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The first 1000 days & after: How hunger effects brain development

The crippling effects of hunger on brain development, and in turn on education, employment and quality of life, become worse if certain vitamins and nutrients are missing

The first 1000 days and after

The image of an emaciated, almost wasted, skinny child comes to mind when we talk of malnourished children — children with thin arms, protruding bellies, and light-coloured hair. Yet, the price malnourished children, their parents, and entire nations pay is far more than just what is apparent.

A malnourished child’s ruling organ, the brain, does not develop at an optimal level due to lack of sufficient nutrition. All stakeholders continue to pay the price for decades to come — both on a personal and a collective economic level. Malnourishment, then, may be the silent and neglected brain drain that no one is talking about.

According to Dr Irshad Danish, National Coordinator, Scaling up Nutrition (SUN) Civil Society Alliance, Pakistan, stunted children have 7-months delay in starting school, have lower intelligence quotient (IQ), are more likely to repeat a grade of school, complete one year less of schooling on an average, and are less likely to graduate high school.

“The effects of malnourishment include a low IQ, poor concentration, attention deficit, and memory disorders,” he says. Mentioning the findings of a report launched by the Pakistan Scaling Up Nutrition (SUN) Secretariat at the Ministry of Planning Development & Reform, in collaboration with the United Nations World Food Program (WFP), he adds that the consequences of malnutrition — including healthcare expenses and lower productivity — cost Pakistan US$7.6 billion, or 3 per cent of GDP, every year.

He says that children who are malnourished learn less at school and earn less when they grow up. Iron and Iodine deficiency in childhood reduces IQ by up to 25 and 13 points respectively. Cognitive deficits from childhood stunting, anemia and iodine deficiency disorders depress future adult productivity, valued at Net Present Value of $3.7 billion per year.

Brain development of the foetus starts in the womb of the mother, particularly in the third trimester, explains Dr D.S. Akram, Founder, Health, Education & Literacy Programme (HELP). “If the mother is malnourished and anemic, there are more chances that the brain growth will not be optimal as insufficient hemoglobin in the mother’s blood means insufficient oxygen for the foetus,” she says, further adding that between the age of three to six months, the baby’s brain grows rapidly, and if there are factors like a malnourished mother, premature birth of the child, or the mother not exclusively breastfeeding the child for the first six months, brain growth may slow down.

Dr Akram also says that if the child does not receive enough food as well as brain stimulus in the first two years, it may lag behind in its key developmental milestones. “When the child goes to school, his ability to perceive, to memorise, his motor skills — all will be slow. This will result in a lack of motivation in the child who will not experience the pleasure of learning. It’s a vicious cycle,” she says. For optimal brain development, according to her, it is imperative that timely introduction of a balanced diet of solid food is introduced, containing micro-nutrients, proteins and fats.

Solutions include early initiation of breastfeeding, exclusive breastfeeding for six months, starting complimentary feeding after six months, and continuing breastfeeding for two years.

Quantifying the link between brain function, academic performance and malnourishment, the Hunger in the Classroom report, 2015, by Food Bank Australia, stated that over two thirds of students who miss out on breakfast can find it difficult to concentrate (73 per cent) or can become lethargic (66 per cent), with over half experiencing learning difficulties (54 per cent) or exhibiting behavioural problems (52 per cent).

Perhaps this is why for Saeed Qureshi, the most rewarding part of his decade-long service of leading Aman Ghar (an initiative of the Aman Foundation), was working on feeding underprivileged school-going children in Karachi.

Since last year, Aman Ghar joined hands with Saylani Welfare International Trust, and meals are distributed to deserving students of 15 schools, which serves both as an incentive for children to come to school, as well as helps them perform better at school. Aman Ghar’s motto has been “food for education”.

Qureshi explains that before the inclusion of the lunch programme, the students were reported to pass out during school hours due to hunger, especially in the summers. Since the lunch programme started, there has been a significant change in the academic performance of the students. “I have seen children come to school on a hungry stomach, eating only paapay (rusks) and chai (tea) at most. Their decision power is impacted as is their ability to shine academically. They are dull and tired, and cannot participate in sports.”

Qureshi says that they mix four kinds of grains to make roti for the wraps for the children, which make up for deficiencies like iron and niacin that boost brain activity. “We have also tried to incorporate leafy vegetables, pulses, and meat in the diet,” he informs.

The crippling effects of hunger on brain development, and in turn on education, employment and quality of life, become worse if certain vitamins and nutrients are missing. Neurologic deficits can be a result of deficiencies in micronutrients like folic acid, iodine, iron, zinc, selenium, copper, magnesium, vitamins A, C, D, E, B6 and B12.

These deficiencies can result in learning disabilities, mental retardation, abnormal levels of cognitive and mental functioning, and even depression, anxiety and withdrawal, all detrimental to a child’s focus on academic activity. Malnourishment can also result in behavioural issues, and lapses in memory and concentration.

When asked how parents can avoid this happening to their children, Dr Danish says that “the first 1,000 days between pregnancy and a child’s 2nd birthday sets the life-long foundation for human capital. After two years of age, the impacts of stunting are irreversible”.

In his opinion, solutions include early initiation of breastfeeding, exclusive breastfeeding for six months, starting complimentary feeding after six months, and continuing breastfeeding for two years. Also, it is important to avoid junk foods and sugary drinks, provide diverse and nutritious balance food which should have necessary amount of proteins, vitamins, minerals and carbohydrates, and consume milk, fruits and vegetables.

“If all relevant stakeholders work together and implement joint interventions for nutrition, we can avoid bad impact of malnutrition on learning, earning and health,” says Dr Danish.

 

http://tns.thenews.com.pk/first-1000-days/?fbclid=IwAR3DSapGsbpLrzaobOQxPG3LlD8d0bgoADYqOyzrpcD649V8yYYunBG3W-w#.XAJckc1oQ1l

 

Knowing the perpetrator of Child Sexual Abuse

 http://tns.thenews.com.pk/knowing-perpetrator/#.WqJhO-hubIW

There is no single profile for a perpetrator of child sexual abuse

Knowing the perpetrator

He is a normal-looking person, leading a seemingly normal life. His eyes are not crazed. He is not unkempt. He has a job and has normal social interactions. There is no apparent sign of a mental disorder. Yet a dark secret lurks behind the shadows — he is a child sexual abuser. There is no formulaic profile that fits a perpetrator of child sexual abuse. There is no way even an adult can identify him or her, leave alone a child. Seven-year-old Zainab of Kasur fell prey to one such felon whose crime remained invisible till Zainab was found, albeit too late.

As Pakistan grapples in the wake of this shocking incident, it is time to raise awareness not just about the crime but also about the criminal who is often imperceptible.

“There is no single profile for a perpetrator of child sexual abuse because not every child sexual abuser is a pedophile. Pedophilia is a disorder and a specific sexual preference; it is a sickness,” says Dr Asha Bedar, clinical psychologist, trainer and researcher, who has worked extensively with cases of child sexual abuse.

As Pakistan grapples in the wake of this shocking incident, it is time to raise awareness not just about the crime but also about the criminal who is often imperceptible.

In her professional experience, Bedar has seen that many perpetrators are not pedophiles. “They can be very seemingly normal and functional people who have no diagnosed mental illness. They can be respected members of the society. They can be popular in social circles, hard to detect and harder to believe to be sexual predators of children. This makes it doubly tough for children to identify them as well.”

About pedophiles, Dr Uroosa Talib, Psychiatrist and Head of Medical Services, Karwan-e-Hayat Hospital, says that they are not recognisable by appearance, speech or demeanour. “To get to the child, they develop a step by step plan. They first observe how they can build a rapport with the child. These are sharp, brutal, cruel people who will go to any length to get what they want.”

Among the celebrities who have courageously spoken up about being survivors of child sexual abuse is female actor, Nadia Jamil, who has used the platform of social media to draw attention to the issue, and toward other victims like Kainat Batool.

Jamil echoes the view of experts that there is no set profile of such a perpetrator of child sexual abuse, or a rapist. “Any man could potentially sexually abuse or molest a child. Rich men have raped and will. Poor men have raped and will. Literate and illiterate men have raped and will. Until you deal with violent and domineering stereotypes created by patriarchy, men will continue to abuse,” she says, sharing her views with TNS.

Read also: Talking point

“Pedophilia is a disease. True pedophiles are attracted sexually to pre-pubescent children in general. The urges and reasons behind the act of abuse may be different between a pedophile and non-pedophile abuser but the danger is the same — being aroused by a child,” she says, adding that not all abusers are men.

Dr Talib says the commonest emotional trauma that leads to personality disorders is child sexual abuse, even if the impact remains only as a suppressed memory or is clouded by denial. “This is one of the most difficult traumas to ever get over. The victims, in turn, can become perpetrators, and often use sex for power. Their morality changes.”

Earlier this week, the Women’s Action Forum (WAF) sent recommendations to the State, as well as to the National Commission on the Status of Women (NCSW); one of these is to conduct psychological and psychiatric evaluations of those convicted of sexual abuse and rape, including of minors.

Bedar also says that research shows that the numbers of girls and boys sexually abused is almost the same. “But due to years of social conditioning boys internalise the idea that they can protect themselves; they do not want to accept their vulnerability. Gender dynamics and abuse have a very strong connection,” she says, adding that socially generated ideas of masculinity make the boys think that ‘if I can’t be a victim than I must have been a part of it’.

Thus, many male victims grow up telling themselves that they must have consented to it, especially if the abuser was a woman. “Boys are also more vulnerable in some ways as they are outdoors more often and parents allow sons to be with strangers like drivers or helpers more readily compared to daughters.”

Evidence suggests that child sexual abuse and rape is linked to gender-based violence in general. “Strong gender role socialisation, power dynamics, myths about gender and rape, lack of strong sanctions and strong male peer support for masculinity and role modelling” are some of the dynamics Bedar feels need to be looked into.

Experts agree that the core to the solution is making the children more aware but parents are a big part of this equation. “Parents need to have a relationship and connectedness with their children that their child can come and share not just successes but also failures, so that if anything like this happens that makes the child feel embarrassed, he or she can still share it with their parents and their parents believe them,” says Dr Talib. “Giving a child the concept of religious boundaries can actually work positively. This also helps them understand the concept of good and bad touch with keeping religious sensitivities in mind. Teach your children rights over their self and the dignity of their bodies.”

Jamil says she would be wary of strange men paying too much attention to a child. “We have to teach our children to be vigilant and to protect themselves and others. Warn them. Keep an eye on them and pray hard. And we have to change the way we educate ourselves and our kids. Till the state invests in the right people…it’s up to us. One child at a time. We cannot afford to stop or give up. We will not give up.”

Udaari reveals Pakistan’s best kept secrets

Published: September 29, 2016
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PHOTO: Draamaz

PHOTO: Draamaz

“Watch Udaari; it is unlike any other drama,” I had said, trying to convince a friend to watch the drama. “No way! Children being abused. Don’t want to even think about it,” was the immediate response.

Brushing issues under the carpet is what we do best. A study titled ‘The state of Pakistan’s children 2015’ by the Society for the Protection of the Rights of the Child (SPARC) states 10 cases of child sexual abuse took place every day in 2015, bringing the total to 3,768 cases last year. These are registered cases. Any educated and realistic guess will tell us that to get the real number it would have to be multiplied manifold. Of these, a lot of abuse cases are incestuous. Communal living may have many advantages as a support system but also exposes unassuming children, and even grown-ups, to the dangers of sexual abuse and rape.

Mann Mayal has ended and Twitter can’t handle it

What Udaari has done is remarkable. It was not because Ahsan Khan played out a difficult character with unexpected brilliance, and that Samia Mumtaz played Sajju so convincingly that everyone who saw the drama wanted to bring her and Zebo home and protect them. It was a brilliant play, well scripted and directed, and technically could have been more nuanced and the characters more layered, but this is not a review of Udaari. This is a look in the mirror. And Udaari became that mirror.

As a journalist who has worked on gender rights and sexual and reproductive health issues, I have met victims of rape of all kinds, including victims of marital rape and sex workers who were raped. Rape is never a laughing matter. Whenever someone cracks a joke about rape, I think of the times when these jokes may not have bothered me because I had not met the butts of those jokes and heard their stories in person. I had not seen the scars, both physical and non-physical, that acts of cowardice and weakness such as domestic violence, sexual abuse and rape leave behind. Watching Udaari made me think of some unfortunate souls, victims and others survivors.

When those children in Kasur, who were sexually abused by the gang who made a living out of selling videos of the acts and blackmailed them, saw Udaari with their families, what must it be like for them? What was the reaction of viewers who saw Udaari in groups or in isolation in Pakistan’s many homes where traders of the flesh reside? The woman in Tharparkar who was gang-raped some two years ago, and got justice after I wrote her story that prompted a suo moto action by the chief justice – what was she thinking when she saw Udaari? The play hit home with the audiences. But it must have been an unforgettable watch for those who have directly or indirectly been exposed to such despicable acts.

Udaari cast shares final thoughts as fans await finale

In 1980 an Indian film, Insaf ka Tarazu, starring Zeenat Aman was initially met with negative responses for being too bold. Rape was something that was not meant to be depicted so openly. It opened certain shut doors. Udaari has managed a much bolder theme more than two decades later in Pakistan, deftly and without relying on the objectification of women as sex objects. It has succeeded in making sure that the take-home message remains that one who has been raped need not be a victim but also be a survivor, instead of the focus being on Zebo’s youth or beauty. This is no mean feat.

But perhaps the biggest contribution of any article, news clipping or talk show, or any drama like Udaari is daring to make taboo and hushed up topics like child sexual abuse open to discussion on a dinner table, at work place and on social media. Let us stop pretending that these evils don’t exist in our society, and that too closer to us than we think. Recognising an issue is the first step to solving it.

Worries pile up as waste grows in Pakistan

Pakistan generates about 20 million tonnes of solid waste annually, and its dumps have become a hub for child labour.

 http://www.aljazeera.com/indepth/features/2014/08/solid-waste-pakistan-karachi-2014867512833362.html
Last updated: 11 Aug 2014 

Some four million children, die each year from waste-related diseases in Pakistan [EPA]
Karachi, Pakistan – In the economic hub of Karachi, Ali, an 11-year-old child, awakens at dawn while the rest of his family sleeps next to burners and barrels that will be used to disintegrate metal waste.

The barrels contain acid, and wires and circuits will be burned in the open air, releasing harmful emissions. But Ali’s impoverished family needs whatever money they can get from this dirty business.

Muhammad Ishaq, 12, is another child hostage to the rubbish he collects for a scrap dealer. In return, the scrap-dealer gives his parents fixed Rs 2500 ($25) a month.

“My shed broke in the recent rains. Where will I live now?” is his recurrent concern, as he refers to the shed made also of, ironically, pieces of wood and cardboard he finds in the trash.

These children get food and clothes from NGOs or common people… They eat at charities and bathe in mosques. They are very susceptible to scabies and infected wounds. They suffer from diarrhoea all year round.

– Rana Asif, Founder of Initiator Human Development Foundation

A waste of a nation

Both Ishaq and Ali are among thousands of Pakistani children who work as scavengers, combing through piles of rubbish for a daily pay that maxes out at about $2.

Besides being out of school, these children face severe health hazards from the unsafe handling of waste.

“These children get food and clothes from NGOs or common people… They eat at charities and bathe in mosques. They are very susceptible to scabies and infected wounds. They suffer from diarrhoea all year round,” said Rana Asif, Founder of Initiator Human Development Foundation, that works for the welfare of street children.

Copper remains the most lucrative find for these boys. It is sold at Rs 500 ($5) a kilo, and aluminium at Rs 100 ($1) a kilo, and all of this is found in electronic waste.

These children – 95 percent of whom are male – are often found at Karachi’s biggest markets for e-waste in the Shershah, Lines Area and Regal neighbourhoods.

“We find computer monitors, and buyers buy them from us for a pittance, but sell it for much more. We get nothing,” said Yaargul Khan, 14, older brother of Ishaq.

Even as child labour remains rampant in Pakistan, almost 5.2 million people; including four million children, die each year from waste-related diseases in Pakistan.

A report by Triple Bottom-Line found that globally, many people did not know their old computers and televisions were shipped to countries such as China, India and Pakistan for “recycling”.

Manually dismantling electronic devices comes with a slew of health hazards, including exposure to toxic substances called furans and dioxins.

Burning these materials is even worse: A burning computer releases dioxins, lead, chromium and other toxic substances. Ali has no choice in the matter, and no gear to protect him from the fumes.

Pakistan generates about 20 million tonnes of solid waste annually, according to the country’s Environment Ministry, and that number is growing by about 2.4 percent each year. The waste management methods in Pakistan, however, remain poor.

The country’s most populous city, Karachi, generates an estimated 9,000 tonnes of waste daily, and garbage collectors cannot keep up.


Recycling is not widely practiced, and in many urban areas, dumping and trash burning are daily occurrences.

Asif Farooqi, the CEO of Waste Busters, a Pakistani waste management and recycling firm, says a big part of the problem is improper waste collection.

His team goes door-to-door collecting garbage bags – in Lahore alone, the company services 70,000 homes – and repurposes the contents. From inorganic trash, Waste Busters derives a form of fuel; from organic waste, they create compost.

Sadly, no organised or satisfactory system of solid waste management has been developed till now. The facilities are much too few compared to the waste generated.    

– Shoaib Ahmed Siddiqui ,Commissioner of Karachi

“What we need from people is to stop open dumping and use garbage bags,” Farooqi told Al Jazeera. “And from the government all we need is administrative support. They should at least not create hurdles for us.”

Shifting the blame

While the administrator for the Karachi Metropolitan Corporation (KMC), Rauf Akhtar Farooqui said the solid waste management is the responsibility of the District Municipal Corporations and not of KMC, the Commissioner of Karachi, Shoaib Ahmed Siddiqui told Al Jazeera that it was, in fact, very much the responsibility of KMC.

“Sadly, no organised or satisfactory system of solid waste management has been developed till now,” he told Al Jazeera.

“The facilities are much too few compared to the waste generated.”

Siddiqui expressed hope that things will get better as a result of the recent formation of the Sindh Solid Waste Management Board.

“This applies to e-waste management as well,” he said.

In neighbouring Punjab province, where over half of Pakistan’s population lives, the Environment Protection Department openly acknowledges the shortfalls, stating on its website: “Environmental legislation is still not well developed in Pakistan, especially in comparison to the developed world. For example, there are no National Quality Standards for [solid waste management].”

Still some hope

The situation has created openings for environmental organisations such as Gul Bahao, which literally builds homes out of rubbish, using materials such as bubble wrap and thermocol.

“Attitudes are changing,” Gul Bahao’s Nargis Latif told Al Jazeera.

“Youth have joined hands with us. Students help us collect funds for this. I am very hopeful.”

Even as the south Asian giant struggles to manage its solid waste, its children continue to scavenge trash for petty income at the cost of their childhood, health and education.

Names of some children have been changed to protect their identity.

Follow Farahnaz Zahidi on Twitter: @FarahnazZahidi

Nation jolted: Rape of minors a rising trend

By Farhnaz Zahidi / Sumaira Khan
Published: April 29, 2014
http://tribune.com.pk/story/701607/nation-jolted-rape-of-minors-a-rising-trend/

child rape

A positive change is that more victims report the crime but experts fear number of minors being raped is rising. PHOTO: FILE

KARACHI / ISLAMABAD: The sexual assault of five-year-old “S” who was then dumped outside a Lahore hospital jolted the nation. The story made headlines for several days. In her, each saw their own child. Much was written and promised, but some seven months later the rapists remain at large and the government continues to chase shadows.

In this particular case, there were some lessons to be learnt. The most shocking is that the rape of minors is a growing trend in the country. “The average age of the rape victim in Karachi, according to data collected, is now nine years,” discloses Shiraz Ahmed, who works for the Karachi-based NGO, War Against Rape (WAR). “Child-rape is definitely on the rise. Many more cases are now being reported, but we can safely estimate that these are only 5 per cent of the actual number of cases.”
Ahmed says that influential perpetrators or their allies intimidate or bribe victims and their families into silence. “And society encourages the issue to be brushed under the carpet,” he adds.

In Punjab alone, there were 2,576 cases reported, according to a report of the Human Rights Commission of Pakistan (HRCP) released recently.

The father of “S” continues to fight for justice. “Due to weak laws and punishment, these beasts continue to destroy the lives of women. I demand action that would set an example,” says Shafqat Mahmud. So far Chief Minister Shahbaz Sharif’s government has been helpless. Possibly this inaction encourages rapists.

Experts say that the more accessible a child is, the more at risk he or she is. Street children top the list. No official numbers are available regarding their exact number, but it is estimated that there are 1.5 million street children in Pakistan, according to the Society for the Protection of the Rights of the Child (SPARC). To add to this, according to the HRCP’s 2013 report, 1,400 juveniles are in jail and the country has some 12 million child workers, half of them below 10. They all fall under the high risk category.

The role of police and the media

WAR’s Shiraz Ahmed says that on one level, more cases are being reported which shows a social change. At the same time he laments the fact that the trend of child rape is growing.
The media and the police also need to play a more positive role, he adds. The media has to be sensitized on how to handle such cases. “The media crosses lines. It shows the faces of the victims, their names and the images of the family,” laments Ahmed, concerned on issues of privacy and safety. “More sensitive reporting of such cases, especially of minors, is what will help in the long run.”

He also feels that the police need to be made more aware and more answerable. Sometimes corruption is the reason why they record complaints under sections that have loopholes.
Shiraz feels that the correct sections should be applied for the concerned crime.

Cycle of abuse

The cycle is never ending. Sarah Jafry, counsellor at WAR, comments, “a sexually abused child may indulge in risky sexual behaviour, wandering from one intimate relationship to another, because the child sees this as a way of feeling valuable and approved. Most of this is unconsciously done.”

Once abused, most victims almost never recover. Dr Rizwan Taj, head of Psychiatry department at Pakistan Institute of Medical Sciences (PIMS) says that the younger the victim, the longer lasting the impact. “Young victims lose trust and confidence they had in relationships.” The victim chooses isolation rather than trying to stabilize relationships with people.
Experts say that the government should arrange for free medical treatment and long-term counselling. This remains a dream for most, however. Many say that the government should wake up to what is becoming a crisis situation. So far, the government has only been sleeping, experts say.


Alarm: Rapid rise in child-rape

• 2,788 child sexual abuse cases were reported in 2012, as compared to 2,303 in 2011.
• On an average, eight children a day were abused during 2012.
• 71 per cent of minors who suffered abuse were girls.
• The age group most vulnerable to sexual abuse among girls and boys was 11 to 15 years.
• Some 5,689 abusers were involved in nearly 3,000 abuse cases, out of which 47 per cent were acquaintances
• 1,214 cases took place either at the acquaintances’ or the victims’ houses, according to the report.
Source: The annual “Cruel Numbers” report by NGO Sahil.

Published in The Express Tribune, April 29th, 2014.