By Ifeanyi Nsofor
ABUJA, Jun 2 2023 – New research shows that Black mothers in the United States disproportionately live in counties with higher maternal vulnerability and face greater risk of preterm death for the fetus, greater risk of low birth weight for a baby, and a higher number of maternal deaths.

While poor maternal outcomes among Black women in the U.S. is not new, improving it is imperative. U.S. policymakers can look to sub-Saharan Africa for guidance on reversing this trend.

The problem of poor maternal health for Black women in the U.S. is dire. Too many Black women die during pregnancy and childbirth due to preventable causes. For instance, the 2020 maternal mortality data rates released by the U.S. Centers for Disease Control showed overwhelming maternal deaths among Black women compared to other women over a 3-year period (2018 – 2020).

The 2020 maternal mortality data rates released by the U.S. Centers for Disease Control showed overwhelming maternal deaths among Black women compared to other women over a 3-year period (2018 – 2020). To put it in context, maternal deaths among Black women in the U.S. is worse than African countries like Namibia, Botswana, South Africa, Libya, Tunisia and Egypt.

To put it in context, maternal deaths among Black women in the U.S. is worse than African countries like Namibia, Botswana, South Africa, Libya, Tunisia and Egypt.

Further, according to the Kaiser Family Foundation, maternal and infant health disparities are symptoms of broader underlying social and economic inequities that are rooted in racism and discrimination.

In a previous piece, I wrote about the way that institutionalized racism is keeping Black Americans sick. Therefore, healthcare providers and policymakers across the U.S. must ensure respectful maternity care for all women during pregnancy, childbirth and afterwards.

The United Nations Office of the High Commissioner for Human Rights says respectful maternity care“encompasses respect for women’s basic human rights, including recognition of and support for women’s autonomy, dignity, feelings, choices, and preferences, such as choice of companionship wherever possible”.

Unfortunately, there is overwhelming evidence that Black American women face disrespect and profound indignity during pregnancy and childbirth. Tennis player and businesswoman Serena Williams almost died due to blood clots after giving birth because her nurse refused to listen to her cry for help. That clot could have led to a stroke. Her doctor eventually listened to her, and this saved her. If one of the most influential and most powerful women can have such a near-death experience, what is the fate of other Black American women who are not as privileged? Respectful maternity care is a way to ensure equity irrespective of class and race.

These are three lessons American policymakers can learn from successful maternal health projects across countries in sub-Saharan Africa as they try to save Black American lives.

First, is the continuum of care – prevention of postpartum hemorrhage project, implemented by Pathfinder International in Nigeria. It was a novel project that deployed several evidence-based interventions to prevent excessive bleeding after childbirth across the country.

These included the use of misoprostol to ensure adequate uterine contraction after the delivery of the baby; use of a plastic sheet with a pouch for blood loss estimation and active management of the third stage of labor to ensure the placenta is properly separated after the baby is delivered. These interventions led to a reduction in women who bled excessively after childbirth and improved the overall survival of women in participating health facilities.

For example, a new study on the efficacy of the plastic sheet carried out in 80 hospitals across 4 African countries, showed a reduction in the number of women experiencing severe bleeding by 60%.

A second example is the maternal nutrition program, implemented by Garden Health International in Rwanda. Adequate nutrition during pregnancy is imperative for the wellbeing of the unborn child.

The first 1000 days of life are even more crucial. Through the Maternal Nutrition curriculum, pregnant women are encouraged to attend antenatal classes at least four times in health facilities where they are educated on how to address the factors that can contribute to malnutrition. Women are taught how to prepare a balanced meal, the importance of hygiene and food safety in preventing malnutrition, the importance of the timely introduction of breastfeeding and complementary feeding, and postnatal care.

For instance, through the “one pot, one hour” cooking initiative, families are taught to use readily available foods to prepare nutritious meals is a core component of this program. Its success led to its adoption by the Rwandan Ministry of Health and it was implemented by 44,000 community health workers across the country.

A last example is the Kangaroo Mother Care for very low birth weight infants in South Africa. Very low birth weight infants are prone to hypothermia – a significant and potentially dangerous drop in body temperature.

According to the WHO, Kangaroo Mother Care involves infants being carried, usually by the mother, with skin-to-skin contact. If the mother is unable to fulfill the role, the father or other members of the family can take on the responsibility of skin-to-skin contact and provide warmth for the infant. A study of Kangaroo mother care of 981 very low birth weight infants admitted at Charlotte Maxeke Johannesburg Academic Hospital over a six-year period showed increased weight gain, lower rates of complications of prematurity and low overall mortality.

A multi-country study by the World Health Organization showed that in Ethiopia, government leadership; an understanding by health workers that kangaroo mother care is the standard of care; and acceptance of the practice from women and families helped improve the implementation of kangaroo mother care.

Institutionalized racism over many decades has put Black Americans in the most vulnerable counties in the U.S. Health policymakers, healthcare providers, donors, non-profit organisations and all stakeholders involved in maternal healthcare in the U.S. must implement interventions that are shown to save lives. The African continent is a great place to look.

Dr. Ifeanyi M. Nsofor, MBBS, MCommH (Liverpool) is Senior New Voices Fellow at the Aspen Institute, Senior Atlantic Fellow for Health Equity at George Washington University, 2006 Ford Foundation International Fellow

By Neville de Silva
LONDON, Jun 2 2023 – On May 24, Sri Lanka President Ranil Wickremesinghe arrived on a three-day official visit to Japan, his second visit to the country, having attended the State funeral of former prime minister Shinzo Abe last September.

This would also be President Wickremesinghe’s second summit with Japanese Prime Minister Fumio Kishida, the first having been on the side lines of the Shinzo Abe funeral, signalling the importance of Japan in Sri Lanka’s foreign policy rethinking and a move away from over reliance on China.

President Wickremesinghe’s visit has more significance than economic persuasion– trying to encourage Japanese investors to return to Sri Lanka after a couple or more bad experiences in recent years.

Under the Gotabaya Rajapaksa presidency, Colombo reneged on major projects agreed to, including a major Light Rail Transit (LRT) in Colombo for which the basic work had already begun.

Colombo dropped it without any prior notice to Japan and also went back on a tripartite agreement with Japan and India (and Sri Lanka) on the development of the Colombo port’s east terminal.

At his meeting with Prime Minister Kishida, Wickremesinghe expressed regret over his country’s past relations with Japan and said Colombo was ready to restart the dropped projects.

Wickremesinghe’s visit however is more than to revive economic cooperation at a time when Sri Lanka is passing through hard times having declared itself bankrupt in April last year. It had to turn to the IMF for a rescue package that would help pull the country out of the economic morass into which it had fallen- or been pushed into it– by mediocre governance and incompetent advisers.

His new relationship with Japan covers a broader canvas that surpasses bilateral relations though to a struggling Sri Lankan people burdened right now by high taxes, increasing tariffs on utilities and unbearably steep prices on domestic commodities, day to day existence presents the immediate priority.

Meanwhile small industries and businesses are shutting up unable to bear operating costs such as huge electricity rates-and higher water rates to come- throwing people out of jobs.

At the same time, professionals such as doctors, engineers, surveyors and IT and technically qualified personnel are quitting the country having found employment abroad or in search of fresh opportunities both in the developed and developing world.

Japan has been particularly helpful in advocating Sri Lanka’s case at the Paris Club on debt restructuring as called for in the IMF programme and has not joined hands with the west in castigating Sri Lanka at the UN Human Rights Council in Geneva as the US, UK, Canada and some European nations have done. Japan’s approach has been more sober and benign

Furthermore, Colombo, embroiled as it is in delicate diplomacy at a time when Indian Ocean politics is becoming more complicated and confrontational, sees Japan along with India and the west as a countervailing force to China’s expanding naval activity and presence in the region.

But there are two other reasons that drive President Wickremesinghe’s interest in establishing closer relations with Tokyo. One is national. The other personal though some might not see it that way.

The national motive is to create more distance in Sri Lanka’s relations with China which had become too close for comfort under the Rajapaksas (both presidents Mahinda and Gotabaya) for a country that could find itself caught in a gathering geopolitical storm given its geostrategic location and China’s continuing interest in widening its footprints and influence in Sri Lanka.

Xi Jinping and his ruling clan would rather see the Rajapaksas back in the seats of power than Wickremesinghe who they consider pro-western in his thinking, especially pro-Washington.

Moreover, one may conclude that Wickremesinghe sees Japan as a more reliable friend and one without super power ambitions.

The other is the strong bond Japanese leaders have developed for and with Sri Lanka dating back to the 1951 San Francisco Conference when some 48 countries met to draft a post-war peace treaty for defeated Japan.

One wonders whether many modern-day observers realise the important role that Ceylon, as it was called then, played at that conference, largely due to the performance of Ceylon’s then Finance Minister Junius Richard Jayewardene, popularly known as “JR”.

Jayewardene, who earned the sobriquet “Yankee Dicky” at home for his pro-US proclivities and in 1978 was Sri Lanka’s first executive president, was Ranil Wickremesinghe’s uncle.

In an article former Sri Lanka Ambassador Bandu de Silva wrote some 8 years ago, he recalls the critical role Ceylon played at the time and an earlier meeting of the Commonwealth Foreign Ministers in Colombo that for the first time proposed that Japan be declared an independent nation.

Ambassador de Silva states that Wikipedia’s account of the conference states Minister Jayewardene’s speech was received with resounding applause. Later, the New York Times wrote that “The voice of free Asia, eloquent, melancholy and still strong with the tilt of an Oxford accent, dominated the Japanese peace treaty conference today.”

What is it that Minister Jayewardene said when the very future of Japan was being debated and discussed that has endured Japan’s leaders and its people to a tiny Indian Ocean-island that itself suffered from Japanese air raids on Colombo in April 1942 and the British naval base in north eastern Trincomalee and had gained independence only three years earlier in 1948?

While some other nations called for curbs on Japan and demanded compensation for war-time damage Ceylon not only urged an independent Japan free to build its future and renounced its right to reparations from Japan.

“Hatred does not cease by hatred but by love”, Jayewardene told the conference quoting the words of The Buddha. Interestingly Sri Lanka and Japan are both Buddhist countries though following two different schools.

Records show that when Japan offered to construct a new building for the Ceylon Embassy in Tokyo the Colombo government politely turned it down.

Perhaps the foundation of the friendship between the two nations is best set out by the Japanese ambassador at the 50th Anniversary Commemoration of diplomatic relations held in Colombo in 2002.

Recalling JR Jayewardene’s speech at the San Francisco Conference, Ambassador Seiichiro Otsuka said: “In the grim aftermath of the war, as Japan began to rise from the ashes and rebuild its nation, it was the government and people of Sri Lanka, then Ceylon, who extended their genuine hand of friendship to the Japanese people.”

“Japan and the Japanese people have been indeed grateful to Sri Lanka for the friendship and magnanimity extended to us at the time of our difficulties by the government and people of Sri Lanka. It is in this spirit that Japan has stood firmly and steadfastly side by side with Sri Lanka as a true friend and a constructive partner for Sri Lanka’s development. Indeed, 50 years of our cooperative bilateral relations has been guided, on our part, by this spirit which Mr Jayewardene spoke of at San Francisco on September 8,1951….friendship and trust.”

However, Minister Jayewardene’s strong and clear support for Japan’s independence might have had a setback for Ceylon elsewhere.

With the East-West Cold War beginning to get warmer, the Soviet Union proposed amendments to the Japan peace treaty that would have restricted Japan’s freedom of action.

Ceylon’s representative took upon himself to counter Soviet Union objections. At one point Jayewardene turned sarcastic saying the amendments with which the Soviet Union sought to “insure to the people of Japan the fundamental freedoms of expression, of press and publication, of religious worship, of political opinion and of public meeting – freedoms, which the people of the Soviet Union themselves would dearly love to possess and enjoy.”

Some might well argue that Moscow took its revenge on Ceylon for Jayewardene’s public rebuke by blocking Ceylon’s admission as a member to the United Nations for some years, arguing that Ceylon was not an independent country as it had a defence treaty with the UK.

How Ceylon gained admission to the UN in 1956 is the result of a quid pro quo with Moscow. But that is another story.

Neville de Silva is a veteran Sri Lankan journalist who held senior roles in Hong Kong at The Standard and worked in London for Gemini News Service. He has been a correspondent for the foreign media including the New York Times and Le Monde. More recently he was Sri Lanka’s Deputy High Commissioner in London.

Source: Asian Affairs, London

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By Zadie Neufville
ROCKY POINT, Jamaica , Jun 2 2023 – Long before the COVID-19 Pandemic, fishers at the Rocky Point fishing beach in Clarendon were forced to venture farther out to sea to make a living or find alternatives to make ends meet.

This once-prime fishing village attracted fishers from up and down the coast. Men like Ephraim Walters, travelled from his hometown in Belmont, 100 or so kilometres (62 miles), up the coast, to Rocky Point, some 30 years ago, and never left.

Rocky Point is Jamaica’s largest fishing community and was once a destination for south coast fishers. But decades of environmental neglect, mismanagement, and poor fishing practices are taking their toll, pushing fishermen into destitution.

In the old days, Walters recalls, fishermen went to sea every day and made enough to build homes, support their families, and school their children. Back then, one needn’t go too far because the 24-kilometre sea shelf at Rocky was the place to be: “We could drop the net in the bay, and we would pull it together with a whole lot of fish, but these days we have to go further out to sea for far less”.

“Sometimes you go out, and you don’t catch a thing, and you can’t buy back the gas you use to go out,” he says.

With too many fishers chasing too few fish, he now travels the 96.5 kilometres (60 miles) to the offshore fishing station at Pedro Banks, using hundreds of gallons of fuel and spending between three and five days to get a good catch. But even then, he says, the value of the catch may not cover the cost of the trip.

The challenges in Rocky Point are a snapshot of the Jamaican fisheries sector, where too many fishers chase too few fish. Former University of the West Indies lecturer Karl Aitken says Rocky’s problem began as many as 30 years ago. As a master’s student in the 1980s, he says he had been recording declining catch numbers even then.

Data from the National Fisheries Authority (NFA) show that only 26,000 of the estimated 40,000 fishermen on the island are registered. Marine catch data between 1986 and 1995 shows a downturn in catch rates from 9,100 metric tonnes to 4,200 metric tonnes per year. There are expansions of the commercial conch fishery that began in 1991 and the lobster fishery.

The consensus is that Jamaica’s fishing problems began with a series of natural and man-made events in the 1980s and 1990s, which resulted in the death of 85 per cent of the island’s reefs and a drastic decline in fish catches. As inshore areas became less productive, pressure mounted on the offshore resources at Pedro Cays.

The 2017 State of the  Environment report points to the growing numbers of fishers as a threat to the  environment, noting that the island’s nearshore artisanal fin-fish and lobster fisheries are potentially environmentally deleterious and associated with overfishing and harvesting.

“The greatest potential for environmental impact is in the fisheries sub-sector is associated with the marine fin-fish sector which continues to grow to supply domestic markets,” the report says.

Walters long for the promised fish sanctuary which he believes will minimise destructive behaviours and save the livelihoods of Rocky Point’s fishermen. Not only are fish stocks collapsing, but the high-value fisheries like conch and lobster are also vulnerable as more people go after the resource. Since 2000, the government has shuttered the conch fishery twice first, when a row over quota resulted in a lawsuit and again in 2018 after a collapse of the resource.

Former director of Fisheries Andre Kong explains that in both cases stocks were low. But in 2018, the fishery was on the verge of collapse. There are those who believe that the conch and lobster fisheries should remain closed for another few years, but fishermen believe that without proper protection, the resources would be plundered by poachers as happened during the Pandemic.

Fishing beaches around Rocky Point have already established sanctuaries which local fishers say have helped to boost their catch rates and the size of the fish they catch. In the neighbouring Portland Bight, three marine protected areas have been established across the parishes of St Catherine and Clarendon.

In the 73-year-old Walker’s birth parish of Westmoreland, the Bluefields Fisherman’s Friendly Society led by Wolde Christos, established one of the largest of the island’s 18 fish sanctuaries in 2009 to boost the falling catch rates, protect local marine life such as the hawksbill sea turtles that nest there, and reduce high levels of poaching.

The sanctuary covers more than 1,300 hectares (3,200 acres). It is working, Christos explains, noting that a government grant helps the fishermen who have been licensed as fish and or game wardens run a tight ship, keeping illegal fishers out.

The pandemic made things worse for many fishers due to the loss of markets. In a report to parliament last year, Minister Pearnel Charles Jr. said that the coronavirus (COVID-19) pandemic has caused disruption in fish production and value chains with the losses of markets locally and overseas, and higher input costs, resulting in significant increases in operational expenses. An estimated USD23 million in losses was sustained in the fisheries sector during 2020 alone.

On the beach, some fishers are doing anything they can to survive. Some are part-time boat builders/ repairmen, electricians, or even mechanics; others now clean fish for buyers to make ends meet. And if the whispers are correct, many have turned to illegal fishing.

Complicating the issue is the fact that aside from regulated fisheries of conch and lobsters, Jamaica has no limit on the amount or size of fish that can be taken. There is almost no data available for analysis, and mesh and net sizes have more or less no effect on the reaping of juvenile fish.

In keeping with commitments and international agreements, in 2018, the government unveiled a new Fisheries Act. It established the National Fisheries Authority to replace the Fisheries Division of the Ministry of Agriculture to strengthen the management and legislative framework of the sector. The act is expected to increase compliance in registration, increase opportunities for aquaculture and increase fines and prison terms for breaches.

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By Baher Kamal
MADRID, Jun 2 2023 – There is a tangled trafficking web that has been woven across the Sahel, which spans almost 6.000 kilometres from the Atlantic Ocean to the Red Sea, and is home to more than 300 million people in 10 countries: Burkina Faso, Cameroon, Chad, The Gambia, Guinea, Mali, Mauritania, Niger, Nigeria, and Senegal.

This is how several international specialised bodies, mainly the United Nations, depict the aggravated situation in this already highly fragile African region, which the UN describes as a region in crisis, as those living there are prey to “chronic insecurity, climate shocks, conflict, coups, and the rise of criminal and terrorist networks.”

The Sahel criminal web deals with an unimaginable range of ‘commodities’, from chilli peppers and fake medicine, to fuel, gold, and guns, through humans and more which are being trafficked via millennia-old trade routes crisscrossing the Sahel, according to a 20 May 2023 report.

The US-led military intervention

Security has long been an issue in the region, “but the situation markedly degraded in 2011, following the NATO-led military intervention in Libya, which led to the ongoing destabilisation of the country,” explains the United Nations.

On 19 March 2011, a US-led North Atlantic Treaty Organization coalition (31 Western member-countries) launched a military intervention in Libya, with coordinated naval and air forces attacks mainly by the United States, the United Kingdom, France and Canada, among others.

Substandard or fake medicines, like contraband baby cough syrup, are killing almost half a million sub-Saharan Africans every year, according to a threat assessment report from the UN Office on Drugs and Crime (UNODC)

Since then the big oil producer Libya has been the stage of growing instability and chaos, let alone a hub of human trafficking, smuggling and slavery.

Humans, weapons, oil…

Such “ensuing chaos, and porous borders stymied efforts to stem illicit flows, and traffickers transporting looted Libyan firearms rode into the Sahel on the coattails of insurgency and the spread of terrorism,” reports the UN.

Fuel is another commodity trafficked by the main players – terrorist groups, criminal networks, and local militias.

“Armed groups now control swathes of Libya, which has become a trafficking hub.”

In fact, in addition to massive human trafficking and migrant smuggling, markets across the Sahel can be found openly selling a wide range of contraband goods, from fake medicines to AK-style assault rifles.

… And medicines that kill

A UN News series exploring the fight against trafficking in the Sahel, on 27 May 2023 focussed on the illegal trade in substandard and fake medicines.

“From ineffective hand sanitiser to fake antimalarial pills, an illicit trade that grew during the COVID-19 pandemic in 2020 is being meticulously dismantled by the UN and partner countries in Africa’s Sahel region.”

Substandard or fake medicines, like contraband baby cough syrup, are killing almost half a million sub-Saharan Africans every year, according to a threat assessment report from the UN Office on Drugs and Crime (UNODC).

Trafficking medication is often deadly; in just one case, 70 Gambian children died in 2022 after ingesting smuggled cough syrup.

Desperate demand

According to the UN, health care is scarce in the region, which has among the world’s highest incidences of malaria and where infectious diseases are one of the leading causes of death.

“This disparity between the supply of and demand for medical care is at least partly filled by medicines supplied from the illegal market to treat self-diagnosed diseases or symptoms,” the report says.

It further explains that street markets and unauthorised sellers, especially in rural or conflict-affected areas, are sometimes the only sources of medicines and pharmaceutical products.

Fatal results

The study shows that the cost of the illegal medicine trade is high, in terms of health care and human lives.

“Fake or substandard antimalarial medicines kill as many as 267,000 sub-Saharan Africans every year. Nearly 170,000 sub-Saharan African children die every year from unauthorised antibiotics used to treat severe pneumonia.”

In the summer of 2022, 70 Gambian babies and young children died from kidney failure after ingesting cough syrup spooned out by their caregivers.

The World Health Organization (WHO) issued a global alert that four tainted paediatric products had originated in India, as local health authorities continue to investigate how this tragedy unfolded.

Caring for people who have used falsified or substandard medical products for malaria treatment in sub-Saharan Africa costs up to 44.7 million US dollars every year, according to World Health Organization (WHO) estimates.

Corruption

Corruption is one of the main reasons the trade is allowed to flourish.

About 40% of substandard and falsified medical products reported in Sahelian countries between 2013 and 2021 land in the regulated supply chain, the report showed.

“Products diverted from the legal supply chain typically come from such exporting nations as Belgium, China, France, and India. Some end up on pharmacy shelves.”

The perpetrators

“The perpetrators are employees of pharmaceutical companies, public officials, law enforcement officers, health agency workers and street vendors, all motivated by potential financial gain,” the report found.

Traffickers are finding ever more sophisticated routes, from working with pharmacists to taking their crimes online, according to a UNODC research brief on the issue.

While terrorist groups and non-State armed groups are commonly associated with trafficking in medical products in the Sahel, this mainly revolves around consuming medicines or levying “taxes” on shipments in areas under their control.

Far beyond the Sahel and Africa

Fighting organised crime is a central pillar in the wider battle to deal with the security crisis in the region, which UN Secretary-General, António Guterres says, poses a global threat.

“If nothing is done, the effects of terrorism, violent extremism, and organised crime will be felt far beyond the [Sahel] region and the African continent,” Guterres already warned in 2022.

Apart from repeated proposals for action and solution, evidence shows that very little has been done, if anything, to halt those merchants of death. Who benefits from such a horrid destabilisation of 10 African countries which already rank among the poorest ones on Earth?