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Looking For The Last Ebola Patients in Liberia: The Race to Zero Tags: Liberia News Ebola Disease African News News2015

On the morning of March 5, a 58-year-old English teacher stood outside an Ebola treatment center in the Liberian capital city of Monrovia, flanked by a row of health-care workers. The smiling woman, Beatrice Yardolo, had contracted the deadly hemorrhagic fever on February 19. Now, just two weeks later, she was at the center of a public discharge ceremony from the Chinese-run facility.


With public health officials, media, and politicians in attendance, Yardolo gave interviews expressing her happiness at being declared Ebola-free. At the time, the teacher was one of 9,249 Liberians who had contracted the virus during the deadliest Ebola outbreak on record, which had by then killed more than 9,800 people throughout Liberia, Guinea, and Sierra Leone — a death toll that has since surpassed 11,250.

"I am one of the happiest human beings today on Earth because it was not easy going through this situation and coming out alive," Yardolo told the Associated Press after her release.

But a sense of unease loomed, even as officials expressed optimism over the fact that Yardolo, for the time being, was the last confirmed Ebola patient in Liberia. For the first time in nearly 10 months, there was not a single person infected with the virus in any of the country's emergency treatment units.

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The sentiment was clear that hot Wednesday morning: The fight against Ebola was not over for the country of 4.2 million people. Officials were still monitoring more than 100 individuals living in Liberia who had come in contact with an Ebola patient in the last 21 days — the incubation period for the virus. It would take a total of 42 days without a new confirmed case of hemorrhagic fever for the World Health Organization (WHO) to officially declare Liberia free of the virus.

The push for zero cases, while difficult, is an essential mark for the afflicted countries to achieve. At its most basic level, Rick Brennan, the director of WHO's Ebola response, explained to me that until we "get to zero cases there's always the possibility that it could flare up again and spread again." Just as important, the fight against Ebola has had devastating effects on health systems, economies, and human resources that will take time to rebuild. "Ebola cases took a lot of energy and resources from the health system," Brennan told me, "and until we end the outbreak, it will be very challenging to fully reestablish essential and comprehensive health services."

Health officials were still concerned that new infections were being regularly reported in Sierra Leone and Guinea, just across Liberia's porous borders. Obstacles in the way of keeping tabs on contacts, public trust, and disease awareness continued to hinder local and international efforts to reach the only milestone that could mark the end of the Ebola outbreak in West Africa — zero cases in all three countries for 42 days straight.

Later that afternoon, I called Liberia's assistant health minister, Tolbert Nyenswah, from a parked car in the New Georgia Estate area of Montserrado County, Liberia's most populous county.

"We don't have any confirmed cases in the ETU, but this does not mean that the fight against Ebola is over," he said, being sure to emphasize in various ways that the country needed to remain vigilant. 

"Of course, everything should remain tight. There is no room for complacency — every citizen should take measures so that Liberia remains at zero, and also support our neighbors," Nyenswah explained.

This was a phone call I'd made many times over the last 10 months to a man who had quickly emerged as the public face of the government's Ebola response efforts. When Nyenswah and I first spoke, in June 2014, the Ebola virus had descended on Monrovia. Traditionally, hemorrhagic fever has plagued isolated rural villages in Central and East African countries like the Democratic Republic of the Congo (DRC), Gabon, and Uganda. The recent epidemic marked the first time the virus hit major cities. The three hardest-hit countries have all reported cases in their capitals — Conakry, Guinea; Freetown, Sierra Leone; and Monrovia.

During a phone conversation in June of 2014, Nyenswah was in a car making his way to various parts of the city to coordinate response efforts. It was a time when public health officials were as hands-on in the fight against Ebola as anyone. Nyenswah told me he had visited a traditional healing center that day where multiple dead bodies and suspected cases were picked up. The assistant health minister was clear about the situation: Liberia needed help.

"The situation is not stable; it's volatile," he said then, going on to stress the country's need for international doctors and help in training local medical staff. At that point, West Africa's first-ever experience with Ebola had become the worst outbreak since the virus was discovered, in 1976 in the DRC, then known as Zaire. A total of 400 confirmed deaths had occurred since December 2013, when the first infection showed up in Guinea's Guéckédou Prefecture. It is thought that a two-year-old boy from the village of Meliandou became patient zero after contracting the virus from a bat — a natural reservoir for Ebola.

That June marked the death of Liberia's first healthcare worker from the virus. Top surgeons, doctors, and nurses would soon follow. International medical charity Doctors Without Borders and WHO announced that the outbreak was getting serious, as infection numbers inflated in Sierra Leone and Guinea as well.

More Liberia News

Ellen Bad-Luck On Liberia Again, Acronym For Ebola In Liberia Liberia 'Ebola In Town' Song, Musicians Reveal The Truth

But it wasn't until August, 1,711 cases and 932 deaths later, that WHO declared a public health emergency of global concern and visuals from the ground started to catch international attention. While the world was just waking up to the crisis, Liberians were already in the midst of an unprecedented and chaotic situation, even from the perspective of a country still recovering from 14 years of civil war.

"Sometimes there were bodies all over. September, the month of September, it was very bad," a case investigator named Victoria Kolakeh told me three days after Yardolo's hospital discharge in March.

"By that time it was difficult," she said, recounting the outbreak, which peaked in Liberia during the months of August and September 2014.

In July of that year, when the government put out an urgent request for health-care workers to help with Ebola response efforts, Kolakeh, a nurse by profession, volunteered. The 40-year-old went through training with a group of five other people to learn basic prevention measures for the virus. Afterward, she joined a group of 14 volunteers, including case investigators, drivers, nurses, and hygienists, who were divided into two teams. They worked in 24-hour shifts, from 8an to 8am the following day, covering the city in its entirety to track down suspected cases and transport people to the hospital.

I met Kolakeh and her team members on a Saturday morning in March, in a war room set up in Monrovia's John F. Kennedy Medical Center. Case-investigation teams had tacked up maps, schedules, and lists of contacts being monitored. Kolakeh was coming fresh off of a 21-day quarantine after entering a treatment center without proper protective gear. She arrived that morning wearing a graphic T-shirt, chlorine-stained pants, and a gray hat. From this meeting she would spend her eight-hour shift waiting for calls to come in with reports of suspected Ebola cases in Monrovia's Sector 1, which included some of the city's most densely populated neighborhoods.

When Kolakeh started, however, case investigations were less organized. She and her teammates responded to calls from all over the city and county, at a time when reports of suspected cases were constantly coming in and the sound of ambulance sirens on the busy streets of Monrovia was constant.

When I asked Kolakeh how exhausted she was during the height of the outbreak, working 24 hours straight and often well past the 8am shift change, she responded bluntly, as Liberians often do.

"Very much, but what to do?" she said. "For me, it was for the sake of my people. I gave myself to work for my country."

Case investigations and contact tracing require intense efforts to locate and monitor all the people an Ebola patient has recently encountered. These response activities are integral to containing the disease. As an outbreak slows down, the process becomes easier, but effective tracing becomes even more essential in the race to zero.

Liberia began seeing a drop in the number of new Ebola infections starting in October, steadily lowering through the beginning of 2015 — even as Guinea and Sierra Leone struggled to control the disease. Brennan explained that at this point, the Ebola response shifted to a phase when detailed epidemiological work became the focus.

"By January, we had reduced the incidents to around a hundred to a hundred and 50 cases per week, but those kinds of big-picture interventions aren't enough to end the outbreak," Brennan told me. "The last mile is all about the detailed epidemiological fieldwork, which we could do once we got to those lower numbers: finding every case, going out to villages, finding each person who's sick, and finding each one of their contacts."

Even as I sat in their dispatch room, the exhaustion of the last several months was still visible on the staff's faces while they waited for calls. As Kolakeh walked me through the layout of Sector 1, she received a phone call from SOS Children's Village, a clinic run by an international charity, saying that a woman with Ebola-like symptoms — vomiting, diarrhea, and exhaustion—had just been dropped off at their entrance.

The team quickly jumped into action, grabbing their bags and loading up a vehicle and ambulance to drive to the site. When

they got there, the sick woman, sprawled out on the cement, refused to board the ambulance and go to an Ebola treatment unit: The stigma and fear around the virus that comes even with just going to the clinic for testing is still alive in the minds of many Liberians. Kolakeh and a social worker spent time coaxing the woman for more personal information, but she refused to provide the contact details of family members.

By chance, the vehicle driver recognized  the woman from his neighborhood and called community members until he obtained her sister's phone number. Kolakeh got on the phone immediately and began the long process of compiling a definitive list of anyone who might have come into contact with the woman. Once this was finished, contact tracers working with Kolakeh would attempt to follow up with the individuals for 21 days until they had passed Ebola's incubation period without exhibiting any symptoms.

Eventually, after more than 30 minutes of discussion, Kolakeh managed to get the woman into the ambulance and take her to ELWA 3 hospital, the largest Ebola treatment center in the world. With a 250-bed capacity, the facility now sits mostly empty.

As with many of the suspected cases Kolakeh and her colleagues had taken for Ebola testing in recent days, the women from SOS Children's Village tested negative for the virus. Diseases like malaria and cholera are commonplace in the region and present Ebola-like symptoms in the early stages. With the virus maintaining its grip in neighboring countries, case investigators must remain vigilant in responding to phone calls and burial teams must continue to perform safe interments until all three nations reach the point of zero Ebola infections.

After I left Kolakeh, Liberia enjoyed a streak of 15 days without a new Ebola case. But on March 20, just six days short of the 21-day incubation period, a 44-year-old woman tested positive for the virus in a Monrovia hospital. Though this was a major setback for the country, health-care workers managed to contain the disease and safely transport the patient to ELWA 3. Not a single person who came into contact with the patient showed signs of the illness.

The woman died on March 27, but six weeks later, Liberia finally hit the milestone it had been chasing for a year. On May 9, the country had managed 42 days without incidence of the disease. Officially, the country was Ebola-free and the outbreak was over.

While WHO said it was confident the country had interrupted transmission, it underscored the fact that Guinea and Sierra Leone were still reporting Ebola outbreaks near their borders. "The government is fully aware of the need to remain on high alert and has the experience, capacity, and support from international partners to do so," WHO concluded.

In the more than two months since, both Guinea and Sierra Leone have continued to report new cases of the illness. In June, the countries recorded an average of 20 infections per week.

Brennan said that while there have been major behavioral changes in communities experiencing continued transmission, much work still needs to be done to overcome obstacles of resistance and awareness.

"If all those communities changed their behavior overnight, we'd end this outbreak in twenty-one days," Brennan explained, adding that he expected to see fluctuation but overall a larger trend downward in the number of cases. While he expressed that WHO is confident West Africa will get to zero cases, he reemphasized the need for detailed and almost flawless epidemiological work in this "last mile" of the outbreak.

"To end an Ebola outbreak requires a level of programmatic excellence that's unusual for most humanitarian programs," he said. "We have to find every case; we have to find every contact."

Just days later, on June 30, one month and three weeks after the outbreak in Liberia was declared over, Nyenswah announced that the dead body of a 17-year-old boy had tested positive for Ebola. A safe burial was performed, and nearby houses in the Margibi County village were placed under quarantine. Suddenly, community health teams had more than 100 new contacts to follow.

Source: Kayla Ruble via Vice News

Investing In Africa, Is Investing In Our Women Tags: Women Africa News African News Development

This year’s 25th African Union Summit theme was highly focused on Women Empowerment, and Development towards “Agenda 2063”. The summit was an in-depth exploration into key issues that plague the success and development of women in Africa. By the end of the summit, a declaration was agreed upon, that highlighted the commitments that would be implemented, as part of Agenda 2063. The commitments taken are in the form of a continental plan that ensures socio-economic transformation, by tackling issues such as women empowerment and gender equality.

Much attention and support was given to the theme, especially with the visit of UN Ambassador and International Actress Angelina Jolie, who joined in on the panel discussions. Jolie spoke on the violence against women, both in conflict zones and “peaceful societies”. She further pleaded with males, more especially African leaders to take a more aggressive approach in dealing with crimes against women.

ISSUES AFFECTING WOMEN
 
According to Jolie, women will not make any progress without the necessary freedoms, education and respect. Reports by the OECD policy say, women in sub-Saharan Africa make up 70 percent of the agricultural labour market, producing some 90 percent of all food. In many ways, women are regarded as key to the success of “Agenda 2063”. There are still barriers , regarding inequality between men and women, as clearly evidenced by the composition of the labour force. For example, women make up 61.9 percent of the people who supply labour to produce economic goods, yet they still acquire low-level skilled jobs, and comprise the majority of the informal sector. These are but a few of the many reasons why organisations such as the African Union work so hard to ensure that issues of gender inequality and others are addressed, for the future sustainability of the African continent. As part of the declaration of commitments in the AU Summit 2015; enhancing women and girls’ access to education, science and technology was one them.

A study headed by Jeanna Bryner called Why Men Dominate Math and Science Fields clarifies why this is so. According to the study, women are less likely to participate in engineering and science fields, if they are going to be out-numbered by men. Stanford University psychologist Mary Murphy calls this gender bias. Other reasons are included but are not limited to societal and cultural upbringing, where men and women are taught to occupy specific job types in accordance to their gender.

THE WAY FORWARD

If we want to stabilize the African economy, a better look at gender inequality should be the first step to solving many of the difficulties women have to endure. This means more women taking up occupation in male-dominated jobs; removing the ideals of remaining in household work. It is estimated that worker productivity can rise by up to 25% if more women participate in these occupations according to Joaquim Chissano, former president of Mozambique. In terms of agriculture, women should be treated and paid equally as the men respectively.

A second consideration should be given to health education. When it comes to sexual and reproductive rights of young women and children, in Africa, our biggest issues lie in the mortality rates of pregnant women, HIV/aids epidemic, access to health facilities, and child marriage (Empowering Africa’s women is the key to economic wealth) .With more knowledge of their health and the choices available to young women, there will be more freedom for them to make decisions that will be beneficial. Lack of information on issues such as family planning as an example, place women at risk of making uninformed decisions that could endanger not only their own health, but that of their dependents too.

Thirdly, basic education. Too many women are still not getting the education that they need, and this stifles progress. Paying mind to the urbanizing world we live in, more participation of women in the economy will lead to empowerment, in so far as Agenda 2063 is concerned. The more empowered women become, generational success can be expected. “Women invest their earnings in the well-being of their children to a far greater extent than do men”- Joaquim Chissano makes an example of this when talking about unleashing the unused resources that is our African women.

The last key point is curbing of women abuse in African countries. If more attention can be given to better policing of crimes against women, there would be less of them. Reason for this phenomenon could be the lack of respect women are held to, in comparison to males. This therefore, should be taught at grass root levels to our children. It is in them that discriminating systems of the past can be amended.

“This is part of Africa rising. Africa will not rise as long as its daughters are bleeding and Africa will never be prosperous or at peace with itself if the whole generation is losing opportunities.” Nyaradzayi Gumbonzvanda, AU Goodwill Ambassador for Ending Child Marriage.

Source: africities2015.org

YELL' 4th Annual Young Liberians Summit: August 20 - 23, 2015 Tags: YELL Local News Organizations Liberia Macdella Cooper Venus Johnson Elijah Nyaneor Randall Dobayou Kimmie Weeks Young E’nnovative Leaders of Liberia

Young E’nnovative Leaders of Liberia, acronym YELL, to host its 4th Annual Young Liberians summit in California’s capital, Sacramento. The program will last for four days from August 20 to 23, 2015 at the Double Tree Hilton Hotel – 2001 Point West Way, Sacramento, CA 95815.


YELL’ 2015 summit promise to have special guest speakers, including some of Liberia’s emerging and young leaders, namely Mr. Randall Dobayou, Global anti-poverty advocate; Ms. Leelai M. Kpukuyou, secretary-General of the Liberian Business Association, LIBA; Mr. Kimmie Weeks, Executive director of the Youth Action International; Amb. Macdella Cooper, founder of the Macdella Cooper Foundation (MCF); Mr. Elijah Nyaneor, one of YELL’ active member; and alongside with Ms. Venus Johnson, Associate attorney General at California Department of Justice.

According to YELL’s said establishment, its aim of this year’s summit is to engage not only young Liberians or Liberians in general, but also those that are interesting in Liberia and its infrastructure, businesses, government and particularly the Liberian people: youth. However, with the on-going deadly Ebola crisis, which spotlighted one of this year YELL’ guest speakers Mr. Randall Dobayou that called on the Liberian government to help pay for all Liberian student school fees, “YELL’s summit will provide some information and a more precise fact about the Ebola situation in Liberia,” one of our staff anticipated. And the public should remember that if perhaps YELL may disclose the deadly Ebola issues in West Africa, its organization reminds the public that “YELL is not a political organization. [YELL] focus on nation building through activism and community service.”

VIEW YELL' 2015 SUMMIT AGENDA or see it below...

Question and Answer with YELL' Vice President Ms. Patience Noah

Q: What Challenges Does YELL Face?
A: Our biggest challenge, thus far, has been building a strong community presence. As a solution, we decided to host the summit in a different state each year. As Liberians, we are still recovering from the effects of the civil war. One such effect is the unwillingness to trust each other and the inability to work together. These are self-imposed stereotypes, and as the young generation of Liberians, we are actively tearing down those misconceptions and stereotypes. By collaborating with the local Liberian communities and other organizations, we are proving that Liberians can and do work together to bring about change.

Q: Who Will Speak at the Summit?
A: Every year we select speakers who can shed new light on the issues that affect Liberia and how those issues can be solved. Our speakers are individuals whose wisdom, knowledge and vision align with YELL’s mission statement and vision. This year, we chose Venus Johnson- Associate Attorney General at California Department of Justice, Ambassador MacDella Cooper Founder of the MacDella Cooper Foundation, Kimmie Weeks- Chairman at Liberia Water and Sewer Corporation, and Executive Director at Youth Action International, and Elijah Nyaneor- Secretary General at Federation of Liberian Association of Massachusetts.
 
Q: Discuss Past Work YELL Has Done in the Community
A: One of the things we pride ourselves on is our platform to nurture future leaders. Most of our members have a prominent role in their local Liberian community. Over time, we hope that all of our members will play such roles in their communities. After every summit, we have a young Liberian who barely knows anything about Liberia tell us how they were grateful for attending the summit because it was very informative and inspiring. We recently launched a YELL chapter in Georgia. A group of young Liberians had the opportunity to run YELL at a local level. So far it’s been very successful. They had their first event in April where they collected feminine products to be donated to New American Pathways and Friends of Refugees. Our goal is to implement this program in every state and hopefully in Liberia as well to give our young people the opportunity to nurture their leadership skills.

Q: What are the Benefits of Becoming a Member of YELL?
A: Being a member gives you the chance to be a change agent in your community, network with likeminded people and collaborate with organizations whose goal is to make a difference in Liberia, the lives of its people and the leadership..

Q: What Will be the Highlights of the Summit?
A: The best part of our summit every year is that we host it in a different state. This allows us to learn about that state, its people and the Liberian Community within that state. This year we are really excited to work with the team from Sacramento, California. They have been doing a great job planning the summit. The team in Sacramento has an extensive list of activities scheduled for that weekend. Some activities are the city tour on Thursday August 20th, a press conference on Friday August 21st and a charity soccer tournament and barbeque on Sunday August 23rd. It will be a fun and insightful weekend and we can’t wait to see all what they have in store.

Source: BeeAfrican Staff | YELL

Akon Lighting Africa Campaign '1.3 Billion Africans Don’t Have Electricity' Plan To Cut It In Half Tags: Akon News Development News2015 Akon Lighting Africa

It’s “a no-brainer.” That’s how hip-hop and R&B artist and producer Akon described using solar energy to bring power to hundreds of millions of Africans.

The Missouri-born Senegalese American had just trekked to Mali from an inaugural meeting in Côte d’Ivoire (Ivory Coast) with top West African leaders to talk about renewable energy solutions.

“Africa needs to be sustainable for a long time and be a crutch for the rest of world instead of the other way around,” Akon told ThinkProgress in a phone interview. “A stable Africa helps the world.”

Akon joined five prime ministers representing Benin, Ivory Coast, Mali, Niger, and Togo who gathered in the Ivory Coast’s economic capital of Abidjan for the West African Energy Leaders Group — a conference for business and political leaders working to develop strategies to address the region’s energy crisis.

“Because of the [lack of infrastructure] in Africa, we need more financial institutions to be a part of it, and partner with people who have a vision for Africa as well,” Akon said.

More than 1.3 billion Africans have no access to electricity; and only 5 percent living in sub-Saharan Africa have electricity.

Those staggering figures prompted the certified platinum recording artist to launch the Akon Lighting Africa (ALA) initiative in 2014, which aims to bring solar power to nearly half — 600 million — of the Africans who live without power.

So far, ALA has provided solar street lamps, micro-generators, charging stations, and home kits to 14 countries — Benin, Burkina Faso, Democratic Republic of the Congo, Equatorial Guinea, Gabon, Guinea, Kenya, Namibia, Madagascar, Mali, Niger, Nigeria, Senegal, and Sierra Leone.

The lack of power “stopped us from doing the things we need to do,” he said. “There wasn’t enough electricity to pull from,” to get Africa on par with the rest of the world developmentally, and solar was “the biggest and quickest solution.”

Global prices for solar modules have significantly dropped over the last decade, hitting a record low in 2014. ALA works with a $1 billion credit line from a Chinese solar system provider, allowing countries to pay back the debt over time.

“We want to empower the people to develop their own opportunities,” Akon said. “[But] before you empower people you have to educate them. So we developed the university,” which focuses on solar energy delivery and maintenance, “so they can [eventually] invent technology of their own.”

Instead of dropping technology on unsuspecting villages, ALA also teaches citizens how solar power works and how to install arrays through an educational training program called the Solar Academy.

“In every village we go to, we want to keep that village sustainable,” and promote entrepreneurship, Akon said. “The involvement of the rest of the world will be key. It will have to be started by Africans, but the technology the world has to offer has to be shared.”

The July meeting was the first of its kind, focusing on partnerships between private companies and state agencies. “There’s no way around: The government and investors are going to have to come together to work this out.”

Source: Thinkprogress.org

African Union Commits to Ending Child, Early and Forced Marriage Tags: Education Kids News Africa

African nations this week pledged to eradicate child and forced marriage in the region at the African Union Summit, according to African Union Goodwill Ambassador to End Child Marriage Nyaradzayi Gumbonzvanda.

Goodwill Ambassador Gumbonzvanda announced this political commitment to eradicate child, early and forced marriages at a panel event at the United Nations Human Rights Council in Geneva yesterday hosted by state delegations, UN agencies and NGOs including the African Union, the Center for Reproductive Rights, UNFPA, WHO and the governments of Sierra Leone, Italy, Belgium,  and Uruguay. 

In 2013, the U.N. Human Rights Council—principal body at the UN that promotes and protects human rights for all—adopted a procedural resolution dedicated to ending child marriage. The event this week called for the Human Rights Council to adopt a substantive resolution that recognizes the human rights implications of child, early and forced marriage, and encourage states to use their national and regional experience, to influence and promote the strongest possible inclusion of language addressing CEFM within a comprehensive human rights based approach

“The illegal and unconscionable practice of child and forced marriage has been ignored by too many governments for far too long, violating the human rights of countless young girls and women across the globe,” said Rebecca Brown, global advocacy director at the Center for Reproductive Rights. “Today’s action by the African Union echoes the many U.N. resolutions and regional initiatives developed to end child marriage, and it is an important and positive step toward change. It’s time governments fulfill their promises and take the necessary next steps to ensure these policies are implemented and enforced.”

During the panel event, Melissa Upreti, regional director for Asia at the Center, discussed how South Asia is making strides to end child marriage. Last year the government of Nepal hosted a convening on using the law to end child marriage, particularly focusing on the need for legal accountability for child marriage. Ms. Upreti also introduced the South Asia Initiative to End Violence against Children (SAIEVAC), which has led the development of a regional action plan to end child marriage that reflects the commitment of all eight South Asian states to take steps to end child marriage as a matter of human rights from 2015-2018.

In 2013 the Center issued the report Child Marriage in South Asia: Stop the Impunity examining the consequences of child marriage, which subject girls to serious crimes, including domestic violence and marital rape, placing their reproductive health and lives at serious risk. The report questions the failure of governments to prevent and prosecute cases of child marriage. Since the launch of the report, the Center has supported the efforts of SAIEVAC, in building a regional commitment to end child marriage and applauds the progress being made under the leadership of SAIEVAC to promote stronger legal accountability to end child marriage in the region.

The Center has played a part in some of the most important advances in reproductive rights worldwide. At the U.N. Committee on the Elimination of Discrimination against Women, the Center secured historic financial reparations for the family of a young Brazilian woman who died from preventable pregnancy complications—the first time an international human rights decision named maternal health a human rights. And at the European Court of Human Rights, the Center called upon Poland to ensure adolescents’ reproductive rights after access to a legal abortion for a rape survivor was repeatedly obstructed.

Source: reproductiverights

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