Suaad Allami, Vital Voices Winner in Nina Magazine
Suaad Allami, a leading Iraqi women’s human rights lawyer, US State Department International Women of Courage Award Recipient 2009 and Vital Voices Global Leadership Awards winner 2014 shares key perspectives around barriers in terms of women’s healthcare from legal and social perspective in Iraq. Based in Baghdad, Suaad founded the Iraqi NGO, Women for Progress, in 2007.
Health is a social, economic and political issue. Above all though, it is a fundamental human right. In Iraq, both national and international frameworks exist, created to get rid of discrimination against women in all its forms. Alongside our country’s constitutional provisions that aim to promote the health of all Iraqi citizens through provision of public health services, Iraqi Public Health Law No. 89 of 1981 provides broad measures aimed to support the maternal health, family planning, and children’s health. However, the law does not make provision for women’s health care facilities; neither does it refer to the prevention and treatment of illnesses specific to women, although pre-and post-natal health care is referenced.
Broadly, Iraqi law does refer to the right to health care. It specifies that children and women should be afforded health security. However, the legal framework is inadequate in terms of ensuring that quality health care is accessible and affordable to women. This particularly applies to those women who are widowed or heading up households for other reasons. It also fails to address the full range of women’s reproductive health issues and concerns (especially adolescent girls and including GBV). Instead, it focuses primarily on prenatal and maternal health.
When considering health rights for women in Iraq, social realities such as poverty and economic dependency must also be discussed alongside legal provision. Traditionally males within households enjoy preferential treatment. This means access to food, for example, can be inhibited by gender. Other traditional practices, such as women needing to obtain permission from a male relative before seeking medical care, are also significant barriers to good health for women and girls. The prevalence of gender-based violence and deprivation, along with lack of influence in the decision-making process, means that although men and women may have similar physical symptoms, women experience these health conditions very differently.
However, one should consider Health rights in Iraq for Women within a wider national context also. The estimated population of Iraq in 2003 amounted to 25 million people. In 2015 it reached 35 million people. 42% of Iraq’s population is less than 14 years old (Iraq is one of the youngest populations in the world).The Iraq Family Health Survey (IFHS) 2006 indicates a high proportion of out-of-pocket spending on health (13% of monthly household expenses).
Poverty rates continue to rise in Iraq, where 23% of the population lives under the level of the poverty line. The bad conditions of rural and agricultural development push the rural population to urban areas, creating a situation where 13% of the buildings are single houses which often house more than a dozen family members. This leads to slum conditions and in turn means that women are not able to access basic health services and resources.
No reliable data is available on the proportion of women living in poverty, but because women are less likely to be part of the formal labour market, they do not receive the benefits of social protection, including access to health care. So, even when health care is available, women may be unable to access it.
High Fertility rates
The total fertility rate in Iraq is high compared to the countries of the world and the Arab states. This is an obstacle to development in terms of maternity and women’s health in general. In 2011 the birthrate reached 4.5 births per woman (neighbouring countries; 2/family). The decline in the number of births in these countries has been directly related to better education and opportunities for women. To confront this challenge the state should provide more health, education, housing and jobs for women in Iraq.
The maternal mortality rate in Iraq stood at 25.8 cases per 10,000 live births in 2012. Unhealthy practices at birth, inadequate health care sources or midwifery and the high level (35%) of anemia among pregnant women are contributing factors. This situation is particularly prevalent among women in rural central and southern Iraq. Furthermore, Ministry of Health reports have indicated that the numbers of women accessing health care are declining, especially in pregnancy. For example first time pregnancy visits to primary health centers in across Iraq has dropped from 66% in 2011 to51% in 2012. In rural areas especially, the lack of female medical staff has an impact. To improve the situation, efforts should be made to educate women about the importance of attendance. This will reduce risks in pregnancy and childbirth. Also, appropriate measures should be taken to appoint the female doctors.
Cultural and social practices
Early marriage is on the increase. Early marriage means girls drop out of school, but also jeopardizes the overall reproductive and mental health of these girls who are unlikely to be physically or mentally prepared to give birth. The numbers of widows and cases of divorce have increased from 28,000 in 2004 to 160,000 in 2012; leaving many women and their children to confront life with no job skills and no financial support.
A combination of backward customs, traditions and practices don’t just result in women being unable to access primary health centers, lack of legal rights can also directly lead to death. This is a true story, one of our cases in our Women for Progress Center.
Nada, a young mother of 17, came to us seeking legal assistance. Her family had compromised her legal rights when her husband divorced her unilaterally and her brother had not allowed her to pursue her rights as he was married to her husband’s sister. So, the negative cultural practice of tribal rule embedded in this family led to her losing custody of her two children, a one year old boy and a two year old girl. This directly led to the death of the boy as his father and his step-mother neglected him. Eventually, when it was obvious how ill he was, this young woman claimed back her son. However, lack of the financial resources meant she was unable to save him. This story shows how often in practice women’s rights established by law are reversed by tribal custom.
Gender-based violence is a critical health issue for women in Iraq. Deterioration of the environment which impacts the root causes (cultural traditions, economic, social, instability of the political environment, and the sectarian violence) is having a significant impact on these rapidly rising statistics. Violence against women leads directly to serious injury, disability or death. However, there are also indirect impacts which include stress-induced physiological changes, substance abuse and lack of fertility control. Abused women have higher rates of unintended pregnancies, abortions, adverse pregnancies and neonatal and infant outcomes, sexually transmitted infections (including HIV), and mental disorders compared to their non-abused peers.
It is also worth noting that the social stigma attached to crimes of sexual violence discourages many women from attempting to access medical treatment. They are unlikely to pursue legal avenues, due to the fear that this may provoke an ‘honour killing’ or social stigmatization
A study conducted by the Ministry of Planning in Iraq has shown that the higher the number of children in families, the more likely gender based violence is. Another key identified factor is the low educational level of women (particularly among the unemployed women). Therefore creating awareness around limiting family sizes and taking practical steps to improve educational and job opportunities should start to make a dent in these frightening statistics.
Iraq has had an official policy of providing family planning and contraception for the last 20 years. However, it is unclear to what extent women are able to access family planning services. Almost one-third of family planning institutions have been destroyed since 2003. Technological advances in family planning are unavailable and both healthcare providers and women alike are unaware of newer family planning options. The key concerns for women seeking health care include respect, trust, privacy and confidentiality – values that are often compromised in busy facilities.
Women are legally free to make independent decisions about their health and reproductive rights, but they are less able to exercise this freedom outside large cities. Furthermore, greater poverty and ignorance about women’s health issues leads many families in these areas to resort to folk remedies and informally trained midwives.
The patriarchal attitudes, cultural and religious beliefs, and economic conditions at social and institutional levels impede women’s free access to family planning services. Women are therefore unable to choose the spacing and number of children in their families.
As a conclusion, societies and their national health systems need to be better geared to meet women’s health needs in terms of access, comprehensiveness and responsiveness. Policies and programmes must ensure that gender norms and socio-economic inequalities do not limit women’s ability to access health information and health-care services. Broader strategies such as poverty reduction, increased literacy, training and education, and increased opportunities for participation in economic, social and political activities will contribute to progress in women’s health. Deliberate steps should be taken to integrate gender analysis and actions into public health policies and financial barriers to the use of services must be eliminated. The economic empowerment of women should be seen as an important component of any policy response.
You can contact Women for Progress through [email protected]; +964 79016 44319