Showing posts from category maternal health.
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Afghanistan’s First Demographic and Health Survey Reveals Surprises [Part One]
›February 14, 2012 // By Elizabeth Leahy Madsen
Late last year, Afghanistan’s first-ever nationally representative survey of demographic and health issues was published, providing estimates of indicators that had previously been modeled or inferred from smaller samples. It shows that Afghan women have an average of five children each, lower than most experts had anticipated, and that their rate of modern contraceptive use is just slightly lower than that of women in neighboring Pakistan.
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Delivering Solutions: Advancing Dialogue to Improve Maternal Health
›“Throughout the 2009-2011 Advancing Dialogue on Maternal Health lecture series, we always heard the same good news: we know how to save the lives of women and girls. But more political will is needed,” said Calyn Ostrowksi, program associate for the Wilson Center’s Global Health Initiative on December 15 for the launch of the series’ culminating report, Delivering Solutions: Advancing Dialogue To Improve Maternal Health.
Joining Ostrowski were co-author Margaret Greene, director of GreeneWorks; Luc de Bernis, senior advisor on maternal health at the UN Population Fund; Tim Thomas, interim director for the Maternal Health Task Force; and Chaacha Mwita, director of communications at the African Population and Health Research Center.
One of the few forums dedicated to maternal health, the series brought together senior-level policymakers, academic researchers, members of the media, and NGO workers from the United States and abroad. The series consisted of 21 separate events, with hundreds of experts sharing their experiences and thousands of participants and stakeholders providing their expertise. The final report captures, analyzes, and synthesizes the strategies and recommendations that emerged from the series.
Promoting Social Change
Unlike other health issues, said Green during her presentation on the findings of Delivering Solutions, the field of maternal health requires a holistic and multi-faceted approach; that is, an approach that looks not only at health systems, but also at underlying social factors. The report divides maternal health into three broad categories: social, economic, and cultural factors; health systems factors; and research/data demands.
Looking first at the social, cultural, and economic issues, Greene highlighted the need to improve nutrition and educational opportunities for young women in developing countries. Policymakers must be convinced that investing in women is not just good for women but good for families and children, she said. The participation of male partners and other male family members is also needed to increase access to maternal health services, such as family planning, and promote gender equality. The report pointed to a number of recommendations to promote male engagement:- Target interventions that educate men about danger signs and pregnancy complications.
- Address pressures that many young married men feel to prove their fertility.
- Inform men about sexual rights and how they relate to the health and wellbeing of their partners.
Health systems and medical resources play an equally pivotal role in reducing maternal mortality as social factors. The report highlights several key areas for strengthening the health system including the expansion of healthcare workers, health finance schemes, technology, and commodity distribution.
One key recommendation is to integrate reproductive health and maternal health supply chains. Four key medicines, oxytocin misoprostol, magnesium sulfate, and manual vacuum aspirators, target the three leading causes of maternal mortality (post-partum hemorrhage, obstructed labor, and unsafe abortion). Efforts to improve the distribution of these commodities should be more widely dispersed in developing countries and supported by community-based interventions. Women in urban slums, for example, face unique challenges that are not being adequately addressed.
Additionally, new technologies should be more creatively and effectively used, in particular the use of mobile phones in rural communities.
Many of the policy recommendations offered by the report, as Greene pointed out, are low-cost and highly effective. Yet three significant challenges remain for the field in general:- Six countries – Afghanistan, Democratic Republic of Congo, Ethiopia, India, Nigeria, and Pakistan – account for over half of the maternal deaths worldwide. The unique problems of each of these countries must be addressed and solved.
- Integration of maternal health with existing health services along with an over-reliance on community health workers can overburden weak infrastructure.
- Unnecessary cesarean births are on the rise as more women deliver in private sector facilities. These births cost 2 to 18 times as much as vaginal births and create unnecessary risks for mothers.
Chaacha Mwita of the African Population and Health Research Center (APHRC), located in Nairobi has seen firsthand the result of an overburdened and inadequate maternal health system in both his personal and professional life. Mwita endorsed the findings of the series report, emphasizing in particular the focus on transportation systems, male involvement, stakeholder dialogue, and education.
Mwita said that collaboration at all levels is the key to improving maternal health. Policymakers must communicate with researchers, who, in turn, must communicate with doctors, nurses, and hospital administrators in the field. The collaborative in-country dialogue series between the Wilson Center and APHRC, he believes, was a highly useful and easily replicable way of encouraging dialogue among relevant stakeholders in the field.
The Big Picture
”Our hope is that we’ve been able to seed discussions,” said Tim Thomas of the Maternal Health Task Force, one of the co-sponsors of the maternal health series. “We hope those seeds will take root and flourish.” Luc de Bernis, senior maternal health advisor of UNFPA, echoed Thomas’ sentiments, emphasizing the need for continued dialogue.
While maternal health has drawn increased international attention, creating political agreement among policymakers is a complex and often difficult process. There has been marked, though uneven, progress in improving maternal health across the globe, but more must be done. The Delivering Solutions report provides a state of the field assessment as well recommendations for existing, easy-to-implement solutions.
Event Resources: -
Engaging Faith-Based Organizations on Maternal Health
›“Faith-inspired organizations have many different opportunities [than non-faith-based NGOs]. The point that is often reiterated is that religions are sustainable. They will be there before the NGOs get there and will be there long after,” said Katherine Marshall, executive director of the World Faiths Development Dialogue at the Wilson Center on November 16. Marshall noted in her opening remarks that maternal health should be an easy issue for all groups, regardless of religious tradition, to stand behind. Yet, in reality, maternal health is a topic that “very swiftly takes you into complex issues, like reproductive health, abortion, and family planning,” she said.
As part of the Advancing Dialogue on Maternal Health series, the Woodrow Wilson International Center for Scholars’ Global Health Initiative collaborated with the World Faiths Development Dialogue and Christian Connections for International Health to convene a small technical meeting on November 15 with 30 maternal health and religious experts to discuss case studies involving faith-based organizations in Bangladesh, Nigeria, Pakistan, and Yemen. The country case studies served as a springboard for group discussion and offered a number of recommendations for increasing the capacity of faith-based organizations (FBOs) working on maternal health issues.
Engaging Religious Leaders in Pakistan
“When working with religious leaders to improve maternal health there are some do’s and don’ts,” said Nabeela Ali, chief of party with the Pakistan Initiative for Mothers and Newborns (PAIMAN). Ali described a PAIMAN project that worked with 800 ulamas (religious leaders) to increase awareness about pregnancy and promote positive behavior change among men.
One of the “do’s” highlighted by Ali was the need to build arguments for maternal health based on the Quran and to tailor terminology according to the ulamas preferences. The ulamas who worked with PAIMAN did not want to utilize the word “training,” so instead they called their education programming “consultative meetings.” More than 200,000 men and women were reached during the sermons and the strategy was been picked up by the government as one of the best practices written into in the Karachi Declaration, signed by the secretaries of health and population in 2009.
Despite the successes of the program, Ali warned against having unrealistic expectations for religious leaders interfacing with maternal health. She stressed the importance for having a long-term “program” approach to the issue, as opposed to a short-term “project” framework.
Behavior Change in Yemen
“Religion is a main factor in decisions Yemeni people make about most issues in their lives and religious leaders can play a major role in behavior change,” said Jamila AlSharie a community mobilizer for Pathfinder International.
Eighty-two percent of Yemeni women say the husband decides if they should receive family planning and 22 percent say they do not take contraception because they belief it is against their religion and fertility is the will of God, said AlSharie. Therefore, the adoption of healthy behavior change requires the involvement of key opinion leaders and the alignment of messages set in religious values. Trainings with religious leaders included family planning from an Islamic perspective, risks associated with early pregnancy, nutrition, education, and healthcare as a human right.
Male Participation a Key Strategy
“As a faith-based organization we believe it is a God-given right to safe health care and delivery so we mobilize communities to support pregnant women to address their needs, educate families about referrals and existing services in the community,” said Elidon Bardhi, country director for the Bangladesh arm of the Adventist Development and Relief Agency (ADRA).
Through female-run community organizations, ADRA educates men and women about the danger signs of labor and when to seek care. For example, many men in Bangladesh hold the belief that women should eat less during pregnancy to ensure a smaller baby is born, thereby making delivery easier, said Bardhi. ADRA addressed such misconceptions through a human rights-based approach and emphasized male participation as a key strategy, ensuring there were seven male participants for every one female.
A Culturally Nuanced Approach in Nigeria
The Nigerian Urban Reproductive Health Initiative (NURHI) is a public-private partnership that identifies and creates strategies for integrating family planning with maternal health. According to Kabir Abduallahi, team leader of NURHI, “family planning” is not as acceptable a term as “safe birth spacing” in Nigeria, so the project highlighted how family planning can help space births and save lives.
Religion and culture play an important role in the behavior of any community. The introduction of a controversial healthcare intervention (such as family planning) in a religiously conservative community requires careful assessment of the environment and careful planning for its introduction, said Abduallahi. Baseline surveys and formative research data helped NURHI understand the social context and refine intervention strategies.
Ten Ways to Increase the Capacity of FBOs
Faith-based organizations’ close links to communities provide them with an opportunity to promote behavior change and address other cultural factors contributing to maternal mortality rates such as early marriage and family planning.
Working in collaboration with FBOs and other stakeholders is critical to promoting demand for maternal and reproductive health services; however, there is limited knowledge about faith-based maternal healthcare and FBOs are often left off the global health agenda. In conclusion, Marshall noted 10 areas the group identified as areas to focus on:- Move projects to programs: Projects are often donor driven and limited in scope and duration. Donors and policymakers should move from project-oriented activities to local, regional, and national-level advocacy programs to build sustainable change.
- Coordinate, coordinate, coordinate: Significant resources are wasted due to a lack of coordination between FBOs and development agencies. A country-level coordinating mechanism should be developed to streamline efforts not only between agencies but also across faiths.
- Context, context, context: A thorough understanding of the local culture and social norms is imperative to successful program implementation.
- Terminology is important: In Pakistan, religious leaders redefined sensitization meetings around family planning and maternal and child health as “consultative meetings” not “trainings.” In Nigeria, the culture prefers “child birth spacing” over “family planning.” In Yemen, it’s “safe age of marriage” instead of “early childhood marriage.”
- Most religious leaders are open and with adequate information can produce behavior and value changes. Utilizing the Quran, Hadith, and Bible can support arguments and emphasize the issue of health and gender equity.
- Relationship building: Winning the trust of religious leaders can be difficult and time-consuming but is necessary for opening doors to patriarchal societies.
- Rights-based approach: A human rights-based approach can be a very powerful agent of change for addressing negative social structures such as violence against women, but it can also create controversy. In Bangladesh, ADRA utilized the approach to educate men about nutrition, dowry and child marriage, and education of women.
- Networks: There is a significant need to create forums that bring together the various FBO and global development communities in order to share knowledge and enhance advocacy messages. Networks are needed to streamline resources and inventory existing research, projects, and faith-based models that work.
- Monitoring and evaluation systems: There is a striking lack of data about the impact and outcomes of FBOs. Increasing the monitoring and evaluation skills of FBO workers can improve evaluation systems and meet the demand for new data.
- There needs to be greater political will for engaging the faith-inspired community.
Event ResourcesPhoto Credit: David Hawxhurst/Wilson Center. -
Jake Naughton, Pulitzer Center for Crisis Reporting
Pulitzer Center Launches Collaborative Reporting Project on Reproductive Health
›The original version of this article, by Jake Naughton, appeared on the Pulitzer Center for Crisis Reporting blog.
The Pulitzer Center launched its collaborative reproductive health-reporting project at this year’s International Conference on Family Planning (ICFP) in Dakar, Senegal. The project brings together four journalists from Africa and four from the United States who will collaborate to enhance local and international reporting about reproductive health across the continent.
The African journalists are Mae Azango of Liberia, Estelle Ellis of South Africa, Sam Olukoya of Nigeria, and Ken Opala of Kenya. Their U.S. counterparts are Christian Science Monitor correspondent Jina Moore; New Yorker editorial staffer Alexis Okeowo; and the Pulitzer Center’s managing director Nathalie Applewhite and visual media coordinator Jake Naughton.
More than two thousand reproductive health professionals and hundreds of journalists from all over the world participated in the conference, which sought to shine a spotlight on the unmet need for family planning services worldwide, and to focus on integrating family planning into general health services.
Continue reading on the Pulitzer Center for Crisis Reporting blog.
Video Credit: “Meet the Journalists: Dakar,” courtesy of the Pulitzer Center. -
Youth Need More Information on Climate, Population Links
›December 9, 2011 // By Brenda ZuluYouth need more information about climate change, but also on its links to reproductive health and gender, said Esther Agbarakwe, technical advisor for the Africa Youth Initiative on Climate Change. Speaking at the joint Aspen Institute, Population Action International, and Wilson Center side event, “Healthy Women, Healthy Planet,” at the COP-17 climate conference, Agbarakwe pointed out that “there are critical issues, like demography, the number of young people, and young women in this population, that should be discussed.” But, she said, they would likely not be brought up in any official manner at the conference because of fears about “population control.”
In Nigeria, young people, and particularly young girls, are frequently excluded from formal discussions about climate change and sustainable development. Growing up, Agbarakwe said she was aware of environmental change due to pollution in the Niger Delta, but her parents did not talk to her about reproductive health. In her community, many young girls had unplanned pregnancies and boys dropped out of school. It was only through a child rights activists’ club that she learned about how she could protect herself.
“That is why there is need to have young women in this discussion,” she said.
Giving a Voice to the Most Affected
Wendy Mnyandu, a student from Durban’s Zwelibanzi High School attending the side event, noted in an interview that climate changes have affected mothers more because they are dependent on the forest for energy.
“It is important for villagers to adapt to new technologies [such as] cook stoves, where they can use less fuelwood that will not take away the forest,” she said.
At the Wilson Center earlier this year, Agbarakwe explained how insufficient rain has led to longer trips to collect water, increasing women’s vulnerability. A friend of hers was raped while walking to the next village to fetch water after her own community’s well dried up – an ordeal that was not only emotionally and physically traumatizing, but also isolated her from her community and jeopardized her future plans and dreams.
“It is important for more men to talk about this topic,” said Roger-Mark De Souza, vice president of research at Population Action international, who also spoke at the side event. “I am talking on behalf of my mother, my daughters, my wife, and my granddaughters, for their voices are not often heard. I am a father of two young teenage boys and they know how to talk about this. By talking about it, we can see how family planning is very effective,” he said.
Talking About Population to Climate Experts, and Vice Versa
“Just last week I was in Dakar, Senegal, at the International Conference on Family Planning,” said De Souza. “I was talking to specialists and I was getting them interested in climate change.” Similarly, “more and more we find that climate change activists and specialists are appreciating that climate change is important to women and their wellbeing,” he said.
Population Action International (PAI) has mapped agricultural production, water stress, and increased vulnerability to climate change. “We see that there are 26 global hotspots where these issues are critical. What we have also done is look at these hotspots to determine where there is a very high unmet need for family planning,” said De Souza. PAI is using these maps to show the climate change community that a cost-effective investment in family planning could increase resilience in these areas.
De Souza said that in order to build support for programs that address these issues, it is important to look at national adaptation programs of action and their funding needs. “Funding is critical, and these types of interventions produce results – we need to understand where those missed opportunities are and tell that story to our policymakers and our delegations that are here in Durban and to keep with that message when we go back home,” he said.
Empowering Young African Women
Agbarakwe became interested in these issues after meeting former president of Ireland Mary Robinson, who also spoke at the side event. “I had met a Nigerian young man who challenged me that it was difficult for a woman to realize her career dreams because one day she will have to be married and bear children,” said Agbarakwe:When I saw my passion, I was confused and asked questions of Robinson on what she would do if she found herself at the crossroads like me. She told me as a young woman, I will find myself at a crossroad. That is why I am very determined about this issue, and that is what is needed, because when young women are empowered they actually can make decisions.
Robinson, the chair of the Global Leaders Council for Reproductive Health, said in an interview that she was heartened to see the number of youth at the side event. In Durban, she spoke with a group of young women who were part of Oxfam’s Project Empower:We met young women and several of them had come from the Eastern Cape [of South Africa]. They had come to Durban to look for work. Instead they found themselves in rural poverty. They had dreams of a better life for themselves, but their daily reality they talked to us about was nobody’s dream. They talked to us about negative impacts of their communities – the violence against women that is very prevalent, the unplanned pregnancies, and the reality of women who even have to use their bodies to gain money.
African women are looking for contraceptives, such as the female condom, where they can be in control, said Robinson; there are about 215 million women in the world who do not want to get pregnant but are not using modern contraception. “If we were to solve that problem, women [would not only] be better mothers, but also be better leaders in their communities,” she said.
The good thing was that they were ready to talk about the problems and did not consider themselves to be victims. They were strong women. They had learned to say ‘no’ and to say ‘respect me.’ They talked about going into some of the clinics and facing encounters with the police and that the police did not respect them. ‘We do not accept that anymore. We know now that we are members of the community who wish to be respected,’ they explained.
Brenda Zulu is a member of Women’s Edition for Population Reference Bureau and a freelance writer based in Zambia. Her reporting from the COP-17 meeting in Durban (see the “From Durban” series on New Security Beat) is part of a joint effort by the Aspen Institute, Population Action International, and the Wilson Center.
Sources: Population Action International, World Health Organization.
Photo Credit: “Viet Nam and Primary Education,” courtesy of flickr user United Nations Photo; video courtesy of Population Action International. -
Jason Bremner, Behind the Numbers
PHE Champions Bring Their Experiences From the Field to the International Family Planning Conference in Senegal
›December 8, 2011 // By Wilson Center StaffThe original version of this article, by Jason Bremner, appeared on the Population Reference Bureau’s Behind the Numbers blog.
This past week at the 2011 International Conference on Family Planning, four practitioners from the field traveled from remote parts of the Democratic Republic of Congo, Ethiopia, Madagascar, and Tanzania to Dakar, Senegal, to share their successes and challenges in reaching remote communities with an integrated package of health, livelihood, and environment services. Together they made up the panel, “Reaching the Hardly Reached: Delivering Family Planning Through Population, Health, and Environment Integration.”
The panelists came from four environmental organizations whose starting point for working in these remote places was the protection of the biodiversity and natural resources upon which all life depends. Dr. Vik Mohan, physician and medical director for Blue Ventures, talked about how he and his organization transitioned from focusing initially on the conservation of coastal marine reserves and coral reefs to now working to improve health care, including access to family planning.
Blue Ventures, in response to community and women’s needs, opened a family planning clinic, and on the opening day, 20 percent of the women of reproductive age in the community came out to request contraceptives. Today they offer a whole spectrum of short- and long-acting contraceptive methods through partnerships with Marie Stopes International, Population Services International, and various funders. Blue Ventures reported that contraceptive prevalence had risen from 8 percent when they began in 2007 to 35 percent today.
Continue reading on Behind the Numbers.
Photo used with permission courtesy of PRB. Left to right: Didier Mazongo, WWF; Vik Mohan, Blue Ventures; Baraka Kalangahe, Tanzania Coastal Management Partnership; and Jason Bremner, PRB. -
Addressing Gender-Based Violence Across Humanitarian Development in Haiti
›Women and girls living in displacement camps in post-earthquake Haiti are “the most vulnerable of a very vulnerable population,” according to Amanda Klasing, women’s rights researcher at Human Rights Watch. Klasing was joined by Leora Ward, technical advisor for women’s protection and empowerment at International Rescue Committee (IRC), and Emily Jacobi, executive director of Digital Democracy, for a November 15 panel discussion at the Wilson Center on gender-based violence in Haiti. “Unless we address the violence – the actual experience of violence that women and girls continue to experience at very high rates in Haiti – we [aren’t] going to be able to create a general environment for women and girls to participate in the rebuilding of their country,” Ward said.
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Emily Puckart, MHTF blog
Maternal Health in Kenya: New Research Unnecessary, Time to Address Existing Gaps
›The original version of this article, by Emily Puckart, appeared on the Maternal Health Task Force blog.
During the recent Wilson Center/African Population and Health Research Center meeting in Nairobi on improving health systems through a maternal health framework, participants focused on knowledge gaps in the Kenyan health system that can negatively affect maternal healthcare. This focus on gaps sparked discussion around research needed (or not needed) in the maternal health field, supply gaps, and gaps between addressing technical, medical issues of maternal health (like preeclampsia or postpartum hemorrhage), and larger society-wide gaps like gender equity. The gaps highlighted by participants at the Nairobi dialogue included:- Gaps in knowledge: During the dialogue, members of the Kenyan maternal health community discussed the possibility of strengthening community health workers as an information delivery platform. Participants wondered about the possibility of using community health workers to distribute information both downward to the end user (patients), and then again to gather information from end users and distribute it upwards through the system to reflect the opinions of the direct users of the healthcare system.
- Supply gaps: Participants argued that while there is a large body of information in terms of maternal health supplies at the national level in Kenya, there is not as much data on supplies at the actual health facility level, where it is much needed and would be very helpful to successfully treat patients.
- Gaps in healthcare delivery: There is a strong need to address inequality in the distribution of health services as there are unequal services in rural and urban areas. Within those broad areas there may be further inequalities, as even in urban areas, slum areas or neighborhoods on the edges of cities may have less access to quality healthcare than populations that live in wealthier areas of the city or closer to the city center. Further there are broader questions of gender and access to care. Where women are not able to control household finances, they may be unable to access and pay for lifesaving care. Participants framed the question in a rights framework, “Do we value the lives of women less than men?”
- Health workforce gaps: There is a mismatch between the supply of health workers and the absorption of those trained health workers in Kenya. Many of them are not incentivized professionally or financially to stay in the system where they are trained. These health workers may leave for other countries or prefer to stay in urban areas depriving rural areas of a surplus of trained health workers.
- Gaps between words and actions: Several of the small working groups pointed to accountability as a serious issue, as there are gaps between the words of politicians on health issues and actual actions. The gap between the government promised funding for health and the actual lower amount of spending was consistently highlighted during the Nairobi dialogue as a serious gap in holding governments accountable for their promises.
The lively conversation provoked by a broad discussion of gaps in the Kenyan health system provided fertile ground to develop action points on maternal healthcare that participants then presented on the second day of the meeting to several Kenyan members of parliament. Ideally, this will be the first discussion of many as maternal health advocates, field workers, and researchers coalesce around ways to address the gaps in maternal healthcare in Nairobi and elsewhere.
Emily Puckart is a senior program assistant at the Maternal Health Task Force (MHTF).
Photo Credit: Jonathan Odhong, African Population and Health Research Center.
