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By Michaela Maynard, Global Health Issue Analyst

For each minute that it takes you to read this post, a woman is dying in labor, and for every birthing death, twenty more women are left suffering from disability. Obstetric fistula is the most devastating of all pregnancy-related disabilities. Worldwide, the condition affects over two million women. Obstetric fistula results from prolonged, obstructed labor without access to timely medical care, typically a caesarean section.  During prolonged labor, the positioning of the baby and the pressure of the infant’s head can result in damage to the organs of a women’s pelvis. In almost 90% of fistula cases the infant is stillborn or dies within the first week of birth and if the mother survives, she may be left with a fistula or hole between the vagina and the bladder or the vagina and the rectum, causing her to constantly leak urine or feces.

Women suffering from fistula are incapable of carrying out their normal workload, and they rely heavily on others for support.  In many instances, women report being divorced from their husbands, ostracized from their families, and forced out of their communities as a result of fistula. The constant leaking of urine and the smell that follows them is stigmatizing; they become outcasts and are pushed deeper into poverty and destitution.

Obstetric fistula is not a third-world anomaly. For centuries, women all over the world have been faced with prolonged, obstructed labor and obstetric fistula. In fact, the first fistula hospital was located in New York City on the site of what is now the Waldorf-Astoria Hotel. In the U.S., the availability of timely obstetric care has helped to eradicate fistula, yet women in Africa, South Asia, and other developing countries of the world still suffer from this preventable and treatable condition.

Surgery can treat the fistula, but the cost of surgical treatment and the lack of trained surgeons prevent women from receiving care. In countries of civil unrest, healthcare services are often depleted, roadways accessible to hospitals and clinics are Read the rest of this entry »

Every fall as the trees shed their colorful leaves I get a little nostalgic. When I see the children in my neighborhood setting pumpkins on their doorsteps and frolicking in leaves, I feel a pang of jealousy. With all the stresses of ‘adult life’ and grad school, I miss the carefree days of my childhood. Then I think about how lucky I was to have that experience, when so many children across the globe have their childhood cut short because of poverty, cultural expectations, and shockingly, as they are forced into marriage.

Think of a young girl in your life.  Think of your sibling, niece, cousin, neighbor, daughter or even a memory of yourself as a child. Now think of 60 million girls just like her married across the globe. Imagine them pressured by families and communities to enter into adulthood at the age of 16, 12 or even 7. Imagine them being forced to marry, often a much older man, and assume the role of a wife and mother.

The emotional, social, and health consequences of this are enormous. These girls are often forced to move far away from their families to be with their husbands. Once they are married they can no longer pursue their education. Since they are so young, they have no say within the family. They are expected to immediately fulfill their roles as wives by becoming sexually active. Most have no sexual and reproductive health education, and no idea of how to protect themselves from STIs or unwanted pregnancies. Furthermore, the girls face pressure to prove their fertility as soon as they are married.

Sexual activity and pregnancy at a young age both bear dangerous health consequences. A young, undeveloped body is often not ready for the physical strain of pregnancy and childbirth. In many of the countries in which child marriage is prevalent, Read the rest of this entry »

About two weeks ago Julia and I attended the US Global Leadership Council’s annual conference. The day was filled with brilliant speakers, but in the end we both agreed that one of our favorites was Gary Knell, President and CEO of Sesame Working shop. He discussed “Muppet Diplomacy”, the idea that through educational television we can develop nations and encourage a more positive relationship between the U.S. and other nations. As Julia mentioned in an earlier post, this was a refreshing viewpoint on a panel that mostly focused on the direct impact of development on business’ pockets (not so surprising since it was a panel on development’s economic impacts).

Sesame Workshop was founded thirty-eight years ago to help low income children in the U.S. prepare for school. The concept was simple: use television to address the developmental needs of children. Since then, the Sesame Street model has gone global. Sesame Workshop works with 18 countries (Australia, Bangladesh, Brazil, Egypt ,France, Germany, India, Indonesia, Israel, Japan, Jordan, Kosovo, Mexico, Netherlands, Northern Ireland, Palestine, Russia, South Africa ) on locally produced media following the Sesame model. Each production team involves the top educators, researchers, psychologists, child development experts, artists, writers and musicians in their respective countries. Today Sesame Street if the most researched show in history.

What is most interesting about this process is how local productions are using the Sesame model to talk about regionally relevant issues. Rechov Sumsum, the production in Israel features Arab-Israeli and Jewish- Israeli muppets living together in harmony. Alam Simsim, Egypt’s production features a bright young female muppet, Khokha, to promote the empowerment and education of young girls.

South Africa’s Takalani Sesame embodies the spirit of the “rainbow nation” and features muppets that speak with accents that reflect the diversity of the nation. Most notable is Kami, a young female muppet who is HIV positive. As South Africa continues to be devastated by the HIV/AIDS epidemic, the show is attempting to dispel the culture of silence and stigma surrounding the issue.

The name “Kami” comes from the Setswana word “Kamodelo” which means “acceptance.” Kami is a Read the rest of this entry »

Last week I posted about an event I attended promoting the International Violence Against Women Act (IVAWA). The event featured guest speaker Rose Mapendo, who shared her own story as a survivor of rape and ethnic violence in the DRC. I was moved by her story and am excited to see IVAWA passed. Today the BBC reported that the UN has moved to address the issue of sexual violence in the DRC. It is an interesting article so I thought I would share.

Don’t forget to contact your representatives urging them to support IVAWA. You can also visit for more information on the legislation and how you can take action.

DR Congo sexual violence victims speak to UN

September 30, 2010

Village of Luvungi, DR Congo. Photo: 6 Sept 2010
Victims of sexual violence in the Democratic Republic of Congo have begun telling a high-level UN panel about their experiences as part of efforts to improve treatment and support.

The hearings began on Thursday in the troubled eastern region of South Kivu.

The panel will travel to provinces throughout the DRC.

The move follows the release of a preliminary UN report into the shocking rape of hundreds of civilians in North Kivu province two months ago.

The report, released last week, documented a four-day attack on the eastern town of Luvungi, and nearby villages – which are within miles of a UN base.

It said three groups of armed militia raped 235 women, 52 girls, 13 men and three boys – many of them “multiple times”. The militia looted more than 900 houses and abducted 116 people.

Read the rest of this entry »

“What have you done today to make you proud?”

Yvonna Chaka Chaka posed this question to the audience at an event I attended last week and it has been on my mind ever since.

The Global Health Council and Johns Hopkins Bloomberg School of Public Health hosted a film screening of The Motherland Tour- A Journey of African Women with Yvonne Chaka Chaka and discussion on the links between global health, development, gender and the Millennium Development Goals.  Speaking on these issues were Dr. Matthew Lunch (Director of the Global Program on Malaria at the Center for Communication Programs, CCP, Johns Hopkins Bloomberg School of Public Health), Louis da Gama (Malaria Advocacy and Communications Director, Global Health Advocates), and Yvonna Chaka Chaka (Entertainer and Humanitarian).

The Motherland Tour documents Yvonne Chaka Chaka’s travels to meet with women across Africa and discuss the most pressing issues they face– including malaria, maternal and child health, HIV/AIDS, women’s empowerment, education, and poverty. The film features personal stories and women-lead grassroots efforts to tackle these issues. Although optimistic and uplifting, the film does not shy away from highlighting the gravity of the present situation. The narrator reminds the audience of the harsh realities.

Malaria kills an African child every 30 seconds.

For rural populations the closest health clinic may be up to a four day walk away.

Most of these clinics are understaffed and under stocked.

In Sub-Saharan Africa over 24 million children and adults are estimated to be living with HIV.

After the screening, Yvonne Chaka Chaka and Louis da Gama explained that they created this film with the intent of “giving voices to the voiceless.” They pointed out that leaders must be reminded of the women they are meant to be representing and who brought them into this world. They also stressed the need for programs focused on empowering women to help themselves. In Yvonne’s words, “I will hold your hand as you help yourself.” Her overall message is that “Africa has hope”, and that hope lies in empowering women (or Well Organized MEN as she joked).

Louis da Gama reminded the audience that just because the economy is in recession does not mean that HIV/AIDs, TB and malaria are also in recession. We need continued funding, to the Global Fund in particular, if there is to be any hope for the improvement of health conditions in Africa.

So back to the question. “What have you done today to make you proud?” Yvonne Chaka Chaka and Louis da Gama recommend that you contact your representatives to encourage them act boldly in support of global health funding. Here are some actions you can take today:

Sign this petition asking Obama to commit $6 billion to the Global Fund in the next three years.

Contact your member of Congress urging to honor the promise of $1 billion a year by supporting full funding for malaria.

Contact your members of Congress and urge them to continue exercising leadership on this critical issue.

Go ahead, make yourself proud!

By AIDemocracy Regional Coordinator Kristen Tebow.
Yesterday, the International Justice Mission (IJM) completed a National Call-in Day for the Child Protection Compact Act (CPCA). Thanks to voices raised around the country, the CPCA was approved by the Senate Foreign Relations Committee (S. 3184) yesterday afternoon! This urgently needed legislation would help eradicate child trafficking in target countries around the world.

Students from Kansas State University and the University of Kansas with AIDemocracy RC Kristen Tebow came together, calling Senators and writing letters, urging them to take action. Senator Brownback, Senator Boxer, and Senator Cardin all supported the legislation and it was passed in the Committee!

Your voice is important! The CPCA will now move to the Senate floor for a full vote and I’d urge you to take three minutes and call your Senators to ask them to vote YES on this important piece of legislation.

IJM Institute has even made the process simple with a link to find out who your senators are (Type in your state in the upper right corner and then look for the “contact” section on your senators’ websites.) and a sample script to make the call.

There are a lot of things you could do in three minutes. Will all of them have a global impact?

From “The Child Protection Compact Act, which was introduced in the House on June 5 by Representatives Chris Smith (R-NJ) and Carolyn Maloney (D-NY), will provide assistance to select “focus countries” through the U.S. Department of State’s Office to Monitor and Combat Trafficking in Persons (G/TIP). These focus countries will receive support in building public justice systems that effectively investigate crimes against children and prosecute perpetrators in numbers sufficient to deter and eventually eliminate the crime. The legislation also authorizes increased assistance for care of survivors of trafficking.

On March 25, 2010, Senators Barbara Boxer (D-CA), Sam Brown back (R-KS) and Ben Cardin (D-MD) introduced a similar bill in the Senate, called the Child Protection Compact Act (S.3184), legislation designed to increase U.S. support to eradicate child trafficking in countries that have the will to end the crime but lack resources.”

To learn more about the CPCA please visit

Thursday morning I attended Stories of Courage and Success: Surviving and Ending Violence Against Women Internationally, an event that was organized to bolster efforts to pass the International Violence Against Women Act (IVAWA, H.R. 4594/ S. 2982). There I was– my first day as an official AIDemocracy intern– sitting before an impressive panel of women’s rights advocates. The excitement I felt being in a room with these dedicated individuals, couldn’t prepare me for what I was about to hear.

After opening remarks from Maria Alexandra Arriaga (Senior Campaign Strategist for the Family Violence Prevention Fund) and Paula Kerger (president and CEO of PBS) a woman took the podium and began to sing to the crowd. Although I couldn’t understand the lyrics, the pain in her song didn’t need a translation.

This woman was Rose Mapendo, a Tutsi woman born in the eastern Democratic Republic of Congo. When the Rwandan army invaded the Congo in 1998 and president Kabila declared Tutsis were the enemy, pregnant Rose, her husband, and seven of her eight children were arrested and sent to a death camp. In the camp Rose witnessed the execution of her husband. According to the commanders at the camp, “women were not worth the bullet” so they were killed in other ways. Rose witnessed her family and friends slowly killed through systematic rape, beatings and starvation. After eight months in captivity Rose gave birth to twin boys on concrete prison floor. She had to beg guards for a piece of bamboo to cut the umbilical cord.

Rose never thought that there was a chance her family would survive the squalor, malnutrition, violence and rape at that camp. Yet through some miracle Rose made it to a refugee camp in Cameroon and eventually resettled to Pheonix, Arizona. She founded Mapendo International in 2003, and “works to fill the critical and unmet needs of people affected by war and conflict who have fallen through the net of humanitarian assistance”. In 2009 Rose was honored with the Humanitarian of the Year Award by the United Nations High Commissioner on Refugees.

This year PBS will be airing Pushing the Elephant, a film that documents Rose’s reunification with her daughter Nangabire. The documentary follows them for a year as they make up for the decade they were separated. The film airs March 2011 as part of PBS’ Independent Lens Series. When Rose finished sharing her story there was not a dry eye in the house. I couldn’t help but wonder how in the 21st century violence against women can still be used as a weapon of war.

The presentation continued with Ambassador George Ward (Senior VP for International Programs, World Vision) and Samantha Mathis (Actor & Human Rights Activist) explaining the on-the-ground reality of gender based violence. Ritu Sharma (President and Co-Founder, Women Thrive Worldwide) bravely shared her own story as a survivor of rape, and highlighted the necessity to act now on International Violence Against Women’s Act (IVAWA).

When 1 in 3 women worldwide experience violence in their lifetime, measures like IVAWA are not only needed but necessary. I encourage all of you to contact your representatives today to request they support this common sense legislation. You can also visit for more information on the legislation and how you can take action.

Read another one of our blogs about IVAWA here.

Yesterday I turned a quarter of a century old (ekkk!). Like every other birthday, my mother did not fail to remind me of how much pain she endured to bring me into the world. “You know, I was in labor for almost two days with you? Do you know how much that hurt? You were a small baby but with such a big head – you almost killed me!” Although at first I began to sigh and give a sarcastic “Yes, mom I know…. Sorry I had such a big head back then,” it really made me think about my 25 years of life. My life could have been so different than it is now.

My life could have been drastically different from day one simply because I was born in a developing country. Because of barriers to access health facilities and with no skilled birth attendant by her side, my mother could have easily added to Nepal’s high maternal mortality rates (today’s ratio as high as 16.6 women dying per 2,000 live births) and I could have been another child with no mother.  Luckily, with a healthy mother and father who were able to provide me with the basic needs survive, I also surpassed Nepal’s high infant and child under-five mortality ratio (today’s ratio: 51 deaths per 1,000 live births), just in time to move to the US at the age of six.

I was able to receive a number of basic needs and opportunities in the US that I most likely would not have had in Nepal: regular visits with the doctor, clean water, immunizations, primary and secondary education, adequate nutrition, sex education or opportunity to attend college, among others. I wondered…if I did not have the opportunities I had living in a developed country, would I have been able to do as much as I have at this age? Would I be able to advocate for the women’s rights, let alone sexual and reproductive health and rights?

Read the rest of this entry »

Worldwide there are approximately 80 million unwanted pregnancies each year. Half of those pregnancies end in abortion, and half of those abortions, an estimated 20 million, are unsafe abortions. These unsafe abortions result in nearly 70,000 maternal deaths each year, and tens of thousands of additional complications and injuries.1

In many cases, even where abortion is legal, there are barriers to safe abortion care, such as a shortage of skilled health care providers, a shortage of equipment or medications, the cost of paying for abortion, lack of information, distance to health centers, or stigma around seeking abortion. In developing countries receiving US Foreign assistance, these barriers, particularly shortages in supplies and training, have been exacerbated in the past by the Global Gag Rule and continue to be exacerbated by the Helms Amendment. Read more about these two detrimental pieces of legislation in my previous blog posts about the Global Gag Rule, here, and about the Helms Amendment, here, to find out what you can do about it.

However, in countries where abortion is still illegal, the situation for women is even more dire. Read the rest of this entry »

It is a widely accepted notion that the education of girls is directly connected to the incidence of poverty. The more educated a girl in a developing country is, the fewer and more healthy children she is likely to have, the more money she is likely to contribute to the family, and the more productive for her community she is likely to be. Another widely accepted fact, however, is that girls do not receive nearly as much education as boys and this is even more true after the onset of puberty. Not only do household tasks often become an expected priority of girls, but even if enrolled in school, many girls are often missing school for a reason girls in developed countries may wish they could use as an excuse to play hooky: that “time of the month.”

A common worry of nearly every female who travels abroad and staple toiletry item, sanitary pads, have a connection to poverty deeper than one may think. A lack of access to convenient and disposable sanitary pads leaves women in developing countries more prone to infections as well as feeling dehabilitated during that one weeks time. According to SHE, Sustainable Health Enterprises, of girls in Rwanda that miss school, 36% miss it because they cannot afford sanitary pads.

In order to extend the benefits that more wealthy women in developing nations receive in the form of multinational cooperation produced feminine products, A. Muruganathm spent many years relentlessly working towards a practical solution. He researched to find a way to increase access to pads for all women, however, was labeled a pervert and ostracized during the process. Despite the taunting, he pushed on.

In 2006, he perfected a machine, costing only $2,500, which produces 120 pads per minute that can be made for 1 rupee and 50 paise each (about 3 cents), without any government subsidies.1 His thought process is that while the larger companies only think in terms of gains on investment, he hopes to create a business with a moral and humanistic foundation. Another success of his efforts is that women are now able to purchase these machines and sell the pads to other women in order to create income. Thus far, access to pads making women more healthy, educated, and productive has been increased in 200 locations in India currently utilizing his sanitary napkin machine.

Market solutions such as these, while very practical on the micro level, will not solve poverty altogether. While every step helps, it is important to keep in mind the structures in place that cause for discrepancies in standards of living. Muruganathm’s production is unique, however, in that he does not see a need for a private-public partnership, and would rather see business flourish on the grassroots level. Some would say that his machine kills two birds with one stone, as it offers a route for economic development as well as addresses an immediate need of women in the developing world.



August 2020

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