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The first global health Issue Analyst training occurred exactly a week ago. Yes we did it, we discussed maternal health, reproductive health in crisis situations and HIV/AIDS all in one night! It is possible!

Slide from Maternal Health PresentationJodi Keyserling, a policy analyst with CARE, started off the night with a presentation on maternal health. Not only did Jodi highlight the issues surrounding maternal health and shocking statistics like the difference between a women’s risk of maternal death in Sub-Saharan Africa (1 in 36) versus those living in the U.S. (1 in 2,100), but also shared recent policy news including the Global MOMS Act.  Here is one of my favorite slides from her presentation that illustrates the intersections between other global health problems and maternal health.

Erika Larson with JSI Research and Training Institute’s reproductive health for refugees ASTARTE program, followed with a presentation on Reproductive Health (RH) in Crisis situations. I had no idea that “8 out of 10 countries with the highest maternal mortality are crisis-affected” or that conflict-affected countries receive 53% less official development assistance for RH activities than non-crisis countries. Here are some slides that I found really helpful (click on images for bigger size):

JSI RH-Crisis-Take awayJSI- What are the consequences

We ended the night with a bang as Kaytee Riek, Director of Organizing at Health GAP, gave us a fabulous presentation on the current HIV/AIDS landscape including how the US is contributing to the fight against HIV/AIDS. Prior to the presentation, I was not aware of Read the rest of this entry »

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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 »

By Sydney Kornegay

The Millennium Development Goals (MDGs) received their 20-year old check-up at the MDG summit in September. The diagnosis? While some of the goals are on track for completion by 2015, others- like reducing maternal mortality- have experienced only patchy progress. The poorest and most vulnerable communities continue to suffer, and have unequal access to basic human services. These trends are particularly true for women.

According to a UNICEF report of the conference, 1,000 women still die every day from complications in pregnancy and childbirth, mostly in Sub-Sahara and South East Asia. That’s one woman every minute. And while that number represents a one-third reduction in the maternal mortality ratio since 1990, it’s not fast enough to satisfy MDG 5. This goal calls for a three fourths reduction in the maternal mortality ratio and universal access to reproductive health care by 2015.

“MDG 5 is not on track for success, based on current trends. An orchestrated global effort will be needed to achieve it.”

“By focusing our efforts on scaling up practical interventions that reach the poorest and most marginalized women, we can reach MDG 5 more quickly, more cost-effectively and more equitably.”

These cost-effective, equitable solutions are already being implemented in several countries.

Take Brazil: In 1996, just over 70% of poor mothers received skilled care during childbirth. According to a recent report by World Health Organization and UNICEF, coverage of skilled birth attendance became almost universal in the country, by 2007, even amongst the poorest.[1] Brazil has focused on sending Read the rest of this entry »

“It’s only by God’s grace that you survive pregnancy.” This statement, made by a 19-year-old girl in the Democratic Republic of the Congo (DRC), illustrates the incredible situation of women in sub-Saharan Africa with little or no access to reproductive health care. The statistics are staggering: every year, approximately half a million women around the world die from pregnancy related causes. More than half are in sub-Saharan Africa, almost all are in impoverished countries, and most deaths are avoidable. Think about the women in your life – how many people do you know who have needed an emergency C-section because the baby was breach or the labor was taking too long? Issues like obstructed labor and post-partum hemorrhage occur with women everywhere. In developed countries, they lead to scary moments and extra medical care.  In the developing world, they often lead to death.

Dire as this situation is throughout the developing world, it is much worse in areas of conflict. Here, women are subjected to the additional burdens of violence and displacement. Emergency response to conflict areas usually consists of extremely basic supplies – food, clean water, sometimes first aid and shelter. But reproductive health services are just as important.

Yesterday I went to a film screening in DC to watch BBC Documentary “Grace Under Fire”, which focuses on Dr. Grace Kodindo, a Chadian Ob/Gyn who travels to the DRC to observe the special needs of women in conflict areas. The film was followed by a panel and Q&A featuring Dr. Kodindo, Mr. Clarence Massaquoi of Liberia, and Dr. Bouba Touré of the DRC. The film was fantastic and the information I learned was staggering. You can watch an excerpt of the film on YouTube, as it was televised on BBC. Read the rest of this entry »

Post by Giulia McPherson, Advocacy Alliances Manager, CARE USA

As a member of CARE USA’s policy and advocacy staff, I spend a lot of my time speaking with fellow advocates and elected officials about our programs and how the U.S. can impact real change in the developing world. Earlier this month I had the opportunity to see some of these programs first hand and better understand what “global advocacy” really means.

CARE has been in Ecuador since 1962 and implements a variety of maternal health, education and environmental programs. We also place a special focus on advocacy by working in solidarity with social movements, influencing attitudes concerning poverty and injustice, empowering local community organizations to engage in advocacy and bringing communities and elected officials together to address policy issues.

On February 8, I had the pleasure of visiting one particular program near the town of Otavalo in the Andean highlands. CARE Ecuador has been working closely with the Municipal Government of Otavalo, the Ministry of Public Health and the Provincial Department of Indigenous Health to implement an Ecuadorian law called the “Free Maternity and Child Health CARE Act”. Although this law called for universal access to healthcare for all Ecuadorian citizens, many indigenous communities were still experiencing high levels of maternal death. Since the majority of indigenous women give birth at home, several areas of concern were identified including an inability to recognize signs of maternal and neonatal risk, the lack of access to transportation in case of an emergency and the resulting delay in emergency care.

When CARE first began to assess this problem, it became clear that healthcare personnel were overlooking certain issues that were of concern to indigenous women. CARE worked closely with the indigenous community and local and federal government to ensure that pregnant women would feel comfortable delivering their babies in a hospital setting, if necessary.

As a result, CARE worked to implement certain changes in how healthcare was administered:

  • Most indigenous women are accustomed to being surrounded by their families when delivering their babies so CARE helped build a ‘Casa Materna’ (or Maternal House) to house families traveling many miles from remote communities.
  • The hospital now trains traditional midwives so that they are certified to both work in the hospital and preside over home births.
  • CARE worked to ensure that women who give birth at home still have access to emergency care if needed by setting up a radio communication system.
  • A garden was planted so that hospital staff could use medicinal herbs to treat labor symptoms.
  • The hospital now offers several indigenous birthing techniques including vertical birthing rooms.
  • Hospital staffs are now trained to speak the local Quichua language to accommodate women who do not speak Spanish.

This innovative program has since been replicated in other hospitals throughout Ecuador. By working closely with the government and local indigenous communities, CARE was able to influence real change and save the lives of women. As the Hospital Administrator reported during her presentation, there were no maternal deaths in this community in 2009 – and with such a dedicated team of doctors, midwives and community leaders the prospect for healthy women and healthy deliveries remains bright.

What does all this mean for CARE’s global advocacy work? It means that while goals like ending maternal mortality and extreme poverty huge undertakings, sometimes all it takes is small changes to empower a community –and women– to meet their own needs.

To learn more about CARE’s maternal health programs visit http://www.care.org/campaigns/2009/mothersmatters.asp. It’s also not too late to buy tickets to CARE’s International Women’s Day event, Half the Sky LIVE, taking place this Thursday at 7:30 pm EST in theaters nationwide.

Photos:

Presentation by Hospital Director

Casa Materna for families and recovering patients

House with a radio tower

Garden for indigenous medicinal herbs

Medicinal herbs used in birth room


On Monday, I was incredibly blessed to be able to witness the birth of my new baby sister. While labor and delivery is always a nerve-wracking experience, I was reassured knowing that my mother and sister were able to receive the best possible medical attention. Walking around the hospital in the “Mother and Baby” wing, my father joked that the hospital was one indoor pool away from being a holiday resort.

Although, when compared to other developed nations, the U.S. actually lags behind in maternal mortality rates, the lifetime risk of an American woman dying from pregnancy-related causes is about 1 in 4,800, as of 2005. In Niger that number is closer to 1 in 7. In fact, over 99% of all maternal deaths occur in the developing world, and 84% are in sub-Saharan Africa and South Asia alone. Due to poor medical conditions, high fertility rates, teenage pregnancies, unmet need for contraception and several other factors, 1,440 women will die from pregnancy-related causes today.

Unfortunately, bringing the level of care that my mother received during her pregnancy, labor and deliver to all women would be unreasonably expensive and impossible considering the state of the healthcare system in many developing nations. Nevertheless, there is a cost-effective and simple solution available right now to help reduce the risk of maternal mortality and morbidity in regions where there is a lack of access to adequate medical services.

Misoprostol is a drug that can be administered orally and stimulates uterine contractions (although the drug’s labeled use is for the treatment of gastric ulcers). This mechanism can induce abortions in early stage pregnancies, induce labor in full-term pregnancies and reduce the risk of postpartum hemorrhaging (PPH), the leading cause of maternal death in Africa and Asia. Because this drug can be used for inducing abortions, many countries, including several in sub-Saharan Africa where the drug would be the first option to prevent PPH in a resource-limited setting, have not approved the sale or use of misoprostol. Fortunately, it seems that some countries are catching on and misoprostol has been recently approved in Uganda, Nigeria and Ethiopia for the prevention of postpartum hemorrhaging.

Research has shown that a single dose of misoprostol, costing only $1, at the time of delivery can half the risk of postpartum hemorrhaging, when compared to a placebo group. The low cost of misoprostol, combined with the easy administration of the drug, makes it an effective method to save the lives of women all over the world. One dollar is a very small price to pay to ensure the health of a new mother and her baby. Hopefully the medical necessity of using misoprostol will overcome the ideological challenges that the drug currently faces.

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