Professional Documents
Culture Documents
HEALTH CARE IN KOSOVO (Published as "Health Care in Kosovo - Public Health Disaster and Renewal" Midwifery Today, Spring 2000 No. 53 and requested after my work there in August, 1999)
Imagine you live in the province of Kosovo. Imagine are a nurse, or mmia (midwife), or professor at the University of Pristina, or a grade school teacher, or the lady who registers new drivers at the licensing bureau downtown. Imagine you are working for the Serbian government, as you have all your adult life. You get up and get your kids ready for school, your husband is out the door, you drive across town to begin your shift, and there are Serbian policemen at the door of the hospital (or school, or municipal building, or courthouse, or any other public place) demanding you present your ID card. "What's going on?" you ask. The young man looks at your ID card, determines you are an ethnic Albanian Kosovar citizen of the Federal Republic of Yugoslavia, not an ethnic Serbian citizen, and keeps your identification card. Then he tells you that by order of a decree from the president of the Republic, Mr. Milosovic, and the congress in Belgrade, you and every other Yugoslavian of Albanian ethnic descent who works in any capacity for the federal, state or local government, is out of a job, as of this morning. The year is 1989. You've been hearing rumors of this since all those problems started between Croatia and the Serbians, then Bosnia and the Serbians. Now all this carrying on, so far away from your little province, is happening to you. The Federal Republic of Yugoslavia is breaking apart. Since President Tito died, it's been pretty much a chaotic situation with Slovenia, Macedonia then Bosnia declaring independence. Here is an excerpt from the book "Kosovo A Short History" by Noel Malcolm (Harper Perennial publishers, 1999): "In legal terms (according to the Badinter Commission, a committee of experts advising the European Union at that time), what happened when those states became independent was not secession, not the breaking away of a few branches from a continuing trunk; rather, it was the dissolution of the entire Yugoslav Federation into its constituent units. The post-1992 self-styled Yugoslavia, often wrongly described as "rump Yugoslavia", is not the
continuation
of
the
old
Yugoslavia
but
a
new
state,
formed
by
the
coming
together
of
two
ex- Yugoslavia
units,
Serbia
and
Montenegro.
And
Kosovo
is
the
province
between
these
two
states.
The
central
government
in
Belgrade
had
decided
by
decree
in
1989
to
fire
all
ethnic
Albanians
who
are
employed
in
any
public
institution
to
prevent
seditious
activities,
and
in
a
socialist
country,
the
government
is
the
major
employer.
90%
of
the
population
in
the
Kosovo
province
is
ethnic
Albanian.
They
and
their
families
have
lived
in
this
area
for
a
millennium.
It
would
be
like
saying
90%
of
the
people
from
Minnesota
are
ethnic
Swedes.
To
the
citizens
of
this
province,
it
didn't
really
make
sense.
They
were
all
Yugoslavians.
But
not
anymore.
Milosovic
and
his
party
had
begun
a
purposeful
and
planned
campaign
of
ethnic
cleansing
for
a
"Greater
Serbian
State".
Rumors
and
propaganda
were
everywhere.
The
year
of
1989
was
a
stunning
one
for
the
people
of
Kosovo.
When
I
arrived
in
August
of
1999,
ten
years
of
unbelievable
hell
had
been
going
on
for
the
majority
of
ethnic
Albanian
Kosovars,
as
well
as
for
their
just
as
surprised
Serbian
neighbors.
This
is
a
place
of
amazing
abundance
from
the
land.
It
is
very
mountainous,
with
three
major
agricultural
valleys
cutting
through
the
province
like
an
upside-down
"Y".
Farmers
have
filled
the
markets
and
tables
of
neighboring
Serbia,
Romania,
Albania
and
Macedonia
for
centuries
with
their
grain,
dairy,
and
produce.
The
valleys
all
join
together
at
the
north
to
enter
into
the
great
Morava
river
basin
valley
and
thus
geographic
access
to
the
Danube
river
basin.
The
people
from
this
province
also
are
known
for
their
generosity,
their
hearty,
loud
humor
and
their
good
wines.
When
I
talked
to
the
doctors
and
nurses
I
had
met
in
Pristina
at
the
Institute
for
Public
Health,
they
said
that
at
first
they
couldn't
believe
this
was
happening
to
them
back
in
1989.
Most
of
the
people
who
are
presently
working
for
CARE
in
Kosovo
(where
I
was
hired
to
review
training
needs
for
health
care
personnel)
had
worked
previously
in
the
refugee
camps
in
Albania
and
Macedonia,
making
room
for
the
thousands
of
neighbors
leaving
Kosovo.
They
couldn't
believe
what
was
happening,
either.
"Hundreds
of
people
were
getting
off
crowded
buses,
just
like
the
big
tour
buses
you
see
anywhere
in
Europe.
The
women
had
their
kids
neatly
dressed
for
2
school,
their
purses
matched
their
shoes,
and
everyone
was
neat
and
clean
and
stunned.
I've
never
seen
anything
like
it,"
said
Liz
Simes,
a
nurse
from
New
Zealand
who
has
worked
in
various
refugee
camps
in
Africa
and
Asia.
Chris
Woodgate,
an
Australian
nurse
with
CARE
hired
to
hammer
out
a
health
care
package
for
returning
refugees
in
Kosovo,
had
been
in
Pristina
for
a
month
before
I
arrived,
and
taught
me
the
most
about
public
health
I
have
ever
learned
in
one
afternoon.
"Imagine,"
she
began,
"for
ten
years
there
has
been
a
parallel
health
and
educational
system
in
place
here.
Since
they
fired
all
the
health
care
personnel,
and
replaced
them
with
Serbians,
people
were
obviously
afraid
of
going
to
hospitals
or
clinics.
They
also
lost
their
insurance
coverage
because
they
were
unemployed,
so
health
care
costs
were
determined
in
a
open
market,
for
people
without
income."
What
happened
was
that
schoolteachers
began
taking
students
from
grade
school
to
university
students
-
into
their
homes
for
classes.
Doctors
and
nurses
moved
the
furniture
around
in
the
basement
of
a
home,
or
perhaps
their
garage,
and
made
a
makeshift
ambulatory
clinic.
After
a
couple
of
years,
some
volunteers
and
donors
began
opening
private
homes
and
calling
them
Mother
Teresa
Homes,
equipping
them
with
basic
health
provisions
such
as
immunizations
for
children,
or
prenatal
care
for
pregnant
women.
All
of
this
resulted
in
a
variety
of
self-designed,
self-implemented,
and
self-evaluated
training
programs
in
health
that
were
neither
accredited,
validated
nor
officially
recognized
by
any
governing
body.
Since
1989,
the
Albanian
Kosovar
health
professionals
have
had
little
or
no
practice
areas
in
hospitals
or
clinics
and
no
access
to
conferences
or
continuing
education.
So,
although
some
doctors
could
find
practical
training
abroad
in
other
European
countries,
most
medical
and
nursing
personnel
practice
in
their
own
houses
or
the
Mother
Teresa
private
health
centers
(where
there
are
no
x-ray,
lab,
surgical
suites
or
other
practical
interventions
available.)
3
Then
the
Serbian
government
passed
a
law
in
1990
saying
that
any
birth
outside
the
hospital
was
illegal
and
wouldn't
be
registered,
unless
the
mother
came
in
with
her
newborn
and
two
other
immediate
family
members
to
say
there
was
an
emergency
and
she
couldn't
help
giving
birth
at
home.
Many
women,
of
course,
refused
to
go
into
the
city
with
their
newborn
and
participate
in
this
farce.
Any
death
had
to
be
validated
by
a
Serbian
doctor,
or
else
that
wouldn't
be
registered
either.
For
10
years
then,
there
has
effectively
been
no
official
registration
of
births,
deaths,
or
any
other
public
health
information
such
as
registration
of
people
with
tuberculosis,
syphilis,
HIV,
measles,
or
anything
else.
Current
Health
Situation
(1999)
-
I
met
with
two
wonderful
public
health
doctors,
Dr.
Drita
Salihu
and
Dr.
Merita
Koinaj,
both
Kosvars
of
Albanian
descent,
who
stayed
in
the
Institute
for
Public
Health
despite
threats
(they
were
sheltered
by
their
colleagues)
during
those
10
years.
They
visited
towns
and
"Health
Homes"
(as
the
private
health
facilities
were
called)
and
did
their
best
to
register
public
information
in
their
tattered
old
paper
notebook.
These
two
valiant
women
have
kept
the
public
health
system
of
the
province
together
by
sheer
willpower
and
a
dedication
to
public
health
(see
photo).
They
told
me
overwhelming
stories
of
personal
horror
they
or
a
family
member
had
suffered
at
the
hands
of
a
few
young
men
with
guns
during
the
10
years.
This
Institute
for
Public
Health
is
attempting
to
re-group
with
their
medical
and
nursing
personnel
in
order
to
put
together
a
uniform
reporting
system
for
public
health
information
as
well
as
educational
validation
systems
for
professionals.
4
The following summarizes the health situation in Kosovo as of August 30, 1999 (statistics are from WHO, UNFPA, UNMIK, CARE Kosovo field reports, Information Bulletin from "Action Against Hunger" and personal communication with doctors at the Institute of Public Health). 70% of the population is under 30 years of age, 1.5% over 75 years old. Population growth rate 1.7%, infant mortality 23.5/1000 both highest rates for Europe. There are no statistics for maternal mortality or morbidity since 1990. Most common childhood illnesses are respiratory and diarrheas. Adult morbidity and mortality mostly from heart and lung disease, diabetes, stroke and cancer (pre1990 data. Post 1990 most probably war related injuries major cause of death). Pregnancy morbidity primarily consists of hypertensive conditions (pre-eclampsia), diabetes and hemorrhage, with infections primarily in the post-natal period. Tuberculosis incidence high at 60-70/100,000. Injuries due to landmines at 10 per 100,000 during June. Very high incidence of unattended home births during the war, with the last documented information from 1989, which states that 23% of Albanian Kosovar women deliver without a skilled attendant. There are no emergency transport services for obstetric emergencies in rural areas. Comprehensive family planning services are not consistently available in Kosovo due to lack of access to appropriate drugs or devices. STI's, including gonorrhea and chlamydial cervicitis/urethritis, are endemic and likely to remain at moderate levels. Sexual violence has been documented and reported including recommendations from UNFPA consultants concerning the need for personnel training in this area of health care. Labor and delivery services are available at all hospitals and in about seven maternity centers within the Health Houses and in an unknown number of Ambulantas 25% of infants do not start breast-feeding until after 24 hours or more after birth, and 35% of mothers stop breast-feeding before 6 months
The
United
Nations
Mission
in
Kosovo
(UNMIK)
is
the
governing
body
for
public
policy,
while
things
get
sorted
out.
There
is
no
connection
with
the
Ministry
of
Health
of
Yugoslavia
in
Belgrade,
so
the
World
Health
Organization
is
the
acting
Minister
of
Health,
until
the
returnees
5
establish
their
own
systems.
This
includes
infrastructure
(Serbians
destroyed
toilets
in
most
public
facilities,
sewer
and
water
treatment
systems
and
took
all
garbage
collection
trucks
back
to
Belgrade
when
they
left.),
educational
validation,
and
re-organization
of
facilities,
meanwhile
concerning
themselves
with
immediate
emergency
health
care
needs
such
as
mine
detection
and
clearance,
vector
control
(there
were
mountains
of
garbage
around
the
city),
potable
water,
sewage
and
detection/treatment
of
communicable
diseases
such
as
syphilis
and
STD's.
Health
Service
Delivery
-
Nurses
do
not
deliver
any
direct
services.
They
are
trained
to
serve
the
doctor.
They
don't
even
take
vital
signs.
I
found
out
why,
when
I
went
to
visit
the
"Medical
High
School"
in
the
capital,
Pristina.
Shqipe
Pacolli,
a
young
16
year
old
who
became
a
new
friend
of
mine,
explained
to
me
that
she
was
going
to
attend
the
Medical
High
School
because
she
wanted
to
be
a
doctor.
She
then
explained
to
me
that
going
to
this
high
school
had
been
an
option
only
for
Serbian
kids
before
1989
(she
has
never
been
to
a
public
school).
If
she
qualified,
she
would
enter
at
9th
grade
and
begin
a
course
of
study
that
included
"hard"
sciences,
psychology
and
social
sciences.
Upon
graduation
from
the
twelfth
grade,
depending
on
the
curriculum
one
decided
upon
during
the
9th
grade,
one
would
graduate
as
a
nurse,
midwife,
lab
tech,
physical
therapist,
radiology
tech,
respiratory
tech,
or
pharmacy
tech.
If
you
"made
the
grade",
you
could
go
on
to
the
University
to
study
medicine
for
5
years
and
become
a
general
practitioner.
With
3
more
years,
you
could
study
to
become
a
physician
with
a
specialty,
such
as
obstetrics.
I
went
to
visit
the
Medical
High
School
on
the
other
side
of
town
near
the
monolithic
public
hospital.
The
high
school
is
three
stories
tall,
"L"
shaped,
cement,
and
totally
destroyed.
I
passed
a
huge
mountain
of
white,
porcelain
toilets
on
the
way
in.
Students
and
adults
were
inside
scrubbing
the
walls
of
graffiti,
painting,
trying
to
put
the
sinks
and
toilets
back
in,
and
taking
out
the
bits
of
broken
glass
from
every
single
window
that
had
been
broken
by
the
departing
Serbians.
I
met
with
the
director
of
the
school,
Dr.
Aisha
Bolen
Castriti,
a
well-dressed
middle- aged
woman
with
three
teenagers
of
her
own.
She
talked
to
me
about
the
curriculum,
how
it
had
6
always
been
a
matter
of
approval
by
the
Ministry
of
Education,
and
how
she
felt
it
had
never
really
met
the
needs
of
the
health
problems
of
Kosovo,
especially
under
the
current
circumstances.
She
was
very
proud
that
she
was
finally
able
to
open
the
school
again
(she
had
been
the
previous
director
until
the
1989
mass
firing)
and
was
anxious
about
opening
on
time
for
the
new
school
year.
The
saddest
thing
I
have
ever
seen
was
the
room
full
of
their
"training
equipment".
There
were
several
old,
iron
beds
with
straw
mattresses
and
no
sheets,
an
old
wooden
mannequin
with
one
arm
(for
learning
how
to
deal
with
a
patient,
I
suppose),
a
part
of
a
small
doll's
torso
for
learning
about
infant
care,
and
two
torn
posters
on
human
anatomy.
That's
it.
No
videos.
No
overhead
projectors.
No
charts
or
laminated
posters.
Not
even
a
skeleton!
Dr.
Castriti
wasn't
too
concerned
about
training
materials
just
yet.
Her
priority
was
on
getting
the
physical
building
in
shape
for
the
coming
winter.
Over
400
windows
had
to
be
replaced!
As
far
as
maternal
and
infant
health
care,
I
will
tell
you
of
a
visit
we
made
to
the
big
referral
hospital
in
the
beautiful
eastern
town
of
Prizren.
The
hospital
is
huge,
a
cement-gray
building
built
in
the
1950's.
The
nurses
wear
green
cotton
dresses
with
a
white
scarf
tied
over
their
hair.
The
doctors
all
wear
white
lab
coats
over
green
smocks.
We
squeezed
through
dozens
of
people
waiting
by
the
door
to
hear
news
of
their
relatives
(no
visitors!)
and
went
to
the
third
floor
maternity
ward
(have
you
noticed
that
almost
everywhere
the
maternity
ward
is
on
the
third
floor?).
We
walked
past
the
"delivery
room",
with
the
door
wide
open.
Three
women
were
in
this
large,
open
room
with
no
curtains
or
other
separation
between
them,
all
with
their
exposed
perineums
facing
the
door.
One
was
about
to
give
birth,
her
legs
up
in
stirrups,
shaved
perineum,
IV
drip,
a
crowd
of
people
around
her
(no
relatives)
and
someone
with
a
mask
on
cutting
an
episiotomy.
The
nurse
giving
us
the
tour
proudly
pointed
out
this
delivery
room.
Everything
stopped
and
all
the
women,
including
the
poor
soul
trying
to
give
birth,
looked
up
at
us
strangers
standing
in
the
doorway.
I
smiled
an
apology,
and
closed
the
door.
Someone
opened
it
up
again
after
we
had
left.
7
"Where
is
the
labor
unit?"
I
asked.
It
is
an
open
ward
with
25
beds.
No
privacy.
"We
average
400
births
a
month",
she
said
proudly.
"How
many
midwives?"
I
asked
her.
There
are
only
three
now,
the
Serbians
all
left
and
the
ones
who
were
here
before
haven't
come
back
yet.
There
are
9
doctors,
3
of
them
OB/GYN
(the
rest
general
practitioners).
There
is
one
anesthesiologist.
There
are
about
30
nurses
who
rotate
shifts.
The
doctors
are
the
only
ones
allowed
to
deliver
the
babies.
The
midwives
mostly
work
in
post-partum
unit,
she
replied.
That
means
9
doctors
for
24
hour
shifts
attending
around
400
births
in
one
month.
We
met
with
Dr.
Jlldze
Gonani,
Chief
of
OB/GYN
who
was
very
happy
to
be
back
in
the
post
she
had
been
discharged
from
in
1989.
She
proudly
told
us
how
she
intended
to
promote
"natural
childbirth"
and
had
the
6
general
practitioners
in
training
to
do
just
that.
"Our
Cesarean
rate
is
only
7%,
she
announced
with
pride.
I
didn't
ask
if
that
was
because
they
had
had
no
training
in
the
practice
of
surgical
operations
in
10
years,
or
if
they
had
no
anesthesiologist
on
staff.
We
just
congratulated
her
enthusiastically.
Then
we
visited
the
Neonatology
unit,
where
all
the
babies
were
"in
with
their
mothers".
The
Neonatologist
in
charge
explained
that
she
was
trying
to
make
this
a
"Baby
Friendly"
Hospital
according
to
UNICEF
guidelines,
and
that
meant
that
the
babies
stayed
with
the
mothers
"at
least
a
few
hours
a
day".
She
then
proudly
showed
me
the
"milk
room",
where
they
mixed
the
formula
and
sterilized
the
bottles.
I
gently
asked
her
about
breastfeeding
protocol.
"Oh,
yes,
well
if
the
mother
wants
to,
but
we
find
that
most
of
our
mothers
prefer
the
bottle,
it's
so
much
easier."
Family
planning
is
now
called
"Family
Health"
because
of
the
insinuations
of
restricting
the
size
of
the
family.
After
a
war,
most
people
will
want
to
hurry
up
and
re-populate
what
they
feel
has
been
a
mass
elimination
of
their
people.
The
most
popular
method
of
family
planning
seems
to
continue
to
be
abortions,
as
that
is
legal
and
free.
In
an
interview
I
did
with
4
ethnic
Albanian
Kosovar
women
who
were
all
pregnant,
every
one
of
them
knew
of
someone
personally
who
became
pregnant
"with
an
IUD
in
place".
They
had
also
heard
rumors
of
mass
sterilization
by
Serbian
doctors
of
Albanian
women
who
had
given
birth
in
hospitals
during
the
previous
10-year
period,
and
as
far
as
they
were
concerned,
the
contraceptive
pill
causes
cancer
of
the
uterus.
8
(Please
refer
to
box)
A
series
of
reproductive
health
assessments
had
been
conducted
previously
by
CARE,
with
men,
women
and
adolescent
groups
of
refugees
while
in
the
camps,
which
demonstrated
that
there
was
a
lack
of
knowledge
for
appropriate
pre-
and
post-natal
care,
child
spacing
methods,
nutritional
care
during
pregnancy,
care
of
infants
and
children,
teenage
sexuality
issue
and
very
little
knowledge
of
STD's
or
HIV/AIDS.
There
is
much
to
be
done.
The
many
people
I
met
with
and
got
to
know
impressed
me
with
their
optimism
and
energy
for
working
towards
a
healthy
future
for
themselves.
They
all
want
to
make
a
better
life
for
their
children,
as
all
people
want
in
all
countries,
of
any
ethnic
descent.
Interview
with
Four
Pregnant
Ethnic
Albanian
Kosovar
Women
26
August
1999,
Pristina,
Kosovo
Our
conversation
took
place
in
the
afternoon,
in
the
outdoor
patio
at
the
CARE
office
in
Pristina,
on
a
beautiful,
warm
fall
day.
The
four
women
range
in
age
from
25
to
28
years
old.
All
are
married
and
in
apparently
stable
relationships.
3
of
the
four
are
pregnant
with
their
first
baby,
one
has
had
a
previous
abortion,
and
the
fourth
is
pregnant
with
her
second
baby.
Only
the
woman
with
her
second
pregnancy
planned
it,
while
the
other
three
did
not.
All
mentioned
that
they
wanted
to
be
pregnant,
although
each
of
their
individual
doctors
had
asked,
on
their
first
prenatal
visit
here
in
Kosovo,
if
they
wanted
to
keep
the
baby,
regardless
of
the
month
of
gestation.
All
four
women
are
of
Albanian
ethnic
descent
living
in
Pristina,
Kosovo.
They
range
in
gestation
from
4
months
(2
of
them)
to
7
months
(1)
and
nine
months
(1).
Active
warfare
in
the
area
can
be
considered
to
have
occurred
from
the
end
of
March
of
1999
to
the
end
of
June
1999.
In
the
year
1989
Kosovar
citizens
of
Albanian
descent
were
purposefully
and
systematically
dismissed
from
all
governmental
jobs,
including
health
and
education
positions.
This
means
they
lost
their
right
to
state
health
care
insurance
and
benefits,
including
prenatal
care,
in
public
hospitals
and
clinics.
9
The
Kosovars
of
Albanian
descent
then
created
a
parallel
health
and
education
system,
in
private
homes
or
private
clinics.
Any
discussion
with
people
now
living
in
Kosovar
must
revolve
around
the
social
political
context
of
separation,
warfare,
massacres,
sexual
violence,
exodus,
refugee
camps,
and
recently,
since
July
of
1999,
returning
to
their
homes
and
villages,
with
hospitals
and
schools
having
been
largely
destroyed
by
the
retreating
Serbian
ethnic
Kosovars.
The
first
question
elicited
much
information
parallel
to
the
answer
sought,
because
of
the
circumstances
of
the
war
and
displacement:
"How
did
you
feel
when
you
first
discovered
you
were
pregnant
with
this
baby?"
"Very
happy,
both
my
husband
and
me."
(Refugee
in
France).
"We
went
to
the
clinic
(in
France)
for
our
physical
examination
and
that's
when
I
found
out
I
was
pregnant.
The
nurse
was
very
nice
to
me,
and
my
husband
was
also
very
happy."
"I
felt
very
confused
and
disoriented
at
first".
(Refugee
camp
in
Macedonia
after
being
at
the
border
for
three
days).
"My
husband
was
very
happy,
but
we
were
also
very
worried."
(Of
the
four
women,
she
is
the
only
one
who
tends
to
manifest
more
physical
complaints
and
discomfort
about
her
pregnancy).
"I
felt
good.
It
felt
interesting
and
strange,
but
good.
My
husband
said
he
was
happy
if
I
was
happy."
(Became
pregnant
in
Pristina,
before
the
war
had
started,
and
did
not
leave
as
a
refugee).
"I
was
very
happy,
this
was
a
planned
pregnancy
because
my
little
boy
is
3
years
old
and
we
wanted
another
baby
now."
(She
and
husband
and
child
were
living
in
Macedonia
at
the
time
and
not
in
a
refugee
camp).
"My
husband
is
also
very
happy."
All
four
women
mentioned
that
they
had
had
sexual
relationships
before
getting
married,
and
none
were
married
because
they
became
pregnant.
All
four
said
that
having
sex
before
marriage
is
"quite
common",
but
that
being
pregnant
outside
of
marriage
as
"very
taboo."
"If
a
girl
gets
pregnant
she
must
get
married.
It
is
a
socially
shameful
thing."
None
had
used
family
planning
methods.
10
There
are
no
sex
education
courses
in
schools,
even
before
the
separation
and
closing
of
educational
systems
to
Albanian
Kosovars,
except
for
a
one-day
class
in
their
high
school
biology
course
(topics
were
menstruation,
masturbation,
HIV/AIDS,
STI's
and
"how
babies
are
made.")
One
learned
from
her
mother
about
"the
time
of
the
month
when
you
could
get
pregnant."
Concerning
Family
Planning
(FP)
issues,
a
free
style
and
lively
conversation
took
place,
with
laughter
about
mistakes
made
and
sharing
of
information.
Some
interesting
insights
may
be
gleaned
from
the
following
quotations:
"We
were
using
condoms
when
we
were
first
married,
but
I
didn't
like
them
because
they
felt
funny.
We
tried
the
withdrawal
method."
(All
laughed
out
loud
at
that
comment).
"Everyone
tries
withdrawal,
but
I
don't
think
the
men
can
do
it,
it's
very
difficult."
(All
agreed
that
most
teenagers
probably
only
know
about
the
withdrawal
method,
and
most
girls
learned
from
their
friends
or
sisters
when
they
were
teenagers
too).
"Most
people
say
that
family
planning
methods
will
cause
cancer."
(I
asked
which
specific
methods).
"They
say
the
pill
causes
breast
cancer."
(All
had
heard
this
rumor).
"I
remember
my
sisters
talking
about
the
pill
causing
sterility.
They
said
the
Serbs
were
giving
family
planning
methods
to
cause
sterility
in
us
Albanians,
so
nobody
wanted
to
use
any
methods."
(All
agreed
to
that
theory
and
had
their
own
personal
anecdotes
around
the
theme
of
"forced
sterility",
including
tubal
ligation,
by
Serb
doctors
toward
ethnic
Albanians).
"You
cannot
get
an
IUD
put
in
if
you
have
never
been
pregnant.
I
don't
like
the
IUD
because
I
don't
like
to
have
to
have
a
vaginal
exam
every
month."
(Each
woman
in
the
group,
and
three
other
non-pregnant
women
in
the
office,
all
knew
of
someone
personally
that
had
become
pregnant
while
the
IUD
was
"in
place")
When
asked
who
makes
the
decision
to
use
methods
or
not,
all
said
the
couple
makes
it
together.
(An
interview
of
6
men
of
reproductive
age
were
also
asked
this
question
and
agreed
that
the
couple
makes
the
decision).
When
I
asked
if
it
was
that
way
in
the
country
too,
they
said
"probably
so
because
there
is
more
education
now."
Before
it
was
only
the
husband
who
decided
how
many
children
to
have
and
how
often,
"like
with
my
parents
or
people
their
age,"
said
one
of
women,
and
they
all
agreed.
11
All
want
to
have
2
or
three
babies
total,
but
none
of
them
were
quite
sure
what
family
planning
method
would
be
the
best
for
them.
All
wanted
more
information
on
this
subject.
The
most
emotional
part
of
the
conversation
for
them
that
afternoon
had
to
do
with
prenatal
care
and
the
lack
of
information,
as
well
as
the
sharing
of
experiences
by
3
women
who
had
already
had
babies.
(Two
other
neighborhood
women
joined
the
group
for
this
discussion,
a
27
year
old
with
one
baby
and
a
26
year
old
with
a
three
year
old
and
a
five
year
old.)
During
prenatal
care
before
the
war,
women
only
went
once
or
twice
"to
see
if
the
baby
was
alright
and
in
the
correct
position."
Even
today,
the
women
don't
like
to
have
a
prenatal
visit,
because
"I
don't
like
having
a
vaginal
exam
each
time"
and
all
agreed.
They
all
talked
about
the
lack
of
any
information,
especially
nutritional
information.
Three
of
the
four
women
said
they
got
most
of
their
information
from
baby
books,
and
all
said
they
talked
with
their
own
mothers
for
information
about
pregnancy,
including
any
questions
or
doubts
they
may
have
concerning
vaginal
discharge.
All
said
that
they
received
prenatal
examinations
from
the
doctor,
never
the
nurses.
Before
the
war
they
could
choose
their
own
doctor
for
prenatal
exams,
and
he
or
she
would
be
the
same
one
to
attend
the
birth.
They
all
liked
that
system
very
much,
and
all
four
of
the
pregnant
woman
now
expressed
concern
that
they
would
have
to
have
a
different
doctor
attend
the
birth
than
the
one
who
did
their
prenatal
care.
None
of
them
liked
the
"rude
treatment"
from
the
nurses
or
the
long
waiting
times
(up
to
6
hours).
To
summarize,
the
prenatal
exams:
are
only
done
once
or
twice
because
of
the
long
waiting
periods
and
the
rude
treatment
by
the
nurses,
plus
the
fact
that
they
receive
a
vaginal
exam
every
time
they
go.
they
receive
very
little,
if
any,
educational
information
about
nutrition,
exercise,
breathing
during
labor,
how
to
prevent
problems
or
how
to
recognize
danger
signs.
The
women
who
had
already
given
birth
explained
labor
as,
one
of
those
awful
experiences
that
you
just
pray
will
be
over
as
soon
as
possible.
12
In
fact,
said
one,
if
they
do
a
cesarean
it's
better
because
you
don't
have
to
suffer
as
much."
In
labor,
women
are
routinely
shaved
of
all
pubic
hair,
given
an
enema,
put
up
onto
a
gynecological
exam
table
with
feet
in
the
stirrups,
have
an
IV
drip
with
Pitocin
inserted,
have
a
vaginal
exam
every
two
to
three
hours
by
her
doctor
and
one
or
more
medical
students,
and
her
vital
signs
are
taken
by
the
doctor
not
the
nurse.
Meanwhile,
the
husband
or
other
support
persons
are
not
allowed
into
the
labor
room,
the
laboring
woman
is
not
allowed
any
liquids
or
food,
not
allowed
to
walk
unless
it
is
to
the
bathroom,
and
she
remains
there
during
the
entire
labor
without
anesthesia
if
there
is
no
medication
or
anesthesiologist.
One
woman
said
it
was
winter
and
she
was
shivering
so
much
from
the
cold
because
there
was
no
heat
in
the
room,
that
her
teeth
were
chattering,
which
attracted
the
attention
of
the
nurse
who
told
her
to
quit
complaining.
For
childbirth
they
are
transferred
to
another
large,
cold,
brightly
lighted
room,
where
they
are
placed
onto
a
different
gynecological
table,
feet
up
in
stirrups,
covered
with
sterile
sheets,
everyone
is
masked
and
gowned,
and
no
husband
or
support
person
at
her
side
("or
that
would
NEVER
be
allowed!"
they
all
emphasized,
but
none
knew
the
reason
for
it).
She
may
or
may
not
have
an
episiotomy
cut,
and
all
three
of
the
pregnant
woman
who
had
previously
given
birth
in
the
hospital
said
they
received
the
Kristellar
procedure
(supraficial
abdominal
forced
pushing
by
another
person
upon
the
woman's
belly
during
the
expulsion
stage).
The
baby
is
taken
away
immediately
and
is
not
seen
again
by
the
mother
for
24
hours.
She
then
delivers
the
placenta
and
the
doctor
"cleans
out
the
uterus
cavity
with
an
instrument
with
a
gauze
on
the
end."
This
was
the
most
painful,
they
all
said.
If
a
cesarean
operation
occurs,
they
are
taken
into
the
operating
room
and
given
general
anesthesia
or
a
spinal,
depending
on
the
anesthesiologist.
They
are
then
taken
to
post-partum
ward,
where
they
are
still
not
allowed
to
eat
or
drink
for
another
24
hours.
They
all
said
the
nurse
does
not
take
vital
signs,
only
the
doctor,
and
if
he
went
home
after
the
delivery,
then
no
one
does
it.
There
is
no
one
to
help
with
breastfeeding,
unless
your
mother
is
allowed
in
to
see
you
the
next
day.
Most
women
prefer
to
bottle
feed
because
the
13
government gave them free supplies, and "no one teaches you how to do it anyway," said one woman. These women were very sober and sad after the amount of information exchanged, and wanted to know how they could access more information. We continued the conversation for some time and they were encouraged to seek out each other for future get-togethers, as well as talk with other pregnant women for more emotional support and information. ___________________________________ Ann Davenport, Pristina, Kosovo, August 1999
14