Showing posts from category Ethiopia.
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PHE Is One Great Idea That Won’t Be On the Rio Agenda, Says Roger-Mark De Souza
›October 17, 2011 // By Sean Peoples“I am now serving as an example to other women in the community because I am not having any more children. I have received training in sustainable agricultural practices, I’m generating income, and I’m educating others,” said Berhane Ferkade, an Ethiopian farmer, to Population Action International’s Roger-Mark De Souza earlier this year. The 39-year-old mother of 11 become one of the community’s model farmers after working with LEM Ethiopia – a local population, health, and environment (PHE) development organization.
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Lisa Hymas on Envisioning a Different Future With Family Planning in Ethiopia
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ECSP caught up with Lisa Hymas, senior editor at Grist, last week during the first South by Southwest (SXSW) Eco conference and she spoke about her recent visit to Ethiopia to see the country’s community health extension program in action. “Ethiopia has a big challenge around population,” Hymas said, “but the government is committed to bringing that down.”
The government extension program places health-workers – young women, for the most part, who have received basic training – directly into each community, where they are able to give out immunizations, provide advice on nutrition, teach families how to properly hang bed nets to prevent mosquito-borne illnesses, and provide family planning services and advice.
Thanks to the program, these health workers and those in the communities they service can “envision very different lives for themselves than their mothers had,” Hymas explained. For instance, one woman recounted that her mother gave birth to 10 children, “and almost died giving birth to the last one, because there was no access to birth control, and there was no good access to health care.” In contrast, she is now able to have a career and to use family planning to delay and space her own childbearing.
For more on Ethiopia’s health extension program, see Schuyler Null’s report on visiting a village health clinic near the town of Fiche last spring. -
Strengthening the Voices of Women Champions for Family Planning and Reproductive Health
›“The health, security, and well-being of families depend importantly on the health of women,” said Carol Peasley, president and CEO of the Centre for Development and Population Activities (CEDPA). “When women have the ability to voluntarily space and limit the number of children they have, maternal and newborn child deaths decrease, as do abortions and abortion-related injuries,” she continued.
Peasley was joined by three panelists on September 28 at the Wilson Center: Dr. Nafis Sadik, special advisor to the UN Secretary General; Tigist Kassa Milko, health communications program coordinator for Panos Ethiopia; and Rosemary Ardayfio, a reporter for the Ghanaian paper, The Daily Graphic.
Ardayfio and Milko both recently participated in a CEDPA-led workshop, which is designed to create effective women champions for family planning and reproductive health.
“The voices of women champions may in fact be the best way to influence policymakers and just average citizens around the world,” said Peasley.
Women’s Rights Essential for Development of All
According to Sadik, women have gained some autonomy over their reproductive health:- Maternal mortality around the world is down by 40 percent compared to 1990 levels;
- Family planning reaches over 65 percent of women who need and want it;
- Many developing countries will achieve parity in girls’ and boys’ education by 2015; and
- Women are increasingly prominent in national and international leadership.
- Women’s literacy rates are still much lower than men’s;
- Pregnancy and childbirth still pose major health risks for women;
- Maternal mortality is the single biggest differential between developed and developing countries;
- We are far from reaching the Millennium Development Goal of reducing maternal mortality by 75 percent; and
- The current unmet demand for family planning (215 million women) is projected to rise by 40 percent by 2050 as the reproductive age population grows.
Local Champions for Local Needs
Although Tigist Kassa Milko and Rosemary Ardayfio come from two African countries hundreds of miles apart, their struggles are eerily similar.
In Ethiopia, the more than 1.5 million women who live in pastoral or nomadic areas shoulder many responsibilities, including walking long distances to fetch food and water for their families. The well-being of these women and their families is further strained by the challenges of climate change and limited health service provision.
To help overcome these obstacles, a number of micro-credit associations now offer female pastoralists alternative livelihood options. Panos Ethiopia also provides “reproductive health, family planning, gender-based violence forums” and “trainings on life skills and saving” to those who come for loans, said Milko.
But “when it’s a choice between walking to get water and walking to get contraceptives, water will win,” said Milko, so it is essential to focus on integrating ways to improve livelihoods, health, and ecosystems – also known as population, health, and environment (PHE) programs.
In Ghana, women also grapple with competing issues of development, poverty, healthcare, and cultural barriers. According to Ardayfio, 35 out of every 100 Ghanaian women want to space or limit births but are not using modern family planning methods. As a journalist, she acknowledged that there are many myths about reproductive health that need to be dispelled. The newspaper she writes for, The Daily Graphic, publishes three articles on women’s health each week.
“The stories of women dying from pregnancy-related causes should continue to be told in a compelling manner until our government makes good on the many international commitments it has signed to,” said Ardayfio. “Our decision-makers should be told again and again that it’s time to scale up family planning.”
Event Resources:
Sources: CEDPA, Guttmacher Institute, Population Reference Bureau, UNESCO, UNICEF, USAID.
Photo Credit: Dave Hawxhurst/Wilson Center. -
Weathering Change: New Film Links Climate Adaptation and Family Planning
›“Our planet is changing. Our population is growing. Each one of us is impacting the environment…but not equally. Each one of us will be affected…but not equally,” asserts the new documentary, Weathering Change, launched at the Wilson Center on September 22. The film, produced by Population Action International (PAI), explores the devastating impacts of climate change on the lives of women in developing countries through personal stories from Ethiopia, Nepal, and Peru. Family planning, argue the filmmakers, is part of the solution.
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Carl Haub, Behind the Numbers
Ethiopia’s 2011 Demographic and Health Survey: Remarkable Fertility Decline, Continued Rural Health Challenges
›September 28, 2011 // By Wilson Center StaffThe original version of this article, by Carl Haub, appeared on the Population Reference Bureau’s Behind the Numbers blog.
Continuing my recent practice of posting a quick summary of results from new demographic surveys in developing countries, here is another new Demographic and Health Survey (DHS) preliminary report, this time from a sub-Saharan African country. This will help readers of this blog to stay right up-to-date with the latest developments.
The Ethiopia 2011 DHS interviewed 16,515 women ages 15 to 49 and 14,110 men ages 15 to 59 from September 2010 to June 2011. The total fertility rate (TFR – the average number of children would bear in her lifetime if the birth rate of a particular year were to remain constant) obtained in the survey was 4.8 for the three-year period preceding the survey. For urban women, the TFR was 2.6 and for rural women, who were a little over 75 percent of the sample, 5.5. There appears to have been an acceleration of TFR decline from the 2005 to the 2011 survey compared with the 2000 DHS, which had a three-year TFR of 5.5. In 1990, a government survey had shown the TFR as 6.4. The desire to continue or cease childbearing provides one insight into possible future fertility trends. Of the women with five living children, 55.8 percent said that they did not wish to have any more children; among women with six or more living children, 68.6 percent said that they also wished to ceased childbearing.
Continue reading on Behind the Numbers.
Image Credit: Population Reference Bureau; data courtesy of Ethiopian Central Statistics Agency (CSA) and ICF Macro, Ethiopia Demographic and Health Survey (EDHS) 2011, Preliminary Report. -
The Role of Faith-Based Organizations in Maternal and Newborn Health Care
›Government and nongovernmental organizations have consistently played a key role in addressing maternal mortality. While these initiatives are well documented, the role of faith-based organizations (FBOs) in maternal and newborn health is less well understood.
In November, the Wilson Center’s Advancing Policy Dialogue to Improve Maternal Health series will bring diverse institutions together such as the Pakistan Initiative for Mothers and Newborns (PAIMAN) and Pathfinder International to discuss country experiences and evaluate opportunities for overcoming challenges.
According to the World Health Organization, FBOs own up to 70 percent of the health infrastructure in sub-Saharan African countries and often work in remote regions where government and NGO services are limited. FBO’s are critical to improving maternal health as they fill gaps in the health system – particularly in low-resource settings – and approaching culturally sensitive barriers that often prevent mothers from seeking health care.
The level of trust communities place on their religious leaders explains one of the main reasons why FBOs are attaining success. A study conducted by Pew Charitable Trust found that a vast majority of people in sub-Saharan Africa identify themselves as adherents of Christianity or Islam, and approximately 75 percent trust their religious leaders.
As partnerships with FBO’s increase, it is imperative that organizations share their lessons learned and identify capacity and knowledge gaps in order to improve effectiveness.
Pakistan Initiative for Mothers and Newborns
The Pakistan Initiative for Mothers and Newborns (PAIMAN), which started out as a six-year project funded by USAID and led by JSI Research and Training Institute, is a strong example of a program incorporating faith to improve maternal mortality rates. The project aims to ensure that women have access to skilled birth attendants during and immediately after giving birth. Additionally, the project focused on increasing the quality of care both in the public and health sectors. PAIMAN was able to achieve substantial success by utilizing various communication interventions such as mass media, community media, and advocacy efforts. One of the most successful initiatives PAIMAN organized was reaching out to 1,000 religious scholars, known as ulamas, to deliver frequent messages on maternal and newborn health care. Since its initiation, this project has “saved more than 30,000 newborn lives resulting in a 23 percent decrease in neonatal mortality,” according to their numbers.
Pathfinder International
Pathfinder International is another great example of an organization that has understood the value of FBOs and worked in collaboration with them to achieve results for maternal health. Pathfinder has worked in numerous countries including Nigeria, Ghana, Ethiopia, Egypt, Uganda, Kenya, and Bangladesh to educate religious leaders and communities on communication strategies for improving maternal health behaviors.
In Ethiopia, Pathfinder organized over 250 religious leaders representing the Orthodox Christian, Catholic, Protestant, Seventh Day Adventist, Mekaneyesus Christian, and Muslim faiths to educate them about maternal mortality. At the conclusion of the seminar, the religious leaders agreed to condemn a host of harmful traditional practices, including female genital cutting, marriage by abduction, early marriage, rape, and unsafe abortion and agreed that they are not required by the Bible or Korean. Religious leaders in Egypt also came to similar conclusions after participating in these types of seminars.
“By helping religious leaders see the links between reproductive health and families’ well-being, Pathfinder enables them to become committed advocates for positive reform,” wrote Mary K. Burke, technical communications associate at Pathfinder International in the 2006 report, Advancing Reproductive Health and Family Planning through Religious Leaders.
Challenges: Equipping and Encouraging
Despite the prevalence of success stories among FBOs to improve maternal mortality, challenges do exist. For instance, although religious leaders are highly respected by their communities, their teachings become useless, as pointed out by a USAID-sponsored Extending Service Delivery Project report, unless they are also properly trained and equipped with the latest service delivery systems and scientific information.
The report also describes the importance of cooperation and support from the government and decision-making representatives. If the private, public, and government sectors are fragmented and no formal recognition exists to acknowledge the work of religious leaders for improving maternal mortality, then success may be significantly hampered.
To learn more about the role of faith-based organizations in women’s health, be sure to check out the Global Health Initiative event on FBOs coming in November, with representatives from PAIMAN, Pathfinder International, and others.
Sources: Extending Service Delivery Project, JSI Research and Training Institute, Pathfinder International, Pew Charitable Trust, USAID, World Health Organization.
Photo Credit: “Woolly hats needed,” courtesy of flickr user Church Mission Society (CMS). -
Fistula, Stigmatization, and Development
›Although obstetric fistula may not be as widely recognized as other maternal health issues, the Fistula Foundation estimates that over two million women and girls in developing countries suffer from this condition today. The World Health Organization has labeled it as “the single most dramatic aftermath of neglected childbirth.”
Obstetric fistula is a devastating condition often resulting from obstructed labor that can cause infections, incontinence, and even paralysis. The condition largely afflicts poor, rural, and illiterate women in developing countries who lack resources and access to emergency care and surgery, and sufferers often face an additional burden of social stigma.
Economic Development and Social Standing
Poor infrastructure and poverty significantly increases the occurrence rate of obstetric fistula. Lewis Wall, in an article for The Lancet, writes that “poverty is the breeding-ground where obstetric fistulas thrive.” Wall cites early marriage, low social status of women, malnutrition, inadequately developed social and economic infrastructures, and lack of access to emergency obstetric services as being major contributors of fistulas in developing countries.
Additionally, “postponing the age of marriage and delaying childbirth can significantly reduce the risk of subjecting young women to the arduous labor that induces fistulas,” wrote Sonny Inbaraj of Inter Press Service News Agency (IPS) in an article about how fistula makes social outcasts of child brides.
In most developing societies where child marriage is common, the social standing of women is defined largely in terms of marriage and childbearing. Child marriages are typically arranged without the knowledge or consent of the girls involved. The norms emphasize a girl’s domestic roles and de-emphasize investments such as education.
Stigmatization of Fistula
There is an undeniable link between fistula and social stigmatization. Rather than receiving assistance from their families and communities, women are often ostracized and in many instances exiled from their communities. This is especially true in developing countries where “the role of women is merely limited to providing sexual satisfaction for their husbands, [and] producing children,” said Dr. Catherine Hamlin, founder of the Addis Ababa Fistula Hospital, in an interview with IPS.
“Many women and girls with fistula endure lives of shame, misery, violence, and poverty,” said Agnes Odhiambo, Africa women’s rights researcher and author of ‘I Am Not Dead, But I Am Not Living‘: Barriers to Fistula Prevention and Treatment in Kenya, in a Human Rights Watch article. Human Rights Watch has focused on fistula, recognizing that birth is a human rights issue. Ignoring the issues of women and girls only diminishes progress on human rights and sends a message that says the rights of women do not deserve adequate attention.
Prevention Efforts
Thus far the fight to end fistula has attracted various government agencies and organizations including USAID, UNFPA, EngenderHealth, Maternal Health Task Force, and the Human Rights Watch. Outstanding individuals have also played a key role in fistula prevention efforts, like Drs. Reginald and Catherine Hamlin, Australian gynecologists who came to Addis Ababa in 1959 for temporary medical work, but after hearing heart-breaking stories from fistula patients, they decided to move to Ethiopia permanently and open the Addis Ababa Fistula Hospital. As the only hospital dedicated exclusively to women with obstetric fistula, the hospital provides care free of change, and has done so since 1974.
Although fistula has gotten some support and attention, the need to scale-up the prevention initiatives has never been greater. As a result of the “poverty and the stigma associated with their condition, most women living with fistulas remain invisible to policy makers both in their own countries and abroad,” wrote Inbaraj on IPS.
“Preventing fistula and restoring women’s health and dignity requires more than good policies on paper,” said Odhiambo at Human Rights Watch. Seriously tackling the issue will require much more than traditional medical and public health interventions – prevention efforts must also take into account underlying social issues, food and economic security.
Sources: The Addis Ababa Fistula Hospital, Campaign to End Fistula, The Center for Global Development, The Fistula Foundation, Human Rights Watch, The Lancet, World Health Organization.
Photo Credit: “Hauwa’u, 25, mother from Rogogo community,” courtesy of flicker user DFID-UK Department for International Development. -
Watch: Alecia Fields on Population, Health, and Environment Advocacy with the Sierra Club
›July 29, 2011 // By Roza Essaw“The issues of population, health, and environment are pretty foreign to a lot of people,” said Alecia Fields, a recent University of Kentucky graduate who participated in a Sierra Club Global Population and Environment Study Tour of Ethiopia last summer as a student fellow.
“I learned about the program, how to be an effective advocate, and I took those tools back to my university on campus and shared it with young people,” said Fields in this interview with ECSP.
Fields came from a women’s health background but found the connections between population, health, and environment (PHE) compelling enough that she wanted to become an advocate on campus. “At first, people don’t think they have a connection to the issue, but once you start talking with people, they really start to see how they are central to a larger issue,” said Fields.
“It is challenging in the United States to see some of the population and environmental issues…but when you go to a developing country, you see the effects right in front of you,” explained Fields. The Sierra Club’s Global Population and Environment Study Tours bring a select group of student advocates abroad to see PHE projects in the field with the aim of creating pro-active messengers of the importance of integrated development in the United States.
Fields visited various sites and organizations in Ethiopia including the Gauraghe People’s Self-help Development Organization (GPSDO), located in the southwest region. “People in Ethiopia have had tremendous success in connecting population, health, and environment within communities and starting integrated programs that work towards development,” said Fields.
Going to Ethiopia provided Fields with concrete examples of the importance of PHE and allowed her to share her experience with young people through meaningful illustrations and moving stories.
“A lot of it deals with figuring out where people are in their attachment to the subject…and try to figure out how that program can connect to them,” she said.
