Photos of Hondurans who were disappeared by the nation’s military dictatorship in the 1980s, hanging in the office of COFADEH.
Co-authored with Gustav Cappaert at Latin Correspondent.
Even though most maternal deaths are preventable, every day 800 women across the globe die due to complications during pregnancy and childbirth.
Peru is one of only two South American countries expected to hit its maternal mortality Millennium Development Goal, one of a set of UN-backed global poverty reduction targets that culminate in 2015. Peru today has a ratio of 67 maternal deaths per 100,000 live births, down from 265 in 1990.
The Andean nation remains behind industrialized countries like Japan (with a rate of six) but way ahead of the world’s least developed nations: in Sierra Leone, which has a maternal mortality rate of 1,100.
Help for expectant mothers
“The principal problem Peru has had is access to maternal health services,” said Mario Tavera, Health Specialist for UNICEF Peru. “Global evidence demonstrates that the reduction of maternal mortality is associated with medically-attended birth in health care centers,” he said.
Peru has made strides on this front, 80 percent of women now give birth at a medical facility, compared to just one quarter in the early 1990s. Over 90 percent attend prenatal care visits.
According to Tavera, Peru has more than doubled the number of state-run health facilities in operation, greatly increasing access to care. Some clinics operate associated casas maternas which allow women who live in remote areas to stay for up to a week as they wait to give birth.
But perhaps the most important change has taken place inside of clinics. “There’s a set of very distinct customs” in rural Peruvian communities, Tavera said. “The people were permitted to bring into the clinic customs from giving birth in their homes.” Family members were allowed into the birthing room for the first time; women were allowed to give birth sitting or on their knees; they could bring a rope to hold onto — another traditional custom.
There are wrinkles in this success story, though.
Creating a one-size-fits-all policy is uniquely difficult in Peru. Its three major regions: coastal desert, mountainous center, and Amazon jungle each demand a different approach dictated by culture and geography.
On the traditionally wealthy coast, the average maternal mortality ratio was 56.4 between 2007 and 2011. In the poorer highland and jungle regions it was considerably higher, at 152 and 137 respectively.
“Peru is one of the most unequal countries in Latin America…Parts of Peru have European levels of mortality, other parts have African levels,” said Tavera.
In the mountains, a long history of discrimination against the majority indigenous population makes some women reluctant to visit government health posts. For one, health care providers rarely speak Quechua, the native language in most of highland Peru.
“Those that speak Spanish ignore us, those of us from the town, from the communities that come down. They humiliate us sometimes or don’t treat us well,” said Teresa Echame Vargas, a health promoter in the rural community of Huilloc.
Perhaps not surprisingly, home birth is more common in rural areas. Although official policy is to support traditional birthing methods and attend home births if possible – a practice supported by medical evidence – in reality it depends on the clinic. “We would like the health posts to attend at home, but they say they can’t,” said Vargas.
Fueling claims of discrimination is the illegal but common practice of imposing fines on women who chose to give birth at home.
Keri Baker, the executive director of the health promotion organization Ayni Wasi, recalled a patient who suffered complications during a home birth, “She hadn’t expelled her placenta all the way which can cause hemorrhaging. We saw her at that point, and she hadn’t sought medical care because of the fact that she had given birth in her home.”
A 2009 survey of women in the coastal community of Huaycan – the majority of whom had migrated from the highlands – found that 46.5 percent of women who elected home birth did so because they’d had a bad experience on a previous hospital visit or knew someone who had. A majority of women in a similar study in 2005 cited discrimination and a feeling of violation by health care providers as reasons to give birth at home.
In a jungle region like Madre de Dios, in Peru’s southeast, communities’ distance to health facilities makes professional attention a challenge. The Spanish-speaking population is transient – attracted by the lucrative business of illegal mining. Women that live in mining camps rarely make the river trip to attend prenatal visits, said Nelva Miraya, the government’s Coordinator for Community Strategy and Reproductive Health for the region.
The area’s far-flung indigenous population of 60,000 is another challenge. Communities in Madre de Dios speak 12 different languages, and live in settlements up to three days away from the nearest hospital. The lack of government presence in these areas raises the possibility that deaths go unreported.
“(Until recently), in the entire region of La Salvación, there was only one obstetrician. She was the only one to intervene in native communities that are two, three, four days away by boat,” said a nurse in Madre de Dios’ capital of Puerto Maldonado.
Although recent progress on maternal mortality is encouraging, Mario Tavera of UNICEF warned about diminishing returns. “(Peru is) starting from a very high rate,” he said. “A country like Chile had 30 (maternal deaths per 100,000 live births). Getting to seven is more difficult.”
I thought we would be celebrating in Havana.
Five years ago, I spent a semester in Cuba as an undergraduate student and forged friendships with Cubans my age in spite of—or perhaps because of—the official antagonism between our countries.
“Politics is shit,” a Cuban friend said one night as we reflected, somewhat tipsy, on the intransigence of our governments. It felt impossible, I added, that our nations could be so distant and yet only be separated by 90 miles.
“Yeah, geography is shit too,” he responded.
When I arrived for a visit last month, I expected a change in tone. The governments of Cuba and the United States had agreed months earlier to establish diplomatic relations months earlier. Since then, the Obama administration had begun working to unravel the complex legal machinery that, for the past half-century, has cut Cuba off from its northern neighbor and brought a lot of economic hardship to the island.
I encountered more trepidation than I expected.
“It will be very good for the economy,” a young man told me in the central city of Santa Clara as we rested on a park bench. “But from the ethical, moral, cultural, social, and even aesthetic perspective, that’s another question.”
Another friend of mine—I’ll call him “Daniel”—suspects that the United States will bring down the Cuban government by lifting the embargo for a period of a few years and then suddenly reinstalling it, choking off Cuba’s newly Americanized economy.
Indeed, the United States hasn’t abandoned the goal of regime change in Cuba. Statements from the Obama administration imply that, through engagement, it is simply looking for more effective means.
“They have done us a lot of damage, but they haven’t achieved what they wanted,” my college Spanish professor told me when I paid her a visit at her house. “They are going to try to do from within what they couldn’t do from outside.”
On the morning of August 14, I went to Daniel’s house to watch on TV as John Kerry presided over the unfurling of the American flag and official opening of the United States embassy in Havana. My friend Yassel Alejandro Padron Kunakbaeva had arrived earlier, and sat shirtless in a rocking chair, smoking a cigarette as he waited for the event to start.
“I think it’s necessary to have diplomatic relations with the United States,” he said, but he had his mind on a much older American flag.
Cuban independence from Spain in 1898 was immediately followed by four years of American military occupation. The United States insisted that Cuba’s constitution grant the United States control over Cuba’s finances and foreign affairs. When US troops left in 1902, two flags flew from Havana’s Morro fortress, one Cuban, one American.
“It was a powerful symbol,” Yassel said.
For half a century, Cuba would be a de facto American colony. American marines made landings in 1906, 1912, and 1917. By the 1950s, American mobsters dominated the island, with the acquiescence of Cuban President Fulgencio Batista. Historian Richard Gott wrote that for Cubans, Fidel Castro’s revolution of 1959 was “the first genuine attempt in their history to establish an independent republic.” Castro and his revolution, despite their flaws, occupy a space in Cuban historical memory similar to that of George Washington in the United States.
Fifty years of US hostility toward that revolution has made the United States an easy enemy in Cuban eyes. Cubans seem unsure how to reinterpret American intentions as the era of diplomatic engagement dawns.
As Kerry’s speech neared, Yassel propped open a hardcover book on the dining room table, so that photos of Marx and Engels faced the TV. “They need to see this,” he said. The heat of Cuban August was apparent even through the TV screen; visiting American men were apparently still obliged to wear black suits. Behind the embassy, three antique American Chevrolets were parked conspicuously within view of the TV cameras.
A few minutes behind schedule, an overhead shot showed Kerry and his delegation striding toward the embassy. “The imperialists are walking through the front door!” Yassel shouted. “I’m seeing it, but I don’t believe it.”
Kerry’s speech was respectful and conciliatory, although he portrayed the preceding half-century of conflict as one between two equals, rather than a global superpower bullying a small island. He outlined the steps the United States has already taken toward rapprochement with Cuba, and the steps that he says Americans are willing to take if Cuba makes political and economic reforms.
As we watched, Daniel avoided the television, sweeping, making coffee, smoking cigarettes. “This is a cultural invasion,” he muttered at one point.
If so, there is a lot at stake. When I first arrived as an exchange student, I quickly realized that Cuba is special. For all of the country’s flaws, there exists a collective spirit deeper than mere cliché or socialist platitude. The Cubans I know share profusely, abhor inequality, rarely get lost in their cellphones. “There’s less alienation of the individual here,” one Cuban put it to me recently in aptly Marxist terms. Cubans also have a strong sense of national identity and pride in culture that I haven’t encountered elsewhere in Latin America. I don’t think it’s a coincidence that this is also the least Americanized country in the hemisphere.
After Kerry’s speech, we made the short bus trip to see the newly hoisted American flag. “I’m not going to get close to that thing, though,” Daniel said, and left us after the bus ride to go sit in the shade under a nearby statue of Cuban independence hero José Martí.
The crowds that had gathered outside during the ceremony had dispersed. A few tourists milled along Havana’s seafront drive, taking photos. The American flag across the street was small, and almost underwhelming. Yassel found it jarring though—one of the few that he had seen in his life. Behind us, the Havana skyline was visible along the Straits of Florida, a pastel medley of Spanish fortresses, dusty apartment buildings, and pre-revolutionary hotels built by American mobsters.
“This is my city,” Yassel said. “I don’t want to see it full of McDonalds and other American companies and think Cuba is no longer an independent country. I don’t want Cuba to become just a country like all the others.”
Published at Generation Progress. Photo: the American flag flies at the US Embassy in Havana, August 14th 2015.
Published at Generation Progress. Photo: young Hondurans protest against mining.
As Al Gore and many others have said, “The future of our civilization is at stake,” due to climate change and a host of other environmental challenges. To preserve a planet worth living on, we will have to put a stop to deforestation, open pit mining, and many other destructive extractive industries. How will we do it if the loggers, miners, and destroyers are willing to kill to stay in business?
An April report from British nonprofit Global Witness shows the importance of that question. The group documented at least 116 murders of environmental activists worldwide in 2014. Global Witness tracked only confirmed cases; the real toll is likely higher.
Since its democratically elected president was overthrown in a 2009 coup, Honduras has seen over 100 killings of environmental defenders. The small Central American nation is the most dangerous place in the world to be an environmentalist.
“A white car with tinted windows and no license plate would always stop near my shop. They wouldn’t roll down the windows,” one Honduran told me when I visited the country last year. He was involved in a campaign to prevent a mine from opening in the rural community where he lived. The mine was near one of the community’s sources of drinking water, and many residents feared that it would contaminate the supply.
He asked that his name not be used due to the threats he has received for his work.
“Then the calls began. Calling me, threatening me, saying they knew where I hung out, knew where my daughter went to school. But I still kept going. From there they sent me a note telling me to shut up, that I was going to regret was I was doing,” he said.
“They said they had me well studied, the places I went, the house where I slept, and that soon they were going to pay me a visit.”
One day, he got a phone call from friends saying that mysterious men were looking for him. He fled his hometown and hasn’t been back since.
“I’ve had moments of reflection. My children are young,” he said. “My wife has asked me with tears in her eyes that I try to separate myself a little bit, because they need me. That has put me between the sword and the wall, because I feel that the need to fight is urgent. I feel a pressure inside of me, a commitment to fight, of total dedication, but I have had to slow down a little.”
If other cases are any indication, the threat is real. In the Honduran community of El Níspero, locals have reported that an iron oxide mine is destroying water sources and farmland. National police have broken up protests against the mine, and in May 2014, the body of anti-mine activist Rigoberto López was dumped in public, tongue cut out and throat slit.
In Peru, Ashaninka indigenous leader Edwin Chota asked authorities for protection after receiving threats from illegal loggers in retribution for reporting their activities. He was murdered in September 2014; a community member told a local newspaper that Chota and three others were bound and shot in front of other residents of their Amazonian village.
One month later in the Southern Philippines, anti-mining activist and indigenous Lumad leader Henry Alameda was “dragged from his house, taken to a forested area and shot dead by a paramilitary group,” according to the Global Witness report.
The damage caused by each of these crimes reverberates far beyond the Honduran highlands, Peruvian Amazon, or Philippine coast. As the killings continue, they enable the type of destructive extractive industry that is damaging all of our futures.
“It’s difficult to quantify,” said Billy Kyte, one of the authors of the Global Witness report. “But I think you can definitely draw a general conclusion” that violence and intimidation against activists is worsening environmental destruction. For every one of the 116 killings documented by Global Witness, there is an even greater amount of intimidation that doesn’t lead to violence, but still deters activism in defense of the environment.
On both ends of the equation, young people are impacted. In the developing world, one doesn’t have to be an adult to defend the environment, or to die for it. Several members of the community of Río Blanco in Honduras have been killed for their resistance to a hydroelectric dam project, among them 15-year-old Maycol Rodríguez. In the same community, the 17-year-old son of a local leader was beaten by police. Berta Cáceres, one of this year’s winners of the Goldman Environmental Prize, got her start as a student activist.
But even where young people aren’t on the front lines, these are fights over our future. Young people have a special interest in preserving both the local ecosystem services their communities rely on, as well as a healthy planet capable of sustaining life. If we’re going to put an end to problems like deforestation, it would help to make sure the deforesters aren’t killing the people who oppose them.
In the most direct sense, it’s a criminal justice problem. The people who target environmentalists are getting away with it.
“From the data we’ve found, conviction rates are unbelievably low. Of over 900 cases, we can only find ten of those in which a perpetrator has actually been tried and convicted,” Kyte said.
A lot of nations are not enforcing the laws they already have in place to protect environmental defenders, according to Kyte. Many nations are also ignoring the UN Declaration on the Rights of Indigenous Peoples, which states that indigenous communities must give prior informed consent before any development projects take place on their land.
Meanwhile, activists are working toward a binding UN treaty that would make businesses more accountable for the abuses that take place in international commerce.
“Competition for natural resources is definitely intensifying,” Kyte said, “while consumption patterns demand that we need ever more resources to feed an ever-growing economy, and our kind of obsession with growth and the growth model demands that we have ever more resources to feed that.”
If the violence is going to end, consumers in the developed world have an obligation to be part of the solution.
“As consumers, young people in the US have a responsibility to ensure they don’t fuel the rapacious activities of the mining and agribusiness companies behind much of the violence against these activists,” Kyte said. “Young consumers should check the sources of the products they buy and where possible identify companies violating human rights abuses and boycott their goods.”
Americans support the violence in more concrete ways as well. The Honduran military—implicated in many abuses against Hondurans defending their land—receives part of its funding from taxes on mining profits, but it also receives funding from the United States.
“If this reaches the ears of those who make the great contributions to the army, for weapons, for all the logistical support for our Honduran compatriots: it would be better if this help didn’t come in this form, but instead for education. Here we need help with education, here we need help with health,” the Honduran anti-mining activist in hiding said.
“We don’t want them to keep sending help to the army,” he said. “This is only bringing mourning to our poor towns, and more and more innocent blood spilled in the streets.”
High water season on the San Martín River in Bella Vista, 2014.
The missionaries I stayed with last year in Bella Vista dodged the worst of the damage, but the disaster has had rippling effects. One Bolivian told me that as much as a third of the country’s rice harvest was destroyed with last year’s floods. The nuns in charge of the boarding house in Bella Vista that supports 25 children have struggled with unavailable food staples and increased prices.
To make matters worse, about a month ago the missionaries told me that a power surge from the city’s shaky electric grid had destroyed the large freezer they use in the boarding house’s kitchen. With inconsistent food supplies in the muggy tropics, this equipment is crucial for storing the meat and perishables that feed the 25 growing children that the missionaries support.
This means the $1409.69 that friends, family, and strangers gave me to support the missionaries’ work came at a fortunate time.
Last week, one of the missionaries in Bella Vista was able to make the two-hour trip over muddy roads to the neighboring town of Magdalena, where she received the first installment of the donations by wire.
About $600 in donation money will be used to buy a new freezer, which will allow the missionaries to continue feeding the 25 orphans and children unable to attend school in their hometowns. It’s a small item that will make a big difference in quality of life for a group of kids who deserve the best.
Heavy rains are likely here to stay though. The recent spate of Bolivian floods was triggered by an unexpected shift in Atlantic trade winds. One Brazilian scientist says the floods could be a preview of the impacts of future climate change.
I’m hoping to continue to support my friends in Bella Vista as they deal with the challenges of a warming world. If you want to get involved in building economic security and climate resilience in eastern Bolivia, give me a shout.