Showing posts from category maternal health.
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Watch: Amy Webb Girard on Integrated Development Strategies for Improved Women’s Nutrition
›“When women become pregnant…their nutrient needs shoot through the roof,” said Amy Webb Girard of Emory University’s School of Public Health in this interview with ECSP and the Global Health Initiative. Girard explains that under-nutrition is a major problem for women – especially pregnant women – in resource-poor settings.
“For example, iron requirements almost double during the course of pregnancy, but iron is one of those nutrients that are really difficult to get,” Girard explained. Meat is not readily available in many developing countries and the iron in non-meat foods is not absorbed as completely. As a result, “women by and large are unable to meet those nutrient needs,” she said.
Fortunately, there is “an arsenal of nutritional interventions available,” noted Girard, including micro-nutrient supplements, behavior change strategies, and integrated facility- and community-based delivery methods.
“Additionally I think it’s very important that we also look at food production. This is a key, key thing,” said Girard. “Women who are able to produce their own foods [and] households that can produce their own foods have greater food security.”
“A lot of these agricultural strategies serve double purposes,” Girard said. “They not only increase the available food and the quality of that food, they improve women’s livelihoods, they give them a source of income, they give them – as some studies have shown – greater ability to negotiate within their own households for how money should be spent [and] whether they should access care or not. So they actually empower women in ways beyond nutrition.” -
Evidence, Links, and Solutions
Maternal Undernutrition
›“Maternal undernutrition is often overlooked as a strategy for reducing poverty and as a key intervention to reduce maternal mortality and morbidity,” said Mary Ellen Stanton, senior maternal health advisor at the U.S. Agency for International Development. Stanton was joined by Dr. Doyin Oluwole, director of the Africa’s Health in 2010 program, and Amy Webb Girard, assistant professor at the Emory University School of Public Health, in the final meeting of the Advancing Policy Dialogue on Maternal Health series on December 15 where they addressed the linkages between poverty, undernutrition, and poor maternal health outcomes.
The Cycle of Malnutrition and Poverty
Many factors contribute to a woman’s nutritional status, including lack of capital, access to land, and poverty; thus, said Oluwole, “we must adopt a multi-pronged and multi-sectoral response.”“General malnutrition is usually associated with iron-deficiency anemia, which leads to poor cognitive function and educational achievement, poor health, and fatigue.” Oluwole said. “These three factors lead to low worker productivity, and low worker productivity leads to income poverty.”
“All of these aggravate malnutrition and so the vicious cycle of malnutrition and poverty continues,” said Oluwole. To break this cycle, she pointed out that countries like Malawi and Mexico have implemented various multi-sectoral interventions that have “stimulated economic growth; implemented targeted social, health, and nutrition programs; and put in place safety nets.”
“In the window of opportunity during pregnancy and the first two years of life, we can make a big difference,” Oluwole said. She advocated for an “integrated anemia package” that provides anti-malarials, de-worming medicine, iron folic acid tablets, and extra food during pregnancy. She also noted the importance of family planning and targeted high-coverage interventions, such as salt iodization, vitamin A supplementation, and breastfeeding promotion.
In conclusion, Oluwole provided several recommendations for the development community to improve maternal mortality rates and undernutrition of women:
Maternal Undernutrition: Our Global Disgrace- Promote universal primary and secondary education, especially for girls
- Stimulate economic growth with a focus on gender and equity
- Invest in infrastructure to reduce transportation time to hospitals
- Postpone age of marriage and of first pregnancy
- Provide targeted and effective nutrition and health interventions
- Encourage private sector participation and government leadership
- Integrate the maternal health and nutrition communities and services
“We don’t tend to look at maternal nutrition and its impacts on the woman herself,” said Girard. The lack of data on the relationship between nutrition and maternal health outcomes “hampers our ability to move maternal nutrition onto the health and development agenda,” she added.“Anemia is widespread; worldwide, it is a significant public health burden, both in women of reproductive age as well as in pregnant women,” said Girard. Studies have shown that moderate anemia increases risk of hemorrhage and may also increase the risk of sepsis, while severe anemia has been shown to directly contribute to maternal mortality. Targeted interventions can help reduce these risks greatly. “For every one gram per deciliter increase in hemoglobin level, you can reduce maternal mortality by approximately 25 percent, but the mechanisms by which this occurs are not well elucidated,” noted Girard.
“We need to include women not as just targets of nutritional interventions, but as beneficiaries in their own health,” said Girard. Key nutritional interventions such as micronutrient supplementation, fortification, and behavior change communication can help to improve not only fetal, infant, and child health, but can also reduce maternal morbidity and mortality. In addition, Girard recommended the following strategies to achieve greater impact:
Together, these strategies can help improve access to nutrition and health services, as well as adequate food for women throughout their lives. “We need to integrate health and nutrition – they are actually the same pillar, complementing each other,” Girard concluded.- Improve nutrition throughout the life cycle, not just during pregnancy
- Look for alternate strategies for micronutrient delivery
- Integrate maternal nutrition into food security and agricultural strategies
- Collect indicators specific to women’s health impacts
- Recognize and address gender bias
Photo Credit: “Bangladesh mothers, kids,” courtesy of flickr user Bread for the World. -
Watch: Joel E. Cohen on Solving the Resource-Population Equation in the Developing World
›December 14, 2010 // By Wilson Center Staff“It’s very hard to put a number on a quantity that depends on future events, processes we don’t understand, and values that may change over time,” said Joel E. Cohenof the Rockefeller University in this interview with ECSP. “That doesn’t mean we have no problems and it doesn’t mean there’s nothing we can do.”
There are three schools of thought or proposed “panaceas,” when it comes to balancing natural resources and population, said Cohen: a bigger pie (new technology to increase productivity), fewer forks (reduced consumption), and better manners (reduced irrational market inequities and better governance).
In the 15 years since his book How Many People Can the Earth Support? was published, Cohen’s approach has changed. While the 1996 book lacked a definitive policy recommendation, he is now analyzing options. “The evolution of my thought has moved from ‘how many people can the Earth support?’ to ‘what do we need to solve problems?’” he said.
You need adequate child and maternal nutrition to produce potential problem solvers and you need education to give them the tools to do it with, said Cohen, who studied the impact of universal primary and secondary education with colleagues at the American Academy of Arts and Sciences.
“If you look at a map of stunting in the world, there are parts of South Asia and sub-Saharan Africa where more than half the children are stunted – that means two standard deviations [of] height below normal for their age,” said Cohen. “Those populations are handicapped at the starting gate because they don’t have the problem solvers.” -
An Integrated Climate Dialogue
COP-16 Cancun Coverage Wrap-up
›December 13, 2010 // By Schuyler NullAfter focused last-minute negotiations, the UNFCCC COP-16 parties meeting in Mexico finally reached an agreement on a package being called “The Cancun Agreements” on Saturday. One of the most important impacts of the agreement (also referred to as the “balanced package”) is the establishment of a green climate fund which will help developing countries adapt to and mitigate the effects of climate change.
For more on the green fund as well as the integration of gender, population, development, and even a little bit of security in the broader climate dialogue, see The New Security Beat’s coverage of Cancun below.- Interview with Karen Hardee: Climate-Proofing Development
- Pop Audio: From Cancun: Roger-Mark De Souza on Women and Integrated Climate Adaptation Strategies
- Guest Contributor Alex Stark: From Cancun: Getting a Climate Green Fund
- The Number Left Out: Bringing Population Into the Climate Conversation
Kicking off our coverage was an email interview with Karen Hardee, visiting fellow with the Population Reference Bureau, on “climate-proofing” development. Hardee gives a brief overview of the UN National Adaptation Programmes of Action system and the current state climate adaptation integration in international development. She points out that one of the enduring positives from COP-15 was a renewed focus on financing tools that has permeated to the top levels of the UN.
Hardee also touched on the nascent but largely unfulfilled connection between population growth and resilience, noting that “of the first 41 programs submitted to the UNFCCC…37 noted that population growth exacerbated the effects of climate change, but only six explicitly stated that meeting an unmet demand for RH/FP should be a key priority for their adaptation strategy and only two proposed projects that included RH/FP.”
Next, Population Action International’s Roger-Mark De Souza was kind of enough to speak with us briefly over the phone from the conference itself, providing a run-down on a PAI-sponsored side event focusing on empowering women in climate debates.
“When you look at the negative impacts of climate change, the impacts on the poor and the vulnerable – particularly women – increase, so investing in programs that put women at the center is critical,” De Souza said.
Leaving gender issues, like child and maternal health and education, out of deliberations like those COP-16 are missed opportunities to get more “power for your peso,” he said.
Alex Stark, formerly of CNAS and now with the Adopt a Negotiator program in Cancun, provided an update and a strong argument for one of the most critical elements of the “balanced package” that many are hoping will come out of Cancun – the establishment of an international fund to help pay for adaptation and mitigation programs in developing countries.
Stark provides an insight into some of the chatter on the floor at COP-16 and also outlines the moral, development, and security advantages to supporting a green fund, pointing out that “by managing displacement, migration, and violent conflict driven by the effects of climate change, such as water scarcity, climate change adaptation can help bolster international security and stability.”
“Within the UN process itself,” she writes, “a robust, well-run, equitable green fund would help rebuild the trust lost between developed and developing countries at Copenhagen last year.”
Lastly, Bob Engelman, of the Worldwatch Institute, provides a broad argument for more inclusion of a key variable in climate debates – population (and not in the Ted Turner mold). He enumerates the common pitfalls of population debates, from sensitivities about personal choices to squeamishness about sexuality and reproductive health, and just plain gender bias.
But despite these barriers, says Engelman, population – and not just growth but demographics too – matters in the climate debate and therefore needs to be part of the conversation (an argument he makes more comprehensively in a new report, Population, Climate Change, and Women’s Lives). Echoing De Souza, he concludes by pointing out that although the discussion may be difficult, the solution is relatively simple: “On population, the most effective way to slow growth is to support women’s aspirations.”
“As societies, we have the ability to end the ongoing growth of human numbers – soon, and based on human rights and women’s intentions,” Engelman said. “This makes it easy to speak of women, population, and climate change in a single breath.”
Sources: Population Action International, Slate, UN Framework Convention on Climate Change, The Washington Post, Worldwatch Institute.
Photo Credit: Adapted from “Trees Dead on Shore of Timor-Leste Lake,” courtesy of flickr user United Nations Photo; Roger-Mark De Souza, courtesy of David Hawxhurst/Wilson Center; “Will you back a climate fund?,” courtesy of flickr user Oxfam International; and “Met Office Climate Data – Month by Month (September),” courtesy of flickr user blprnt_van. -
Expanding Access to Maternal Health Commodities
›“This is not just about getting quantities of drugs out, this is about saving women’s lives with really simple products that work,” said Julia Bunting, team leader of AIDS and reproductive health at the UK Department for International Development and coalition chair of the Reproductive Health Supplies Coalition, at the ninth meeting of the Global Health Initiative’s 2009-2010 Advancing Policy Dialogue on Maternal Health series. Joined by panelists Melodie Holden, president of Venture Strategies Innovations (VSI), and Elizabeth Leahy Madsen, senior research associate at Population Action International (PAI), the panel discussed the challenges and strategies for expanding access to maternal health commodities.
Integrating Maternal Health and Family Planning Supply Chains“It is often said that the family planning and the maternal health communities have very different views of supplies… but actually [both communities] recognize that we need to explore the continuum,” said Bunting, addressing the need to integrate maternal health commodities into existing reproductive health supply chains. “I really think the stars are aligned right now for advancing this agenda,” added Bunting.
“Many of the commodities that we talk about in terms of reproductive and maternal health cost tiny amounts to deliver, but actually save lives and are some of the most cost-effective interventions we have both in public health and in broader development,” said Bunting.
No Product, No Program
“Supplies are a key element in programs to improve maternal health and they are also a tangible and visible hook to increase awareness and commitment,” said Madsen. “Policymakers whose eyes glaze over when they hear the term ‘health systems strengthening’ can grasp… much better when they learn that supply shelves in clinics are bare and that women are making great efforts to reach facilities, only to leave empty- handed,” said Madsen.
Presenting research conducted by PAI, Madsen discussed the availability of four key maternal health medicines and products in Bangladesh and Uganda including:
By focusing on supplies that target the three leading causes of maternal mortality, Madsen and her colleagues identified factors that inhibit access to these commodities and developed recommendations for strengthening maternal health supply chains.- Oxytocin: used to prevent post-partum hemorrhage
- Misoprostol: used to prevent post-partum hemorrhage
- Magnesium Sulfate: used to treat pre-eclampsia
- Vacuum Aspirators: used for treatment of early and incomplete abortion
Madsen identified several strategies to strengthen supply chains for maternal health commodities including forecasting and preparing for growing demand, advocating for government and donor support, encouraging scaling-up of community-based approaches, promoting family planning, and focusing on human resource training.
“In maternal health, if a supply to prevent or treat a life-threatening complication is in stock, there must also be a way for a woman to reach it in time… and in most cases a provider who knows how to administer it,” said Madsen.
“This research is intended to lay the groundwork for future advocacy and policy initiatives by providing an evidence base that is informed by local expertise,” said Madsen. “We hope that this information will inform program implementation, funding decisions, and awareness raising.”
Getting the Product to People: The Case of Misoprostol
“The story of Misoprostol is still being written. The goal is to invest in creating access to interventions that are low-cost and relatively simple to use,” said Holden. By sharing lessons learned, Holden described VSI’s experience registering and procuring Misoprostol and demonstrated how community mobilization is imperative to overcoming major challenges for large-scale implementation.“Making products available is not without challenges,” said Holden. To increase access to Misoprostol in rural communities, maternal health experts must work to “engage communities, educate and mobilize women, train providers at all levels of the health care system, and provide support to distributors to jump start sales,” said Holden. “By looking holistically across entire health systems, bringing in great interventions, addressing the components of supply and demand, and working with local partners, we can have lasting impact.”
While the price of Misoprostol has decreased significantly, Holden stressed the need to identify creative ways along the supply chain that reduce costs to the end user. Additionally, “establishing policies around this new intervention not only establishes its reach, but also makes its use institutionalized, which means it will be part of the system even if governments or individuals change,” said Holden.
“If there is a gap between what could be achieved with Misoprostol and what is being achieved, we need to go back to the model and figure out what pieces aren’t working,” concluded Holden. “The work is complex and takes time, but it’s worth it.”
Photo Credit: “Rapid HIV testing,” courtesy of flickr user DFID – UK Department for International Development. -
Hans Rosling Double Feature: ‘The Joy of Stats’ on BBC and Population Growth at TED
›Hans Rosling, creator of Gapminder and professor of international health at Sweden’s Karolinska Institute, hosts a new documentary on the BBC called The Joy of Stats that takes a look at the breadth and depth of data available today to analysts and private citizens alike.
In the clip above, Rosling demonstrates his primary interest in world health, tracking life expectancy and income over the last 200 years to show both the remarkable progress that has been made but also the tremendous gap that remains between those at the top (the very rich and healthy) and those at the bottom (the very poor and sick).
Rosling has been a vocal (and visual) advocate for expanding people’s knowledge of the world by presenting statistics in innovative ways. “Statistics should be the intellectual sidewalks of a society, and people should be able to build businesses and operate on the side of them,” he said at a discussion at the Wilson Center in May 2009.
In particular, Rosling’s focus has been on health, poverty, and the developing world, where he’s advocated for increased focus on child and maternal health and education. “The role of the old West in the new world is to become the foundation of the modern world – nothing more, nothing less,” he said during a TED talk on population growth (see below) where he broke from his more flashy visuals and went analog – using IKEA boxes to illustrate population and consumption growth. “But it’s a very important role. Do it well and get used to it.”
Rosling’s Gapminder software has been incorporated into Google’s Public Data Explorer, where many development indicators from the World Bank, World Health Organization, and others can now be easily tracked by anyone. For more on Google Data and to see an example set of indicators (agriculture as a percentage of GDP vs. fertility rates over the last 50 years), check out this previous Eye On, on The New Security Beat.
Video Credit: “Hans Rosling’s 200 Countries, 200 Years, 4 Minutes – The Joy of Stats – BBC Four,” courtesy of BBC, via YouTube, and “Hans Rosling on global population growth,” courtesy of TED. -
World AIDS Day 2010: Not Yet in a Position to Say “Mission Accomplished”
›December 1, 2010 // By Schuyler NullToday is World AIDS day. More than 33 million people are currently living with HIV around the world, according to the UN, and the vast majority of them (22 million) are located in sub-Saharan Africa.
“We have halted and begun to reverse the epidemic. Fewer people are becoming infected with HIV and fewer people are dying from AIDS,” said Executive Director Michel Sidibé in the 2010 edition of UNAIDS’ annual report.“However we are not yet in a position to say ‘mission accomplished.’ Growth in investment for the AIDS response has flattened for the first time in 2009. Demand is outstripping supply. Stigma, discrimination, and bad laws continue to place roadblocks for people living with HIV and people on the margins.”
Particularly in sub-Saharan Africa, “people on the margins” often means women and children. As a result, there has been more and more integration of HIV/AIDS programs with gender and maternal health. The environmental community has also worked closely with HIV/AIDS interventions in places where the destruction of natural resources makes certain populations more vulnerable than others and valuable conservation efforts are threatened.
As development efforts become more cross-sectoral, it’s important to keep in mind and maximize these connections between community, economic, and environmental health.
Check out The New Security Beat’s coverage of HIV/AIDS integration with other health and environment programs including coverage from the Global Health Initiative’s “Integrating HIV/AIDS and Maternal Health Services” event last year, a sit-down interview on the challenges facing HIV-positive adolescents with Harriet Birungi of the Population Council in Kenya, and an examination of how gender-based violence contributes to women’s vulnerability to HIV.
Sources: Population Reference Bureau, UN, World Wildlife Federation.
Map Credit: World AIDS Campaign. -
Watch: Blue Ventures PHE Program in Madagascar
›“All conservation efforts will be in vain if family planning issues aren’t addressed,” says Rebecca Hill, project manager for the Sexual and Reproductive Health Programme at Blue Ventures in a video highlighting their population, health, and environment (PHE) programming in Madagascar.
While primarily a marine conservation group, Blue Ventures also recognizes the need for integrating population into their efforts. They began a family planning program in southwestern Madagascar in 2008 as part of a “holistic approach to conservation.” The project aims to address the high unmet need for family planning, high fertility and maternal and infant mortality, and conserve the coastal environment. “We are directly saving lives,” Hill says.
Rapid population growth is creating an unsustainable strain on natural resources, as Matthew Erdman of Blue Ventures wrote in a previous post on The New Security Beat:The average total fertility rate in Velondriake is 6.7 children per woman, according to our data. On average women are only 15 years old when they first conceive. To compound this problem, a majority of the population is under the age of 15 – at or approaching reproductive age. At the current growth rate, the local population will double in only 10 to 15 years. The local food sources, already heavily depleted, barely feed the current population, let alone twice that amount. Without enabling these coastal communities to stabilize their population growth, efforts to improve the state of marine resources and the community’s food security are considerably hindered.
Hill describes the situation in the village when she joined the Blue Ventures in 2008 as “alarming,” with women “having up to 17 children despite not wanting children.” Many people in the town had never heard of condoms and had no idea how to use them, she said, and “they are desperate to have access to contraception.”
Today, the initial family planning program has been scaled up to the surrounding region and generated significant community involvement by peer educators teaching community members about sexual and reproductive health. It’s also become the first PHE project to receive support from the UNFPA within Madagascar.
There are currently 18 community-based distributors who give out two types of contraception in their villages. The fact that the community has so fully embraced the project shows that it can be replicated elsewhere, says Hill in the video. “Communities themselves have harnessed the ideas and consider that what we’re doing is vitally important.”
“Addressing family planning needs and issues is inextricably linked with conservation issues,” says Hill. “All conservation efforts will be in vain, if family planning issues are not addressed.”
Video Credit: Blue Ventures Family Planning Project from Alexander Goodman on Vimeo.
