xiv Amartya Sen: The landmark report that launched this field of inquiry was Amartya Sen, "More Than 100 Million Women Are Missing," The New York Review of Books, December 20, 1990. That was followed by Ansley J. Coale, "Excess Female Mortality and the Balance of the Sexes in the Population: An Estimate of the Number of 'Missing Females,' " Population and Development Review, September 17, 1991. The third estimate is Stephan Klasen and Claudia Wink, "'Missing Women': Revisiting the Debate," Feminist Economics 9 (January 2003): 263-99.
xvi 50 percent more likely to die: That estimate of excess female mortality among Indian infants comes from the United Nations Development Programme but may be an understatement. Professor Oster cites data indicating that between the ages of one and four years, girls in India die at a rate 71 percent higher than if they were treated the same as boys. Emily Oster, "Proximate Sources of Population Sex Imbalance in India," manuscript, October 1, 2007. The 71 percent is derived from Oster's figures of 1.4 percent expected mortality for Indian girls between the ages of one and four, compared to actual mortality of 2.4 percent.
xvii quantified the wrenching trade-off: Nancy Qian, "More Women Missing, Fewer Girls Dying: The Impact of Abortion on Sex Ratios at Birth and Excess Female Mortality in Taiwan," CEPR Discussion Paper No. 6667, January 2008.
xx In 2001 the World Bank: Engendering Development Through Gender Equality in Rights, Resources, and Voice, World Bank Policy Research Report (Washington, D.C.: World Bank, 2001); also, The State of the World's Children 2007: Women and Children, the Double Dividend of Gender Equality (New York: UNICEF, 2006).
xx The United Nations Development Programme: United Nations Development Programme: Global Partnership for Development, United Nations Development Programme Annual Report 2006 (New York: UNDP, 2006), p. 20.
xx "Women are the key": Hunger Project, "Call for Nominations for the 2008 Africa Prize," statement, June 3, 2008, New York.
xx French foreign minister Bernard Kouchner: Bernard Kouchner, speech to International Women's Health Coalition, New York City, January 2008.
xx The Center for Global Development: Girls Count: A Global Investment & Action Agenda (Washington, D.C.: Center for Global Development, 2008).
xx "Gender inequality hurts economic growth": Sandra Lawson, "Women Hold Up Half the Sky," Global Economics Paper No. 164, Goldman Sachs, March 4, 2008, p. 9.
CHAPTER ONE Emancipating Twenty-First-Century Slaves
5 There are 2 to 3 million prostitutes in India: That estimate comes from Moni Nag, Sex Workers of India: Diversity in Practice of Prostitution and Ways of Life (Mumbai: Allied Publishers, 2006), p. 6. It is generally in accord with other estimates. An estimate in the same range comes from an NGO in Delhi, Bharatiya Patita Uddhar Sabha, which calculated that there are 2.4 million sex workers across India. A 2004 journal article asserted that India has 3.5 million commercial sex workers, a quarter of them seventeen or younger: Amit Chattopadhyay and Rosemary G. McKaig, "Social Development of Commercial Sex Workers in India: An Essential Step in HIV/AIDS Prevention," AIDS Patient Care and STDs 18, no. 3 (2004): 162.
5 One 2008 study of Indian brothels: Kamalesh Sarkar, Baishali Bal, Rita Mukherjee, Sekhar Chakraborty, Suman Saha, Arundhuti Ghosh, and Scott Parsons, "Sex-trafficking, Violence, Negotiating Skill and HIV Infection in Brothel-based Sex Workers of Eastern India, Adjoining Nepal, Bhutan and Bangladesh," Journal of Health, Population and Nutrition 26, no. 2 (June 2008): 223-31. These self-reported estimates of the proportion of prostitutes in India who entered brothels voluntarily may be high, because of the prostitutes' fear of punishment from pimps for telling the truth.
5 China has more prostitutes: In the early 1990s, a common estimate for the number of prostitutes in China was 1 million, and that had increased to 3 million by about 2000. In recent years, higher figures have often been used. Qiu Haitao, author of a Chinese-language work on China's sexual revolution, estimates that there are 7 million sex workers in China. A scholar, Zhou Jinghao, who has written about the history of prostitution, has estimated that there are 20 million prostitutes in China. Another, Zhong Wei, offers an estimate of 10 million. The higher numbers include er-nai, who are more like concubines or mistresses in other countries. One reason to give credence to the high estimates is that the authorities have periodically released figures suggesting that more than 200,000 women a year are arrested annually in the standard spring crackdown on vice. There is some forced sex trafficking in China's southwest of girls from ethnic minorities who do not speak Mandarin Chinese well, and some of those girls end up in the brothels of Thailand or Southeast Asia.
China's larger problem with trafficking concerns not prostitution but women who are to be wives of peasants in remote areas. This phenomenon, called guimai funu, exists on a vast scale; researchers have estimated that there are many tens of thousands of cases each year. Typically the young woman is promised a job in a factory or restaurant in a coastal area and then is taken to a remote village and sold to a man for the equivalent of a few hundred dollars. She may be tied up for the first few months, or at least closely watched so that she does not escape. After the woman has a baby, she usually resigns herself to her fate and decides to stay in the village.
9 And The Lancet: Brian M. Willis and Barry S. Levy, "Child Prostitution: Global Health Burden, Research Needs, and Interventions," The Lancet 359 (April 20, 2002).
9 27 million modern slaves: The figure of 27 million slaves appears, for example, in the opening line of Not for Sale, a commendable call to arms against trafficking by David Batstone (New York: HarperCollins, 2007). The figure is widely cited in the growing literature about human trafficking. Two of the more scholarly works are by Louise Brown, a British sociologist who conducted research among the brothels of Lahore, Pakistan. Her books include The Dancing Girls of Lahore (New York: HarperCollins, 2005) and Sex Slaves: The Trafficking of Women in Asia (New York: Vintage, 2000). Somewhat more popular is Kevin Bales, Ending Slavery: How We Free Today's Slaves (Berkeley: University of California Press, 2007). An impressionistic anthology is Jesse Sage and Liora Kasten, eds., Enslaved: True Stories of Modern Day Slavery (New York: Palgrave Macmillan, 2006), with chapters about individuals from all over the world. Igor David Gaon and Nancy For-bord, For Sale: Women and Children (Victoria, B.C.: Trafford Publishing, 2005), provides a focus on the problem in southeastern Europe. Human Rights Watch has also published excellent studies of trafficking in Japan, Thailand, Togo, Bosnia, and India. Gary Haugen, an evangelical Christian who founded International Justice Mission, an antitrafficking organization with a large Christian following and a global network, has written Terrify No More: Young Girls Held Captive and the Daring Undercover Operation to Win Their Freedom (Nashville, Tenn.: Thomas Nelson Publishers, 2005).
10 and a very small number of boys: We focus on female sex slaves because they far outnumber the males. There are male prostitutes in the developing world, but they are more likely to be freelancers who are not forced into the business or locked up in brothels. One careful sociological study of male sex workers is Mark Padilla's Caribbean Pleasure Industry: Tourism, Sexuality, and AIDS in the Dominican Republic (Chicago: University of Chicago Press, 2007).
11 As the journal Foreign Affairs observed: The quotation comes from Ethan B. Kapstein, "The New Global Slave Trade," Foreign Affairs 85, no. 6 (November/December 2006): 105.
11 In 1791, North Carolina decreed: Rodney Stark, For the Glory of God: How Monotheism Led to Reformations, Science, Witch-Hunts, and the End of Slavery (Princeton, N.J.: Princeton University Press, 2003), pp. 320-22.
CHAPTER TWO Prohibition and Prostitution
28 HIV prevalence was inexplicably high: Kamalesh Sarkar et al., "Epidemiology of HIV Infection Among Brothel-Based Sex Workers in Kolkata, India," Journal of Health, Population and Nutrition 23, no. 3 (September 2005): 231-35.
28 Harvard School of Public Health: The MAP Network, which monitors AIDS, found that sex-worker HIV prevalence in Kolkata was 1 percent until 1994, and that it reached 51 pe
rcent in Mumbai in 1993. MAP Network Regional Report, October 1997.
28 Another is Urmi Basu: One of the most creative efforts to help Indian children in the brothels is the Kalam creative writing project, through Urmi's program in Kolkata. It conducted poetry workshops to teach the children how to write poems, and then published some of those poems--in English and Bengali--in Poetic Spaces, a privately printed booklet. The idea is that Bengalis revere culture and poetry, and so if they see that prostitutes and their children write poetry, they will feel more empathy for trafficking victims. We don't know if the project succeeded in building empathy, but it did produce moving poetry. The Kalam project was conducted with the Day-walka Foundation, a small American foundation that focuses on trafficking in India and Nepal.
29 But Anup Patel: The statement from Anup Patel is from a manuscript, "Funding a Red-Light Fire," prepared for publication in the Yale Journal of Public Health. Anup, a Yale medical student, used his extra scholarship funds to form a group to help trafficking victims: Cents of Relief (www.centsofrelief.org).
31 Mumbai's brothels historically were worse: The crackdown approach was also applied in Goa, India, but there hasn't been much serious follow-up to determine if it worked. A bitterly critical comment on that crackdown, favoring instead the Sonagachi model, is Maryam Shahmanesh and Sonali Wayal, "Targeting Commercial Sex-Workers in Goa, India: Time for a Strategic Rethink?" The Lancet 364 (October 9, 2004): 1297-99. Likewise, sympathetic accounts of a model like DMSC's can be found in Geetanjali Misra and Radhika Chandiramani, Sexuality, Gender and Rights: Exploring Theory and Practice in South and Southeast Asia (New Delhi: Sage Publications, 2005), especially chapter 12. Those sympathetic to the Sonagachi model sometimes argue that while sex work is unpleasant and dangerous, so are scavenging at garbage dumps and other jobs that the poor typically perform. Melissa Farley is among those who counter that while there are many unpleasant jobs, prostitution is uniquely degrading. She is editor of Prostitution, Trafficking, and Traumatic Stress (Binghamton, N.Y.: Haworth Maltreatment & Trauma Press, 2003).
31 A decade later, Sweden's crackdown: Norway looked at both the Swedish and Dutch models and produced an excellent report about the two approaches. Most of the data come from that report: "Purchasing Sexual Services in Sweden and the Netherlands, a Report by a Working Group on the Legal Regulation of the Purchase of Sexual Services," Oslo, 2004. Likewise Scotland examined the Dutch and Swedish approaches, along with that of New South Wales in Australia, and preferred Sweden's strategy: Scottish Parliament, Local Government and Transport Committee, "Evidence Received for Prostitution Tolerance Zones (Scotland) Bill Stage One," February 4, 2004.
CHAPTER THREE Learning to Speak Up
52 A retired high court judge, Bhau Vahane: Raekha Prasad, "Arrest Us All," The Guardian, September 16, 2005.
The New Abolitionists
55 "The agricultural revolution": Bill Drayton, "Everyone a Changemaker: Social Entrepreneurship's Ultimate Goal," Innovations 1, no. 1 (Winter 2006): 80-96.
CHAPTER FOUR Rule by Rape
61Women aged fifteen through forty-four: The calculation that more women die or are maimed from male violence than from the other causes comes from Marie Vlachova and Lea Biason, eds., Women in an Insecure World: Violence Against Women, Facts, Figures and Analysis (Geneva: Centre for the Democratic Control of Armed Forces, 2005), p. vii. The discussion of acid attacks comes from the same work, pp. 31-33.
62 21 percent of Ghanaian women reported in one survey: Ruth Levine, Cynthia Lloyd, Margaret Greene, and Caren Grown, Girls Count: A Global Investment & Action Agenda (Washington, D.C.: Center for Global Development, 2008), p. 53.
62 political office in Kenya: Swanee Hunt, "Let Women Rule," Foreign Affairs (May/June 2007): 116.
62 Woineshet: Emily Wax, a superb reporter, published an excellent article about Woineshet's case from which we also gained details: "Ethiopian Rape Victim Pits Law Against Culture," The Washington Post, June 7, 2004, p. A1.
67 Namely: sexism and misogyny: The late Jack Holland wrote a fine book a few years ago titled Misogyny: The World's Oldest Prejudice (New York: Carroll & Graf, 2006). He wrote that he often encountered surprise that a book about misogyny would be written by a man, and his response was always: "Why not? It was invented by men."
67 One study suggests that women perpetrators were involved: Dara Kay Cohen, "The Role of Female Combatants in Armed Groups: Women and Wartime Rape in Sierra Leone (1991-2002)," unpublished essay, Stanford University, Palo Alto, Calif., 2008.
68 As for wife beating: Robert Jensen and Emily Oster, "The Power of TV: Cable Television and Women's Status in India," manuscript, July 30, 2007, p. 38.
Mukhtar's School
70 Mukhtar Mai: For more information about Mukhtar Mai, read her autobiography (full disclosure: Nick wrote the foreword). It's Mukhtar Mai, In the Name of Honor (New York: Atria, 2006). See also Asma Jahangir and Hilna Jilani, The Hudood Ordinances: A Divine Sanction? (Lahore: Sang-e-Meel Publications, 2003).
CHAPTER FIVE The Shame of "Honor"
83 Half of the women in Sierra Leone: Rape figures in Liberia, Sierra Leone, and parts of the Kivus come from Anne-Marie Goetz, "Women Targeted or Affected by Armed Conflict: What Role for Military Peacekeepers," UNIFEM presentation, May 27, 2008, Sussex, U.K.
85 John Holmes: The quotation about Congo comes from an excellent article: Jeffrey Gettleman, "Rape Epidemic Raises Trauma of Congo War," The New York Times, October 7, 2007, p. A1.
87 The hospital is called HEAL Africa: In this chapter we focus on the HEAL Africa hospital in North Kivu. In South Kivu there is another hospital, Panzi Hospital, with a similar story of heroism as it treats rape victims and repairs fistulas.
CHAPTER SIX Maternal Mortality--One Woman a Minute
93 Fistulas like hers are common: For a medical review of issues related to obstetric fistulas, see "The Obstetric Vesicovaginal Fistula in the Developing World," supplement to Obstetric & Gynecological Survey, July 2005. Catherine Hamlin wrote an autobiography that was published in her native Australia: Dr. Catherine Hamlin, with John Little, The Hospital by the River: A Story of Hope (Sydney: Macmillan, 2001).
96 L. Lewis Wall: L. Lewis Wall, "Obstetric Vesicovaginal Fistula as an International Public-Health Problem," The Lancet 368 (September 30, 2006): 1201.
98 Eleven percent of the world's inhabitants: "Of Markets and Medicines," The Economist, December 19, 2007.
98 maternal mortality ratio (MMR): The figures are not terribly reliable, largely because the death of a pregnant woman in the villages isn't considered significant--and so nobody counts all of them. The numbers we use are principally drawn from a major UN study, Maternal Mortality in 2005: Estimates Developed by WHO, UNICEF, UNFPA, and the World Bank (Geneva: World Health Organization, 2007). It's an excellent overview of the statistics. The statistical approach has been tweaked somewhat since the previous study: Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF, UNFPA (Geneva: World Health Organization, 2004).
99 psychological studies show that statistics: The research by psychologists on how we are moved by individual cases and not by large-scale suffering raises important issues for anyone trying to galvanize a public response to suffering. It certainly shapes the way we approach our work. See Paul Slovic, "'If I Look at the Mass, I Will Never Act': Psychic Numbing and Genocide," Judgment and Decision Making 2, no. 2 (April 2007): 79-95. Remarkably, the human interest in helping victims seems to taper as soon as the number of victims rises above one.
A Doctor Who Treats Countries, Not Patients
103 Allan Rosenfield: Some of the quotes come from a brochure, Taking a Stand: A Tribute to Allan Rosenfield, a Legacy of Leadership in Public Health, published by Columbia University's Mailman School of Public Health, 2006.
CHAPTER SEVEN Why Do Women Die in Childbirth?
113 two basic evolutionary trade-offs: The discussion of evolution borrows from a wonderful book about the history of childbirth: Tina Cassidy, Birth: The Su
rprising History of How We Are Born (New York: Atlantic Monthly Press, 2006).
115 In one careful study: Nazmul Chaudhury, Jeffrey Hammer, Michael Kremer, Karthik Muralidharan, and F. Halsey Rogers, "Missing in Action: Teacher and Health Worker Absence in Developing Countries," Journal of Economic Perspectives 20, no. 1 (Winter 2006): 91-116.
116 "Maternal deaths in developing countries": Mahmoud F. Fathalla, "Human Rights Aspects of Safe Motherhood," Best Practice & Research: Clinical Obstetrics & Gynaecology 20, no. 3 (June 2006): 409-19. Dr. Fathalla is an Egyptian obstetrician who has championed maternal health issues.
116 As The Lancet noted: The quote about the lack of interest in women's issues reflecting an unconscious bias comes from Jeremy Shiffman and Stephanie Smith, "Generation of Political Priority for Global Health Initiatives: A Framework and Case Study of Maternal Mortality," The Lancet 370 (October 13, 2007): 1375.
117 Exhibit A is Sri Lanka: An excellent discussion of Sri Lanka's success in curbing maternal mortality is found in Ruth Levine, Millions Saved: Proven Successes in Global Health (Washington, D.C.: Center for Global Development, 2004), especially chapter 5. Honduras is often touted as another example of how even poor countries can achieve astounding reductions in maternal mortality. In the early 1990s, the Honduran government targeted maternal health and the reported MMR in Honduras dropped by 40 percent in seven years. But nothing is as simple as it seems. In 2007, the UN used a new methodology to calculate a maternal mortality ratio for Honduras that was actually higher than it had been back in 1990. Were the improvements in Honduras real? The only lesson seems to be that reliable maternal death figures are exceptionally elusive in poor countries. The success--or possible success--in Honduras is discussed in Levine's Millions Saved, and also in Jeremy Shiffman, Cynthia Stanton, and Ana Patricia Salazar, "The Emergence of Political Priority for Safe Motherhood in Honduras," Health Policy and Planning 19, no. 6 (2004): 380-90. Kerala, India, is also often cited as an example of a place where political will reduced maternal mortality, and that is probably right. Kerala's MMR is variously estimated as anywhere between 87 and 262, compared to a figure of 450 for India as a whole.
Half the Sky: Turning Oppression Into Opportunity for Women Worldwide Page 31
