Amongst some of the northern Muslims, it is erroneously believed that if a girl does not marry earlier than 18, she will not be able to have more than two children. They also hold the view that those girls who marry after the age of 18 are certain to reach their menopause early. The only safeguard against this early menopause is early marriage. This view is contrary to recent medical studies and findings that put the menopausal age on the average from 45 and above and with recent developments in the field of gynaecology, the claim is unfounded. Those who hold this belief also conjecture that it is a ploy to introduce western standards with the ultimate aim of reducing the Muslim population.

Due to high rate poverty and illiteracy, it is very easy for beliefs like these to sink deeply into the bone marrows of the unsuspecting people. Families are usually poor and an early marriage could be a step out of poverty and the north being a patriarchal and Muslim stronghold, the girl child has no stake in her future. She is expected to obey the dictates of the parents especially that of the father. Compounding the whole problem is the fact that sex education is a taboo not only in the north but also in the whole country. Nigeria does not allow the teaching of sex education in the schools. Beside the ban on sex education, the religious dimension of the drama is also complicating the issue the more. In Islam, the Koran is considered an active word of God; consequently the interpretations of the Koran and injunctions of the Muslim theologians like the Ulamas must be obeyed. There is no room for reasoning the Koran. It must be swallowed hook, line and sinker. Against this backdrop, the ongoing boycott of the passage of the Convention in the north, encouraged by the Council of Ulamas are viewed from a theological angle, considered very strong and fanatically obeyed.

Part of the reason why the prohibition of early marriage was introduced in the Convention and supported by the version domesticated in Nigeria is because of series of surveys that linked the high rate of Vesico-vagina Fistulae (VVF) and Recto-vagina Fistulae to early marriage and teenage pregnancy. Approximately 80% of fistulae cases reported in Nigeria are due to unrelieved obstructed labour during childbirth. Most of these cases are in the north. Obstructed labour is directly related to the custom of early marriage predominant amongst the Muslim north. These marriages as noted earlier usually take place before the age of 18 and sometimes before the onset of menstruation, as early as 11 years old. Early marriage invariably leads to early sexual contact and subsequent pregnancy at a time when a young girl is not adequately physically developed to permit the passage of a baby with relative ease. This can lead to a prolonged and obstructed labour and damage leading to the misery of fistulae.

Early marriage can also disrupt the education of the girl child which is the leading factor responsible for the high rate of poverty and illiteracy in the north. With early marriage there is a likelihood of passing on poverty to a child and since the mother herself is not literate, she is not likely to send her children to school having not known the value of education herself. This is a major contributor to the endless cycle of poverty and illiteracy predominant in the north. In the 10 years between the drafting of the domesticated version of the Convention and its enactment in 2003, it was subjected to several reviews by the Muslim Ulamas and Christian leaders. This was done to ensure not only a level playing ground but to guard against any part of the Convention violating any religious belief. The Convention on the Rights of the Child is the first legally binding international instrument to incorporate the full range of human rights-civil, cultural, economic, political and social rights. In 1989, world leaders decided that children needed a special convention just for them because people under 18, often need special care and protection that adults do not. They also wanted to make sure that the world is aware that children have human rights too.

The Convention sets out these rights in 54 articles and two Optional Protocols. It spells out the basic human rights that children everywhere have: the right to survival; to develop to the fullest; to protection from harmful influences, abuse and exploitation; and to participate fully in family, cultural and social life. The four core principles of the Convention are non-discrimination; devotion to the best interests of the child; the right to life, survival and development; and respect for the views of the child. Every right spelled out in the Convention is inherent to the human dignity and harmonious development of every child. The Convention protects children's rights by setting standards in health care, education, legal, civil and social services.

By agreeing to accept the obligations of the Convention by ratifying it, national governments committed themselves to protecting and ensuring children's rights and to hold themselves accountable for this commitment before the international community. State parties to the Convention are obliged to develop and undertake all actions and policies in the light of the best interests of the child.

Monday, May 03, 2010

Homophobia: A Threat To The Achievements Of Human Rights And Civilisation!

Thirty-seven years after a giant move was made to remove homosexuality from a book that listed it as a mental and emotional disorder, homophobia, homophobic attacks and homophobic laws aimed at stifling the human rights of the homosexuals are sadly still on the increase. It was a very controversial move and that move nearly broke the back of the American Psychiatric Association; the body that made the move of removing it from its official manual that lists mental and emotional disorders. It was in 1973 and two years after that another controversy ensued when the American Psychological Association followed suit by passing a resolution to support the removal. In 1990, the World Health Organisation made a similar move by urging all mental health professionals to help dispel the stigma of mental illness that some people still associate with homosexual orientation. Sadly, despite all these developments many countries still consider homosexuality as a form of disorder punishable with various forms of punishment including imprisonment, persecution, torture, lynching, and death penalty. For instance, according to issue 155 of May/June 2009 edition of the 'Amnesty Magazine', "At least 25 boys and men are reported to have been killed in Baghdad this year because they were or were perceived to be gay. The killings are said to have been carried out by armed Shi'a militiamen and by members of the tribes and families of the victims".

Under Saddam Hussein's regime homosexuality was criminalised in 2001. However, there were no recorded executions or imprisonments. It is only in recent years that militias have sought and murdered gays and lesbians in Iraq. In the neighbouring Iran which is a theocratic state the story looks scarier. Homan, an Iranian lesbian, gay, bisexual and transgender exile group, estimated that around 4,000 people were executed for homosexuality from 1979-1990 alone. The figure for 1990-2010, though not officially released is feared to be higher. Following the Iranian revolution of 1979 a very large number were either executed or lynched without trial. Those killed reportedly included foreign visitors including gay activists from the Lavender Crescent Society in San Francisco who were taken from the airport in Tehran shortly after their arrival and summarily shot dead. In the early 1980s, an attempt to set up a gay organisation in the country led to 70 executions. In 1992, about 100 gay people were sentenced to death following one raid on one private party.

During this period, it is very common to see in the media images of gay and bisexual men hanging from trees. Executions of lesbians took place as well. The executions were carried out with impunity to the extent that additional ‘smokescreen' charges, such as rape and kidnap, were rarely made, probably because there was very little international interest or protest at these widespread killings of homosexuals. Since the world did not care much about the execution of homosexuals in those days, the tyrants in Tehran felt no need to disguise their actions and motives. If the scenario is bloodcurdling and could be understood because of the status of Iran as an Islamic and theocratic state, then what happens in the democratic Jamaica would certainly make a person to feel sick. In Jamaica, homosexuals are extra judicially beaten, lynched and often murdered. The story of a young man called Brian summarises the treatment being meted out to homosexuals in Jamaica on daily basis. These days he wears sunglasses to hide his left eye damaged, he claimed, by kicks and blows with a board from a Jamaican reggae star Buju Banton. Brian is gay and Banton is an avowed homophobe whose song ‘Boom Bye-Bye’ decrees that gays "haffi dead" (have to die). In June 2004, Brian claimed that Banton and some of his thugs burst into his house near Banton's Kingston recording studio and ferociously beat him and five other men. After complaints from international human rights groups, Banton was finally charged but couple of months later a judge dismissed the case for lack of evidence. It was a bitter decision for Brian, who lost his landscaping business after the attack. This is not an isolated case; in fact it is one amongst many. Few years back, two of the island's most prominent gay activists Brian Williamson and Steve Harvey, were murdered and a crowd celebrated over Williamson's mutilated body. This did not happen in Iran or Saudi Arabia but in Jamaica in the Caribbean. Perhaps most disturbing is the fact that many anti-gay assaults have been acts of mob violence. In 2004, a teen was almost killed when his father learned he was gay and invited a group to lynch the boy at his school. Months later, witnesses accused the police of aiding and abetting another mob that stabbed and stoned a gay man to death in Montego Bay. And recently a man from Kingston, Nokia Cowan, drowned after a crowd shouting ‘batty boy’ (Jamaican word for homosexual) chased him off a pier.

"Jamaica is the worst any of us has ever seen," says Rebecca Schleifer of the US-based Human Rights Watch and author of a scathing report on the island's anti-gay hostility.

Jamaica may be the worst offender, but much of the rest of the Caribbean also has a long history of passionate homophobia. Islands like Barbados still criminalize homosexuality and some seem to be following Jamaica's more violent example. Recently two American CBS News producers were beaten with tire irons by a gay-bashing mob while on holidays in the Caribbean Island of Saint Martin. One of the victims, Ryan Smith, was airlifted to a Miami hospital, where he received an intensive care as a result of a fractured skull. Gay-rights activists attribute the scourge of homophobia in Jamaica largely to the country's increasingly thuggish reggae music scene spiced with gangsterism. Buju Banton is an epitome of this culture. One of his first hits, 1992's ‘Boom Bye-Bye’, boasts of shooting gays with Uzis and burning their skin with acid "like an old tire wheel." Another artist, Elephant Man declares in one song, "When you hear a lesbian getting raped/ it’s not our fault...Two women in bed/ that’s two Sodomites who should be dead." As if there is no end to this, yet another artist called Bounty Killer urged his fans and listeners to burn "Mister Fagoty" and make him "wince in agony."

Reggae's anti-gay rhetoric is also deep in the country's politics. Jamaica's major political parties have passed some of the world's toughest homophobic laws and regularly incorporate homophobic music in their campaigns. "The view that results," says Jamaican human-rights lawyer Philip Dayle, "is that a homosexual isn't just an undesirable but an unapprehended criminal."

In Nigeria, the biggest black nation on earth, the story is also the same. Despite having had her own fair share of the evil of homophobia in 1998, Nigeria is yet to learn a lesson. It is fast becoming the homophobic capital of Africa. Justin Fashanu was a Nigerian-English footballer who played for a variety of clubs between 1978 and 1997. His transfer to Nottingham Forest in 1981 made him the first £1m black footballer. In 1990 Fashanu encountered hostility after becoming the first prominent footballer to identify himself publicly as homosexual. In May 1998 he committed suicide as a result of the ugly homophobic reception he received including public rejection by his own blood brother, John Fashanu. Despite the wide publicity the ugly incident generated, the Nigerian National Assembly recently initiated what has been described as the toughest homophobic bill in Africa; an achievement that was only recently toppled by the Ugandan Kill-The-Gay Bill. If the Nigerian homophobic bill had made it into law, it would have handed out a maximum sentence of five years imprisonment on same-sex couples, those engaging in same-sex wedding ceremonies, as well as on those who perform such services and attendees. Homosexual acts between consenting adults are already illegal in Nigeria under a penal code that dates to the British colonial period. The bill's vague and dangerous prohibition on any public or private show of a "same sex amorous relationship" which could be construed to cover having dinner with someone of the same sex would open any known or suspected gay man or lesbian to the threat of arrest at almost any time. The bill also criminalizes all forms of political organizing on behalf of gay rights. In a country with a high rate of HIV and AIDS, the ban on holding any meetings related to gay rights could make it impossible for medical workers to counsel homosexuals on safe sex practices or for specially-tailored medical care to be delivered to homosexuals. Efforts to pass the bill last year met a stumbling block partly because of strong condemnation from the United States and the European Union. It was however recently revived.

If the Nigerian scenario is too bad, in the neighbouring Senegal-the only West African country to have had democracy since independence-it is certainly barbaric and heartbreaking. To the long list of abuse meted out to suspected homosexuals in Africa, Senegal has added a new form of degradation; the desecration of their bodies after burial. In the past two years, at least four men suspected of being gay have been exhumed by angry mobs in cemeteries in Senegal. The violence is especially shocking because Senegal, unlike other countries in the region, is considered a model of democracy and tolerance. Even though homosexuality is illegal in Senegal, colonial documents indicated that the country has long had a clandestine gay community. In many towns, they were tacitly accepted, says Cheikh Ibrahima Niang, a professor of social anthropology at Senegal's largest university. In fact, the visibility of gays in Senegal may have helped to prompt the backlash against them. The latest victim of this barbarism is a young man named Madieye Diallo. Madieye Diallo's body had only been buried for a few hours when the mob descended on the weedy cemetery with shovels. They exhumed the corpse, dragged it away and dumped it in front of the home of his elderly parents. The scene of May 2, 2009 was filmed on a cell phone and the video sold at the market. It passed from phone to phone, sowing panic among gay men who say they now feel like hunted animals.

In the United Kingdom, the fight against homophobia has gone a long way but unfortunately there are still some pockets of homophobic incidents here and there including in some government quarters especially in the nation’s asylum system. “Britain’s asylum system is homophobic. The Home Office is refusing asylum to genuine lesbian and gay refugees and sending them back to countries where they are at risk of arrest, imprisonment, torture and even execution,” said Peter Tatchell of the gay human rights group OutRage! “The government seems more interested in cutting asylum numbers than in ensuring a fair, just and compassionate asylum system. It is failing gay refugees who have fled savage persecution, including death squads, vigilante attacks and attempted so-called honour killings,” he added.

The United States of America does not have a good picture ether. Despite the fact that five states have successfully legalised gay partnership in the past couple of years, homophobia regrettably, is still on the increase. It is still taking ages to repeal the controversial ‘Don’t Ask, Don’t Tell’ policy that forbids openly gay men from serving in the United States Army. And recently, in the State of California, the Church of Jesus Christ of the Latter-day Saints otherwise called the Mormons played a very pivotal homophobic role in the successful passage of a piece of legislation called ‘Proposition 8’. The ‘Proposition 8’ upturned the State’s Supreme Court ruling legalising gay marriage. In a letter dated June 29, 2008, Mormon leaders in Salt Lake City told the church members to work hard to pass Proposition 8 in California. Members of the Mormon Church contributed a whopping $8 million to the "Yes on 8" campaign to pass a ballot measure that removed basic civil rights from the state constitution. But the homosexual members of the church are not immuned from the stress of homophobia. The alienation felt by this group was highlighted in 2000 when one of them, 32-year old Stuart Matis committed suicide on the steps of the Mormon’s church in Los Altos, California, over the church treatment of gays, lesbians and bisexuals. This scenario echoes a similar incident in the Vatican when Alfredo Ormando, a 40-year-old gay man from Palermo, Sicily, set himself on fire in St. Peter's on Jan. 13, 1998. He died of his injuries 10 days later. In his suicide note, Ormando wrote at length of how he felt rejected by the church and the pain it had caused him. To many, he has become a symbol of what they see as the intolerance of Italian society and the Roman Catholic Church.

The story continues with no end in sight. As of December 2008, homosexuality was illegal in 80 countries and punishable by death in seven including Nigeria. In its 1994 decision in Toonen v. Australia, the UN Human Rights Committee, which is responsible for the International Covenant on Civil and Political Rights, declared that such laws are in violation of human rights. Also the Principle 21 of the Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Gender Identity Says that everyone has the right to freedom of thought, conscience and religion, regardless of sexual orientation or gender identity and that these rights may not be invoked by the State to justify laws, policies or practices which deny equal protection of the law, or discriminate, on the basis of sexual orientation or gender identity. It is purely against this backdrop that the 34 member countries of the Organization of American States in 1998 unanimously approved a declaration affirming that human rights protections extend to sexual orientation and gender identity.

With Panama decriminalising homosexuality in 2008 and Burundi for the first time in its history criminalising it in 2009, the world now counts 80 countries with State-sponsored homophobic laws. Seventy-two countries and three entities (Turkish-occupied North Cyprus, Gaza and Cook Islands) punish consenting adults with imprisonment, while five countries (Iran, Mauritania, Saudi Arabia, Sudan, Yemen and parts of Nigeria and Somalia) punish them with death penalty. As a result of the ugly dimension homophobia is taking there was a meeting recently between the French Minister of Human Rights and Foreign Affairs Rama Yade and Louis George Tin, the founder of the International Day Against Homophobia. At the end of the meeting, Yade announced that she would be appealing at the UN for the universal decriminalization of homosexuality. The appeal was quickly taken up as an international concern. Co-sponsored by France, which then was holding the presidency of the European Union, and The Netherlands on behalf of the European Union, the declaration had been intended as a resolution but later changed to use the format of a declaration because there was not enough support for an official resolution. The declaration was read out by Ambassador Jorge Argüello of Argentina on December 18, 2008, and was the first declaration concerning gay, lesbian and bisexual rights to be read in the General Assembly of the United Nations. The declaration condemned violence, harassment, discrimination, exclusion, stigmatization, and prejudice based on sexual orientation and gender identity. It also condemned killings, executions, torture, arbitrary arrest, persecution and deprivation of economic, social and cultural rights on the grounds of sexual orientation.