“We do not need new legislation… we need affordable, effective, and scalable solutions,” said Shn Gulamnabi Azad, Minister of Health, India, at the opening ceremony of the first-ever Global Maternal Health Conference in New Delhi. Co-hosted by the Maternal Health Task Force and the Public Health Institute of India, this three-day technical meeting builds upon the momentum of Women Deliver and the G8 summit by bringing together 700 researchers, program managers, advocates, media, and young people to exchange ideas, share data, develop strategies, and identify solutions for reducing maternal mortality.

In order to reduce India’s maternal mortality rates, Azad called for the repositioning of family planning programs to include maternal and child health and not limit the scope of services to population control as historically executed. Improving family planning and maternal health services must also address the reproductive health needs of adolescent girls, and India is currently developing a new ministry that will target gender inequality, poverty, early child marriages, as well as other critical health issues important to young girls such as the dissemination of sanitary napkins.

“Although the legal age of marriage is 18, there are districts in India where 35 percent of the population is married between the ages of 15-18,” said Azad. During the side event “Adolescent Girls: Change Agents for Healthy Mother and Child,” technical experts such as Anil Paranjap of the Indian Institute of Health Management presented evidence that girls who marry between 15-18 are five times more likely to die during childbirth than women in their early 20’s.

“We still have deep-rooted subordination that makes it very difficult for young women to realize their sexual and reproductive health rights,” said Sanam Anwar with the Oman Medical College. Interventions such as the UDAAN project – a private-public partnership between the Center for Development and Population Activities (CEDPA) and the Government of India – demonstrate promising solutions for empowering young people through the use of existing infrastructure. In collaboration with teachers, parents, principals, and students, this project successfully increased leadership skills and improved youth knowledge on menstruation, health, friendship, peer pressure, early marriage, and reproductive health, said Sudipta Mukhopadhyay of CEDPA.

Empowering “young people” to improve maternal health also requires that the community support committed new thinkers and future leaders. The Young Champions of Maternal Health Program is a unique and refreshing group of young professionals from 13 countries dedicated to improving maternal health, and I look forward to learning how this new energy will further the maternal health agenda.

Originally posted at Maternal Health Task Force, by Calyn Ostrowski of the Woodrow Wilson International Center for Scholars, Coordinator of the Maternal Health Dialogue Series in partnership with the Maternal Health Task Force and UNFPA.

Photo Credit: “Indian Girl” courtesy of flickr user Jarek Jarosz.

The 2010 Global Maternal Health Conference kicked off today, perhaps fittingly, in India – one of the world’s fastest growing nations but one that also faces serious reproductive health challenges. The Wilson Center’s Calyn Ostrowski is in New Delhi for the conference and will be providing updates to The New Security Beat throughout the week.

Those interested can also find a schedule of events and list of participants on the conference website as well as live webcasted events on the main page. Stay tuned!

Photo Credit: “Mumbai, India, November 2009” courtesy of flickr user travelmeasia.

“Investing in women and girls is the right thing to do,” says Mayra Buvinic, sector director of the World Bank’s gender and development group. “It is not only fair for gender equality, but it is smart economics.” But while it may be smart economics, many developing countries fail to address the underlying social causes that impact economic growth, such as poverty and gender inequality. Buvinic was joined by Dr. Nomonde Xundu, health attaché at the Embassy of South Africa in Washington, D.C., and Mary Ellen Stanton, senior maternal health advisor at the U.S. Agency for International Development (USAID), at the sixth meeting of the Advancing Policy Dialogue on Maternal Health Series, which addressed the economic impact of maternal mortality and provided evidence for the need for increased investment in maternal health.

One of the hottest topics at the “Women Deliver” conference earlier this month—where panels ran the gamut from HIV prevention and family planning to gender-based violence and maternal health—was the intersection of women’s reproductive health, global population growth, and climate change.

As panelists at three of the conference’s climate-focused events noted, women in poor, rural areas are especially vulnerable to the impacts of climate change. In many developing countries across Africa, Asia, and Latin America, women take on much of the burden of farming, gathering fuel, and supplying fresh water for their communities. As a result, they bear the brunt of hardships when climate change alters seasonal precipitation patterns, or increases scarcity of key natural resources.

In addition, “the more assets, the less vulnerable one person is,” said Lorena Aguilar of the International Union for Conservation of Nature. “Worldwide, compared to men, women tend to have more limited access to resources that would enhance their capacity to adapt to climate change—including land, credit, agricultural inputs, decision-making bodies, technology, and training services.”

Women’s hardship in the face of climate change can also have a negative effect on reproductive health. Aguilar remarked that during the dry season in parts of rural India and Africa, 30 percent or more of women’s daily caloric intake is spent on fetching water alone. The enormous physical strain placed on women’s bodies because of those tasks has resulted in higher miscarriage rates among those populations, she noted.

Educating Girls to Protect the Environment

Organizations like the United Nations and the Global Gender and Climate Alliance have been working in recent years to bridge the gap between women’s rights and climate change, and reframe climate change in terms of human development. But to date, women’s struggles with climate change have not translated into meaningful economic, educational, or healthcare support at the local government level, with women’s welfare “at the very bottom of the priority list” for most developing countries, according to Nickie Imanguli with Advocates for Youth.

The unmet need for family planning tools and services is perhaps the movement’s principal challenge going forward. With an estimated 200 million women having an unmet need for family planning, unintended pregnancies could be exacerbating environmental problems such as depletion of forests, water, and other finite resources. But most panelists expressed optimism that the growing recognition of a connection between climate change and women’s reproductive health might lead to a boost in funding for family planning initiatives in underserved areas of the world.

Speakers at Women Deliver emphasized that reproductive health can be bolstered by improving educational opportunities for girls in poor rural areas. Joy Nayiga with Uganda’s Ministry of Finance Planning Economic Development noted that “girls are more likely than boys to drop out of school to help their mothers gather fuel, wood, and water.” This trend, she said, robs females of an opportunity for educational advancement, and heightens the likelihood they will end up starting families of their own while very young.

Nayiga and other panelists asserted that empowering females through education leads them to take greater control over their own sexual health, making it easier for them to start their families later in life, or perhaps have a smaller number of children.

Encouraging women to take a more active role in family planning in this regard serves as “a win-win situation for women, their communities, and the nations of the world,” by “bending down the overall trajectory of population growth,” asserted the Worldwatch Institute’s Robert Engelman.

Some speakers also argued that enabling women to delay motherhood if they want could yield direct environmental benefits for nations of the Global South that are struggling to adapt to climate change. Since women are often responsible for overseeing agriculture and forest resource management practices in their communities, they help create localized carbon sinks across the developing world.

“Women pull carbon out of the atmosphere and bury it, in farm soils, in trees that they grow,” noted the Worldwatch Institute’s Engelman, who even suggested women’s aggregate impact removing carbon could be more effective than cap-and-trade plans.

Moving Slowly From Talk to Action

Given both their vulnerability to the effects of climate change—and their potential to help offset those same impacts—“women are critical stakeholders in climate change moving forward,” said Population Action International’s Kathleen Mogelgaard. So far, however, while there may be growing discussion about giving women a more prominent seat at the table when developing climate change adaptation and mitigation plans, that has not yet happened.

“We’re not seeing big government investment in empowering women on the issue of climate change,” remarked Leo Bryant, with Marie Stopes International, a U.K.-based NGO specializing in sexual and reproductive health. Instead, Bryant said, it has been NGOs that have been doing much of the heavy lifting of bringing women into the conversation.

But many panelists felt that, in time, governments will recognize it is in their enlightened self-interest to link issues of gender rights and climate change. “By upholding women’s rights,” concluded the IUCN’s Lorena Aguilar, “we are in fact making one of the most crucial preparations associated to climate change that any society can make.”

Click here for additional New Security Beat coverage of reproductive health talks at the Women Deliver conference, or here for more coverage of the interplay between traditional gender roles and family planning.

Sources: International Institute for Sustainable Development, International Union for the Conservation of Nature, Marie Stopes International, Population Action International, Population Reference Bureau, The Times (U.K.), United Nations Development Programme, Women Deliver, Worldwatch Institute.

Photo Credit: “Climate Change Canvas” courtesy of Amnesty International.

The landmark Women Deliver conference, which concluded last week, reinvigorated the global health community’s commitment to improve reproductive health at both the grassroots and global levels. Providing a major boost was the Gates Foundation’s announcement that it will commit an additional $1.5 billion over the next five years to support maternal and child health, family planning, and nutrition programs in developing countries.

“We haven’t tried hard enough,” said Gates Foundation co-founder Melinda Gates. “Most maternal and newborn deaths can be prevented with existing, low-cost solutions.” Examples of these efficient and effective solutions were presented at the three-day conference’s dozens of panels on a wide range of issues, including climate change, contraceptive commodities, fistula, gender inequities, adolescent family planning, communications and technology, and much more.

Delivering Solutions for Girls and Women

“We know how to intervene; there does not need to be a magical solution,” said Søren Pind, Denmark’s minister for development cooperation, at the June 7 opening ceremony of Women Deliver 2010.

In its second year, the conference has gathered delegates from 146 countries representing hundreds of non-governmental organizations (NGOs), governments, and civil society organizations under the theme “Delivering Solutions for Girls and Women.” Delegates are working to share projects, policies, successes, and innovations in the field of maternal health and to develop strategies to meet Millennium Development Goal 5.

“Recent trends show great progress and this is very encouraging,” said Gamal Serour, president of the International Federation of Gynecology and Obstetrics (FIGO), speaking of a recent study by the Institute of Health Metrics and Evaluation (IHME). The study found that annual maternal mortality has dropped 34 percent–from 526,000 to 342,900–between 1980 and 2008. Nevertheless, Serour maintained that “we are far away from our goal for 2015.”

Overcoming Tradition and Religious Barriers

Investing in women’s health is not only the right thing to do, it is also economically advantageous. When women are healthy, they provide tremendous benefits to their families, communities, and countries. Women contribute to a majority of the small businesses and agricultural activities of developing countries and their unpaid work at home accounts for almost 33 percent of the world’s GDP. Unfortunately, over 215 million of these women do not have access to family planning services, resulting in unwanted pregnancies, childbirth, and maternal deaths.

There are many barriers to family planning in developing countries, not the least of which are cultural and social traditions that can uphold negative gender-based norms. Tailoring campaigns to address these gender inequities was the subject of discussion at the “Cultural Agents of Change Delivering for Women” session, where panelists acknowledged that collaboration and partnership with a wide-range of actors–from members of the local legislature to civil society organizations and actors in the health sector–are necessary to facilitate change.

Graciela Enciso of the Centro de Investigaciones y Estudios Superiores en Antropología Social-Sureste in Mexico, added that advocacy campaigns to increase support for family planning should be “linked with research.” In many traditional societies, strict interpretations of religion are used to control and disempower women; donors and NGOs “need to think outside the religious box at every point,” said Mary E. Hunt, co-director at the Women’s Alliance for Theology, Ethics, and Ritual.

Male Contraception, Gender Roles, and Family Planning

“I think it is important not to hide behind our cultures and religion,” said Ngozi Okonjo-Iweala, managing director of the World Bank. “We need to work with men and work together to overcome gender inequality.” “Male participation” has been a key theme echoed throughout Women Deliver and is often highlighted as a strategy for reducing maternal mortality.

At the “Men Deliver: Men’s Role in Family Planning” breakout session, experts addressed how new and existing technologies in male contraception and shifting gender roles can help to scale up family planning interventions. “Reducing unwanted pregnancies can also be carried out through male contraception,” said John Townsend, vice president of the reproductive health program at the Population Council.

Condoms are traditionally the main method of contraception for men, but usage rates quickly fall over time and to wear a condom “becomes the women’s responsibility,” said Townsend. To address issues around condom usage, development of alternative family planning technologies, such as gels and implants, is underway. As these technologies are being developed, however, it is important for program managers and donors to consider existing gender norms and the willingness of men to utilize new methods.

In researching gender roles in family planning in Zambia, Holo Hochanda, the chief technical administrator of the Planned Parenthood Association of Zambia, determined that there are many entry points for male intervention and increased family planning. “Men are clients, policymakers, and service providers. Each of these roles provides an opportunity to discuss utilization of male contraception and gender inequities in family planning,” he said. “Men can be key mobilizers and agents for change.”

For more coverage on Women Deliver 2010 click here and to learn more about the Wilson Center’s Maternal Health Dialogue Series visit the Global Health Initiative’s website here.

“Referral has been called an orphan cause,” said Patricia Bailey, public health specialist for Family Health International and Columbia University, because it is “everybody’s responsibility and therefore nobody’s responsibility.”

As part of the Maternal Health Dialogue Series the Woodrow Wilson International Center for Scholars’ Global Health Initiative convened a small technical meeting on May 19, 2010, with 25 experts from five countries to discuss their experiences and share lessons, challenges, and recommendations for improving transportation and referral for maternal health. Following the technical meeting, a public dialogue was held on May 20, 2010, to share the knowledge gaps and recommendations identified. The formal report from the technical meeting will be available in the near future.

“Displaced people are like every other human being, they want, they need the advantage of family planning. They are asking only for services to be available for them, affordable for them, and acceptable for them,” said Dr. Grace Kodindo in a recent interview with ECSP about the challenges of family planning in conflict regions. The OB/GYN from Chad calls for family planning services to be included in the provisions made for displaced and refugee communities.

Kodindo identified five key barriers to family planning for displaced people, including a lack of coherent policies for displaced people in host countries and a lack of awareness and attention by donors to family planning. Other barriers include the lack of access in remote areas, and a lack of knowledge and therefore demand.

However, in many cases family planning services are very much in demand. One refugee mother compared herself to a “hen being followed by many chicks,” said Kodindo, who “ask[s] the government and the donors to give and to make policy that can really facilitate the provision of services and to provide funding so that services can be available to all these people.”

Kodindo, who recently spoke at a Wilson Center panel on “Family Planning in Fragile States,” is also speaking in DC on Thursday, June 3 at a showing of the documentary about her work in the Democratic Republic of the Congo, Grace Under Fire.