This article reports the findings of research conducted with a randomly selected sample of men aged 18–49 years from the general population of the Eastern Cape and KwaZulu-Natal, who were asked in an anonymously conducted survey about their rape perpetration practices, motivations, and consequences thereof. Overall 27.6% of men had forced a woman to have sex with them against her will, whether an intimate partner, stranger or acquaintance. Some perpetrated alone, others with accomplices. Most men who had raped had done so more than once, started as teenagers, and often had different types of victims. Asked about motivations, men indicated that rape most commonly stemmed from a sense of sexual entitlement, and it was often an act of bored men (alone or in groups) seeking entertainment. Rape was often also a punishment directed against girlfriends and other women, and alcohol was often part of the context. A third of men had experienced no consequences from their acts, not even feelings of guilt. More commonly there was remorse and worry about consequences, and in a third of cases there had been action against them from their family, that of the victims, or respected community members, and about one in five had been arrested for rape. This research confirms that rape is prevalent in South Africa, with only a small proportion of incidents reported to the police. Many of the roots of the problem lie in an accentuated gender hierarchy. This highlights the importance of interventions and policies that start in childhood and seek to change the way in which boys are socialised into men, building ideas of gender equity and respect for women.
Values, Policies and Rights
In 2008 WHO analysed 186 national constitutions and found that 135 (73%) include provisions on health or the right to health. Of these, 95 (51%) constitutions mention the right to access health facilities, goods and services, which includes medicines. Only four national constitutions (2%) specifically mention universal access to medicines. There are at least three different routes, the study argues, through which the right to health – and essential medicines – can be recognised in national legal frameworks. The strongest government commitment is created by including the right to essential goods and services in the national constitution. The second approach is constitutional recognition that international treaties ratified by the State override or acquire the status of national law. The third option, inclusion of health rights in other national legislation, is easier to create but also easier to change or cancel. The full range of strategies should be used to promote universal access to essential medicines through rational selection, affordable prices, sustainable financing and reliable health systems, the article argues. Constitutional recognition of the right to access essential medicines is an important sign of national values and commitment, but is neither a guarantee nor an essential step – as shown by those countries that have failing health systems despite good constitutional language, and those that have good access without it. Yet constitutional recognition creates an important supportive environment, especially in middle-income countries where health insurance systems are being created and patients are becoming more aware of their rights and are more vocal in demanding them.
In light of the World Health Organization's declaration that non-dependent drinking contributes more to the global burden of alcohol-related disease than does drinking by those who meet diagnostic criteria for dependence, this article argues that clinicians, researchers and decision-makers need to consider microsocial and macrosocial impacts of alcohol use, not just addiction and clinical effects on individuals meeting diagnostic criteria at the extreme high end of the alcohol-use spectrum. It suggests some qualitative dimensions to further define social or low-risk drinking and proposes that all drinking beyond that be described as harmful, because of its impacts on personal, community and population health.
Gay Kenyans will be driven further underground and away from HIV prevention, treatment and care services following a recent call by Prime Minister Raila Odinga for a nationwide crackdown on homosexuals, activists say. Addressing a rally in Nairobi on 28 November, Odinga ordered the police to arrest and bring criminal charges against anyone found engaging in sex with someone of the same gender. He added that the country's constitution made it clear that homosexual activity was not tolerated. David Kuria, chair of the Gay and Lesbian Coalition of Kenya, said the prime minister's remarks will negatively impact the government's efforts to include the country's gay population in HIV prevention programmes. For example, activists warned that few would be willing to participate in a government survey - due to start in December - that aims to draw on responses from the country's gay population to inform HIV programming for men who have sex with men (MSM). Activists said potential respondents would be too fearful of being targeted by the authorities. Homophobia is widespread in Kenya, but this is the first time such a senior political figure has openly called for legal action against homosexuals. In October, a cabinet minister who called for tolerance towards gays was urged to resign for promoting ‘un-African’ culture.
This article proposes six action strategies to guide global health researchers to synergistically target women's health outcomes in the context of improving their right to freedom, equity, and equality of opportunities. Its main purpose is to offer a feasible approach to health researchers who, conceptually, may link women's health to social and cultural conditions but are looking for practical implementation strategies to examine a women's health issue through the lens of their human rights. The proposed strategies include becoming fully informed of women's human rights directives to integrate them into research, mainstreaming gender in the research, using the expertise of grass-roots women's organisations in the setting, showcasing women's equity and equality in the organisational infrastructure, disseminating research findings to policymakers in the study locale to influence health priorities, and publicising the social conditions that are linked to women's diseases. The article explores conceptual and logistical dilemmas in transforming a study using these principles and also provides a case study to illustrate how these strategies can be operationalised.
This paper identifies South Africa as a country with much internal and cross-border migration within a region of high population mobility, and argues that the country urgently needs to develop, implement and monitor an evidence-based, coordinated, multilevel national response to migration and health. This includes acknowledging the developmental benefits of migration, ensuring ‘healthy migration’ and engaging with a ‘place-based’ approach to addressing the diverse health needs and health impacts of the multiple migrant groups present within South Africa. The paper recommends that South Africa develop a co-ordinated regional response to migration and health. It should support the implementation of a regional framework for communicable diseases and population mobility. Four priority areas were identified: monitoring migrant health, developing partnerships and networks, developing migrant-sensitive health systems and putting in place policy and legal frameworks for migrants’ health. Migrants and migrant communities should be involved in health and migration responses, the paper argues.
This article reviews formal and informal mechanisms through which the World Health Organization (WHO) is promoting policies for the advancement of women's health, such as Countdown to 2015 and the Partnership for Maternal, Newborn, and Child Health. Specific attention is given to examples of innovative strategies WHO has adopted in recent years to increase political commitment to women's and children's health and influence the development of policies supportive of country efforts to achieve Millennium Development Goals 4 (MDG4) and MDG 5 (to reduce child mortality and improve maternal health, respectively). It is expected that WHO’s commitment to women’s health and efforts to translate its political agenda of improving the lives of women and girls through influencing policy development at the country level will progressively increase under the leadership of Dr Margaret Chan, the current WHO Director General. The Director-General has indicated that improvements in the health of the people of Africa and the health of women are considered the key indicators of WHO’s performance in the coming year.
The United Nations Global Strategy for Women's and Children's Health, together with the African Union’s commitment to deliver a coordinated campaign to improving maternal, child and newborn health and the G8’s commitment of US$5 billion, form part of a global strategy to save 16 million mothers and children by 2015. The strategy, according to this article, aims to integrate service delivery and funding platforms, involving a wide range of stakeholders, research and innovation, and track progress through an accountability framework. Planned outcomes include: 43 million new users having access to comprehensive family planning and 19 million more women giving birth attended by a skilled health worker with access to necessary infrastructure, drugs, equipment and regulations. The strategy is designed to ensure that 2.2 million additional neonatal infections are treated, 21.9 million additional infants are breastfed, 15.2 million more children are fully immunised in the first year of life and that 117 million more children aged less than five years receive vitamin A supplements. To deliver these interventions, 85,000 more health facilities and up to 3.5 million additional health workers are needed.
According to this article, one aspect of the efforts of global capital to shape health policy in developing countries is the practice of so-called ‘independent’ think tanks, which seek to put into the public domain seemingly dispassionate opinion pieces on public policy, but which are openly oriented to promoting free market policy at the expense of public benefit. These think tanks propose that only free market liberalisation can solve problems related to food security, housing and health, but offer limited empirical evidence for this. The role of large corporate funding in their work is obscured. The article presents one example, the London-based International Policy Network, which is argued to promote private healthcare by arguing that human rights are not indivisible and inalienable, and by dismissing the validity of social and economic rights, particularly the right to health.
The 52nd East, Central and Southern African (ECSA) Health Ministers Conference was held in Zimbabwe from 25-29 October 2010, with the theme ‘Moving from Knowledge to Action: Harnessing Evidence to Transform Healthcare’. A number of resolutions were passed, calling for governments to promote evidence-based policy making, engage with the international community/global movement towards achieving universal health coverage, develop training programmes and monitoring mechanisms for improved maternal child health and reproductive health/family planning, establish and/or strengthen a national gender commission for dealing with gender-based violence and child sexual abuse, develop and monitor strategies for retaining health workers in the region and support strategic leadership in global health diplomacy. Further resolutions call for ECSA countries to prioritise nutrition interventions, strengthen monitoring and evaluation systems, strengthen the response to multi-drug resistant and extremely drug resistant tuberculosis, and strengthen partnerships for health by ensure that partner involvement in health programmes is aligned and harmonised with national health policies, plans and priorities. The countries should develop mechanisms for tracking health care investment and evaluating the outcomes of partnerships.