I welcome Senator Mary Henry, Deputy Fiona O'Malley and Ms Catherine Heaney, chief executive of the Irish Family Planning Association. They are before us today to discuss the report of the parliamentary study tour to Ethiopia, which continues to be one of the key priority countries for Irish bilateral aid. Ireland Aid programmes have been ongoing in Ethiopia since 1993 and strong links have developed between both countries. Based on this relationship, Ethiopia was chosen as the host country for a study tour by Irish parliamentarians last September. I invite Senator Henry to give an overview of the report which will be followed by a question and answer session.
Parliamentary Study Tour: Presentation.
I thank the committee for inviting us. Our male colleagues, unfortunately, are unable to be with us, but, given that a great deal of the work we did out there was with women, it is probably appropriate that we are here. As the committee knows, Ethiopia is an incredibly poor country and there is a serious lack of access to health care for a large number of people. A total of 60% of the population live more than a six hour walk from an all weather road. The maternal mortality rate is one of the highest in the world. Women have a one in ten lifetime chance of dying in childbirth and the infant mortality and under five mortality rates are very bad as well. I have all the figures here if the committee would like to see them. The under five mortality rate for boys is 195 per 1,000 and for girls 170 per 1,000. They really are shocking. Children virtually have a one in five or six chance of dying before they are five years old.
The fertility rate is incredibly high as well. At 6.7, it is one of the highest fertility rates in the world. Women there have very poor access to care when they are pregnant or when they are delivering children. About 4% of women in rural areas have access to trained medical care when they give birth. The death rate is bad enough in women who are over 18 but in teenagers the death rate is twice that of women over 18. The work Ireland Aid and UNFPA are doing there is incredible. I am a great believer in mol an óige agus tiocfaidh sí and this is an area where one can see that our money is being extraordinarily well spent. I praise those from Ireland who are working there.
One of the most important things that we felt when we were there was that women need information. In this country information has made a great difference to women's health. I was looking at an article in the Irish Medical Journal recently which looked at the difference in maternal mortality rates, fertility rates and parity rates over the last 30 years. In 1997-8, of the women who gave birth here, 25% gave birth to five or more children and our maternal mortality rate was considerable. Nowadays the rate of five or more children is only 5% - in urban areas it is 1% - and our maternal mortality rate is negligible. Our birth rate has not gone down much because more women are actually giving birth.
One can see that information and access to contraception would make a very big difference to women in Ethiopia and to that effect we went to see family planning clinics and health clinics. We were impressed not only by the work that those from outside the country were doing, but also by the work that Ethiopians were doing. One unfortunate fact is the high incidence of AIDS. While it is not as high as in some other countries, health workers had very little in the way of protection for themselves when treating patients, for example, rubber gloves, and this put them at risk when they were trying to care for people with AIDS. Perhaps my two colleagues wish to comment before the committee asks us any questions.
Ms Catherine Heaney
I wish to mention some of the overriding things which we observed while we visited. We met a few senior political figures, including the health Minister and the deputy chairman of the parliament. There were some political practices that we felt needed to be changed to move things forward. One of these was that the Ethiopian constitution, which is a written constitution and rights based, could be changed by a single act of parliament and parliament comprised an 85% majority. We felt that if rights were to be enshrined, particularly for women, it needed to be a more solid constitution and perhaps a referendum should be required.
The other one or two observations that we made once again hit at the AIDS and HIV situation. While the rates are, in relative terms, lower than in a number of other sub-Saharan countries we felt that we were not getting the true picture of the level of HIV and AIDS because the programmes that were being implemented did not have much political expediency behind them. In some respects we felt that there was no political commitment or national co-ordination. Although a strategy is in place, we felt it could be better, particularly around the health promotion area and the kind of messaging at a political level.
Another observation relates, as Senator Henry mentioned, to the level of maternal mortality and child mortality but we also observed some extreme complications women had to endure around childbirth which in some cases left them permanently disabled. They did not necessarily kill the women but maybe would have serious long-term health implications for them, such as fistulae. It is important to point out that the issue is not just maternal mortality but other damaging health implications too.
It was my first trip to Africa and it was an eye-opener because whatever about seeing the poverty, smelling it is another matter altogether. The people all knew about Ireland and were grateful to have the help and support of the Irish Government. It is such a young democracy that there are problems around this and we were interested in the 85% majority in parliament. The Ethiopian Government is to conduct a census next year. Some of the money that Ireland gives it is going towards this because it is vital to get information. It is a vast country and even in Addis Ababa the amount of tarmacadamed road is extraordinary.
During that trip I learned of the very good work UNFPA is doing in the area of health. Healthy reproductive life is very important to development aid. There is a tradition in Ethiopia for people to marry very young. I am aware that has changed in terms of its constitution, but many people there cannot read and communications are so poor that the constitution does not matter a great deal. Women have multiple pregnancies very young and this had led to the fistula problem. We spoke to young people who had many children and said they were delighted they could get contraceptives because it allowed them - in some cases with the agreement of their husbands - to make better decisions regarding their family and they could have healthier families. One of the main findings we discovered was that if contraceptives and other medical items were more available, they would have a great impact on the health of the nation and of mothers in particular. The major problem is the lack of availability of simple medical items such as rubber gloves. There is a massive shortage of such items. The health implications of not having rubber globes in a community where HIV is so prevalent is great. We found that the availability of such simple medical items would make all the difference.
I welcome the delegation and thank Senator Henry for her report. It is an interesting one and, taken with the Ireland Aid report and the bilateral work that is done between Ireland and Ethiopia, is a useful information tool for us. It is important that Ireland continues to support the effort of UNFPA in developing countries, particularly when there is a concerted and organised movement and strong propaganda about withdrawing financial support from such activities in developing countries. For example, the Bush Administration has to its shame withdrawn funding for such activities in the poorest countries of the world, in respect of which Ireland rightly articulates opposition at every international fora.
Ireland has continued not only to support reproductive programmes in developing countries but is increasing its funding of such programmes. We increased our contribution to UNFPA significantly by 38% in 2003, which was a welcome development in the context of opposition to such funding.
Ethiopia is one of our priority countries for overseas development assistance and will continue to be so because it is so needy. One of the major disadvantages Ethiopia has is that its massive population of close to 69 million people live in difficult and challenging circumstances and face constant chronic food and security difficulties given Ethiopia's recent long-standing war with its neighbour Eritrea. It is currently suffering food shortages and for that reason Ireland will continue to intensify its engagement with it.
I agree with the objectives of UNFPA , particularly in Ethiopia and other developing countries with high populations, that the health and education of the girl child is a fundamental aspect of human development in developing countries. If women and female children are educated, the country has some hope of developing in a better way. Reproductive freedom and choice is an extremely important aspect of women's health in developing countries. Every effort should be made to support not only UNFPA centrally at the United Nations level but through NGOs in developing countries. I would like to see more co-ordination between Ireland Aid and UNFPA at local level in the field. All of the projects initiated by Ireland Aid, at central Government level here, are tested for their impact on women. That aspect is taken into account whether in respect of education, sanitation, primary school education or health programmes. All these are tested at initiation stage for their impact on women. All our programmes are gender proofed. There could be better co-operation and integration of the aims of UNFPA into Ireland Aid programmes and our health programmes.
It was sad but laughable that while there is a ministry for women in Ethiopia——
With only one person.
——it has only one staff member. That is what we are up against in developing countries. That is why it is important the donor country insists at the initiation and development of programmes in developing countries that the benefits of aid go equally to boys and girls and men and women. We cannot assume that the developing country will push out the boat for women. That goes without saying.
It is good that UNFPA organises a familiarisation programme and study tours for parliamentarians. I am sure other Deputies would be interested in becoming involved in such study tours. As the programme develops, it may be extended to a wider circle of parliamentarians because many Deputies have never had the opportunity to visit a developing country and see the great life altering work that is done as a result of assistance given by rich countries like Ireland to poor countries like Ethiopia. I thank Senator Henry for her report and assure her that we will continue to advocate support for reproductive freedom in developing countries through UNFPA in the future.
I very much support UNFPA in its work. It is useful to have this presentation at this time given the campaign that is now being unleashed for the second or third time on its work in different parts of world, particularly in Peru and China, which has been examined by the State Department of the United States and others and found to be without foundation, yet Deputies and Senators continually receive information about allegations and so forth. Therefore this report is welcome.
I am struck by how little social anthropological work exists on the family planning issue coming through UNFPA. Such work would be very useful. Put simply, to some extent there is some rough evidence that suggests that when there is very high infant mortality under the age of five, women have several more children. If there is a high level of child survival beyond the age of five and measures such as oral rehydration therapy are applied, one moves from concern for child survival into the food provision area. One might ask what is the effect of that on child spacing. That is precisely where social anthropological work is vital because it raises the issue of how the concept of child spacing is accepted by people, particularly by women.
My second point relates to issue of child pregnancies, which is what they are, and the availability of information in the primary system. The description of clinics with nobody in attendance makes sad reading. The issue of child mothers also arises. In some African countries where people have advanced towards universal primary education - it was happening in Iraq also - the mother has to walk long distances if a member of the family is ill and a female child is given the duty of looking after the younger children. When one considers the female participation rates in primary education, they correspond very dramatically to food and other crises. This is a huge problem. I congratulate the team involved in the production of this useful report.
Like other members, I thank Senator Henry for the comprehensive report presented to the joint committee. I had also looked at the poor woman who is in charge of the women's ministry. Realising she had one person to help her to light up the whole of Ethiopia and make them all aware of women, she said "I can do nothing".
I am interested in the fistula problem raised by Deputy O'Malley I understand the Deputy is engaged in a fund raising event. When is it to take place?
The date is to be confirmed. It will happen during the summer.
I confess that after 20 years in the Houses of the Oireachtas, I was not aware of the existence of this group. I would like to know more about it and its plans for the future. It may appear naive but how does one choose the people who go on the study trips? The group's work is central to furthering research and development in those countries Much of what is taking place in Ethiopia has been mentioned by Deputy O'Donnell as being hugely important. The work being done by Senator Henry's group should feed into the formal aid process through Departments. Women have no chance if they are girl mothers and have children every 12 months and if, in turn, many of the children die before they are five years of age. Food provision is an obvious problem; clearly, breast-fed children have a better start in life and live longer. There is a need for development in this area.
What is Senator Henry's view on the current famine, having witnessed it during her visit? It is obvious she was horrified by what she saw in the areas she visited. The Senator recognised that the Ireland Aid is being well used. Does she think anything additional could be done or did she identify any priority issue, especially in the area of development co-operation? We are aware HIV-AIDS is a huge problem. What is the position with other diseases such as tuberculosis, malaria, etc.? Representatives of the joint committee hope to visit the area in the coming months.
I am delighted with the interest shown in this matter. Deputy O'Donnell cannot be sufficiently thanked for her work in getting as much aid as she did for these countries because the money is being well spent. One could see the difference it made. I hope we can achieve the 0.7% target because money makes a huge difference there. Deputy Higgins' comment about social anthropology is very important but this is a delicate subject with which to deal. While the age of marriage was raised from 16 to 18, each province must introduce this provision in its own area. By the time we left, only two provinces had done so. I do not know what difference the legislation would make because they should have tried to delay the age of first pregnancy. They were managing to do this because the death rate in obstructed labour of girls in their early teens is horrific. As Ms Heaney said, there is not only the problem of mortality, there is also morbidity. These young girls become incontinent, both faeces and urine, and are thrown out of their houses. Unless they are dealt with in places such as the Fistula hospital, their lives are over. It is a very serious issue.
One could say that many women were not in a position to refuse sex. This is a very serious problem. The issue of trying to space pregnancies is important. If the woman is breast-feeding a child and is working in the fields, that is fine. If she has another child, it is called the back baby. If she has another baby almost immediately, the back baby is displaced, left at home and fed whatever may be around the place, which is totally unsuitable for it, and dies. I witnessed these terribly sad situations. As is clear from the report, I went back on my own initiative to talk to the women parliamentarians and the women doctors. It is an area in which they are making great efforts to help women to space their children until they are at least two years old.
Is breast-feeding common?
Yes.
In that case, there would be a natural spacing.
Unfortunately, it does not seem to stop ovulation. I saw a woman who had given birth in a hut in which there was donkey dung and this was quite a prosperous home. In the dark, I realised there was another child with her aged about 11 months or a year wondering from where his supper would come. Breast-feeding as we know it is totally useless as a contraceptive. It is the baby who is no longer the back baby who dies. This is important in view of the high mortality rates. They are very enthusiastic about injectable contraceptives because so many of them live considerable distances away from clinics. It is a six hour walk to the clinics and injectable contraceptives last about three months. I hope they will get more help in this area.
Senator O'Rourke asked how the members of the group were chosen. About a year and a half ago Ms Heaney and I started to think of people who might be interested in the group and tried to ensure we had people from all the parties and various representative groups within the Parliament. Certainly we can spread membership even wider. This was the first important tour of people from Parliament. Now that so many people are interested, we will certainly circulate information to a wider group.
I read in the report that the influence of the Catholic Church is very strong. Is this the case?
It is, but it was not unhelpful.
That is the point I was about to make because it appears from the report that it was very helpful.
None of the churches was unhelpful because they are all very worried about these high mortality rates. We found no opposition from any quarter because there was great concern about the situation. The fact that one in five children dies before the age of five is horrific. Women are very important in the workforce.
Regarding what the chairman said about the other diseases, malaria is not too bad in many of these countries as they are located above the level at which malaria is prevalent, which is fortunate. The Ethiopian population lived in the highlands but due to population pressure they now have to inhabit parts of the lowlands which have lower rainfall and are less fertile. That is the reason they are having such trouble with famine. We saw very good stocks of food aid but the problem is getting it distributed because the roads are incredible.
TB is a major problem. HIV is not as bad as in other places but again we tried to tell young girls in particular about reproductive rights and that they did not have to have sex. There is a myth in some areas that if a man has sex with a young virgin he will pass the virus on to her and will get rid of it. It sounds quite plausible when it is explained like that.
Somebody asked about schooling and education for girls. There are many abductions of girls of ten, 11 and 12 years and that stops parents sending their daughters to school. If these girls are abducted, by the time they are returned they are nearly all HIV positive because they have been used for sexual practices.
The life expectancy of approximately 40 years is not good. Unfortunately, it has decreased in recent years due to the famines and the population pressure.
On behalf of everyone here I would like to thank Senator Henry for writing this helpful report. We intend to have a special look at Ethiopia, taking in the different aspects. It is what we call Project Ethiopia and we will include Senator Henry's report, with her permission.
Certainly.
Ireland has had quite an involvement in Ethiopia, which is a priority area for us. I thank Senator Henry for coming here today and giving us such an exposition of the situation, which reminds one of what went on in Ireland a long time ago.
One would be struck by that.
We gradually moved on from that but many of the problems in developing countries are problems we faced. Consequently, Irish people have much to offer. There are huge agricultural populations in Ethiopia and in many of the other affected countries and we must try to find out how to handle those as they develop. Many of the people living in cities would not realise it but the flight from the land has been continual over a long period and we must develop alternative jobs for people. This report is an excellent and helpful contribution. I congratulate the group on its work, which we support, and we will build some of its principal views into our own report.
I thank the Chairman and committee members. We have names of some useful contacts. There is much we can do to be helpful in Ethiopia. When I saw animals in the houses in various places, I began to wonder if I should not give a speech on the value of the half door.
With the agreement of members, I would like to deal with the remaining items in private session.
The joint committee went into private session at 4.15 p.m. and adjourned at 4.25 p.m. sine die.