World Population Day 2018 highlights ineffective and unsafe pregnancy prevention behaviors and practices. What about emergency contraception?

By Melissa Garcia

Melissa Garcia is a Technical Advisor for the International Consortium for Emergency Contraception, hosted by MSH. This article originally appeared on the ICEC website

For this year’s World Population Day on 11 July, our community celebrated and affirmed the right to family planning. On this day, the United Nations Population Fund (UNFPA) also called attention to the many people around the world unable to realize this right.

The Guttmacher Institute’s analysis , Adding it Up, estimates that globally, 214 million women of reproductive age in developing regions want to avoid pregnancy but are not using a modern method of contraception. One hundred and fifty five million women are not using a contraceptive method. Some 59 million women use traditional practices and remedies for pregnancy prevention. UNFPA has listed some of these practices in this article and accompanying photo essay. They are cause for concern because the users of such “pseudo” contraceptive practices act in the belief that they are protecting themselves from the risk of unintended pregnancy. But in fact they are exposing themselves to that risk, and potentially to further health consequences.

This phenomenon affects emergency contraception (EC) as well. The majority of women are not aware that a contraceptive option after sex exists, in most countries that capture EC knowledge in their most recent Demographic and Health Survey (DHS) data.  Most women have never heard of the dedicated, safe and effective pill, and copper- IUD regimens that are the only effective post-coital method. Continue reading “World Population Day 2018 highlights ineffective and unsafe pregnancy prevention behaviors and practices. What about emergency contraception?”

Recent Provider Training and Client Counseling Tools on Emergency Contraception

By Melissa Garcia

Melissa Garcia is the technical advisor for the International Consortium for Emergency Contraception (ICEC), which is hosted by MSH. This article originally appeared on the ICEC website

Emergency contraceptive pills (ECPs) are an important part of the family planning method mix and for post-rape care, being the only effective way to reduce the risk of pregnancy after sex, whether unprotected, insufficiently protected or coerced.

At the global level, women have low levels of awareness of ECPs as a contraceptive option. This could be due in part that ECPs are not consistently included in contraceptive counselling, and/or because the right tools and information are lacking to dispel myths and misinformation. As ICEC’s mission is to ensure the safe and locally-appropriate use of EC in all reproductive health programming, we have made recent investments to support the global health care workforce by improving provider training and client counselling and awareness of ECPs at global, regional and national levels. In partnership with several other organisations, materials were created to provide up-to-date guidance on EC. While the focus is on levonorgestrel (LNG) ECPs–the most commonly available type of EC globally–select resources provide detail on the expanded post-coital contraceptive method mix.

ICEC has provided technical review to several global-level provider training materials, including EC training modules on FPTraining.org for providers (in English and in French) and for pharmacists (in English and in French). The latest edition of Family Planning: A Global Handbook for Providers has updated guidance as well; see the EC chapter here. Continue reading “Recent Provider Training and Client Counseling Tools on Emergency Contraception”

Pregnancy clubs: Group antenatal care in Uganda and Kenya

Shafia Rashid is principal technical advisor for the FCI Program of Management Sciences for Health. 

Women participate in the opening ceremony of a Lea Mimba pregnancy club session at a health facility in Kenya. (Photo by M4ID)

We were pleased to see the blog post from the Maternal Health Task Force which highlighted a review of published literature and informant interviews to develop a common model for group antenatal care (ANC), an innovative service delivery approach for re-organizing ANC in low-resource settings. In comparison to the current one-on-one model, group ANC is increasingly recognized as being more responsive to women’s and health providers’ needs,  encouraging self-care, and providing women with the emotional and social support to navigate an often isolating and stressful time in their lives. Continue reading “Pregnancy clubs: Group antenatal care in Uganda and Kenya”

Estrategias de abogacía para promover la partería en México

Por Eliana Monteforte y Aishling Thurow

(Read the English version here.)

Fotografía por Eliana Monteforte/ MSH

Las parteras son la primera línea en la atención en salud materna, y pueden constituirse en potentes defensoras de cambios ya que conocen los enormes obstáculos que atentan contra su capacidad de brindar una atención de cálida a cada mujer que reciben en su centro de salud o su comunidad. Ellas conocen perfectamente las necesidades en salud de las mujeres y sus bebés debido a que trabajan cada día para satisfacer dichas necesidades. Identifican las limitaciones en los sistemas de salud – en términos de recursos, personal, establecimientos y políticas- y permanentemente bregan para solventarlas. Y manifiestan abiertamente sus necesidades de capacitación, supervisión y políticas más justas, porque a esta labor que han dedicado sus vidas y representa su sustento.

El gobierno mexicano ha sido receptivo a la necesidad de fortalecer el rol de la partería profesional en el continuo de atención a la mujer, y las parteras han aprovechado esta voluntad política para hacer incidencia política a favor de su profesión en sus respectivos estados.  En febrero de 2018, el Programa de FCI en MSH, con apoyo de la Fundación John D. and Catherine T. MacArthur convocó a equipos de parteras y profesionales de salud de cinco estados mexicanos a que desarrollaran planes estratégicos de abogacía. El propósito del taller fue promover políticas estatales que permitan a las parteras brindar una atención de calidad y respetuosa a las mujeres, las adolescentes y los recién nacidos. Continue reading “Estrategias de abogacía para promover la partería en México”

Advocacy strategies for advancing midwifery in Mexico

By Eliana Monteforte and Aishling Thurow

(Leer la versión de español aquí.)

Eliana Monteforte is a Senior Technical Advisor, and Aishling Thurow is a Project Support Associate at Management  Sciences for Health

Photo by Eliana Monteforte/ MSH

Midwives can be powerful advocates for change because, as frontline health workers, they know all too well the enormous challenges that threaten their ability to deliver high-quality care to every woman they see in their clinic or community.  Midwives understand the health care needs of women and newborns because they work to meet those needs every day. They see the gaps in their health care systems–in resources, staffing, facilities, and policies–because they continuously struggle to fill those gaps. And they speak the truth about their needs for training, support, and enabling policies–because this is the job to which they have dedicated their lives and livelihoods.

The Mexican government is receptive to strengthening the role of professional midwifery in the continuum of women’s health care, and midwives are ready to leverage this political will to advocate for their profession in their respective states. In February, the FCI Program of MSH, with support from the John D. and Catherine T. MacArthur Foundation, convened teams of midwifery providers from five Mexican states to develop advocacy strategies to advance state-level policies that enable midwives to provide high-quality, respectful care for women, adolescents, and newborns. Continue reading “Advocacy strategies for advancing midwifery in Mexico”

Identifying and Treating Gestational Diabetes Among Women Living with HIV in Ethiopia

By Mebrahtu Abraha Gebremikael, Elke Konings and Christie Roberts, Management Sciences for Health (MSH)

This article originally appeared on the Maternal Health Task Force (MHTF) blog

Gestational diabetes may be a neglected contributor to the continuing high rates of maternal and neonatal mortality in sub-Saharan Africa. Without proper care, gestational diabetes—high blood sugar that is detected during pregnancy (and can include previously undetected pre-pregnancy diabetes)—increases the risk of eclampsia, miscarriage, obstructed labor, hemorrhage and fetal death, yet pregnant women in developing countries are rarely screened for the condition. Gestational diabetes is also a leading risk factor for preterm birth and stillbirth and can lead to other newborn health complications, such as abnormal birth weight, congenital malformation, respiratory distress syndrome and hypoglycemia.

recent study conducted in Ethiopia by Management Sciences for Health at one rural and two urban health centers in the Tigray Region of Ethiopia aimed to understand the prevalence of gestational diabetes in Ethiopia and its risk factors and assess the feasibility of integrating low-cost services for gestational diabetes into antenatal care. The study found that relatively simple and low-cost interventions could help manage gestational diabetes for many women—but there were different outcomes among women living with HIV and those without the condition. Continue reading “Identifying and Treating Gestational Diabetes Among Women Living with HIV in Ethiopia”

Midwives of Hidalgo

Videographer: Pablo Romo Alvarez

Professional midwives provide lifesaving care to women and newborns. The government of Hidalgo state, Mexico, has launched a comprehensive midwifery program that aims to improve maternal health outcomes while providing services to women along the continuum of care, from pre-pregnancy to delivery and the immediate postnatal period

With funding from the John D. and Catherine T. MacArthur Foundation, the FCI Program of MSH works with midwives and maternal health service providers to strengthen advocacy and build evidence for midwifery practice in six states in Mexico.

 

 

Targeting Gestational Diabetes During Antenatal Care: Experience from Ethiopia

By Mebrahtu Abraha Gebremikael, Elke Konings and Christie Roberts, Management Sciences for Health (MSH)

This article originally appeared on the blog for the Maternal Health Task Force (MHTF)

Photo by Warren Zelman

Even as more women in Ethiopia are receiving antenatal care (ANC) services, coming earlier in their pregnancies and more frequently for care, maternal mortality remains high. The leading causes of maternal death include hypertension, eclampsia, hemorrhage and obstructed labor, all of which are more common among women with gestational diabetes, or high blood sugar that is detected during pregnancy. Gestational diabetes can also have serious effects on babies, including abnormal birth weight, congenital malformation, respiratory distress syndrome or stillbirth. Evidence suggests that gestational diabetes is highly treatable and, since it is associated with other conditions, there may be opportunities for integrated treatment approaches. But pregnant women in Ethiopia are rarely screened for this condition, which contributes to gaps in diagnosis and the measurement of prevalence. In fact, it is not clear how widespread the problem is around the world: Varying estimates show gestational diabetes affecting less than 1% to as many as 28% of pregnant women globally. Continue reading “Targeting Gestational Diabetes During Antenatal Care: Experience from Ethiopia”

In Mali, community volunteers strive to stem the practice of female genital mutilation

Community volunteers display flipcharts they use to inform community members about harmful consequences of gender-based violence, including female genital mutilation. Photo by Adama Sanogo/MSH

I started practicing female circumcision when I was 20 years old. I learned the practice from my grandmother and mother as a way to make money. One day, after seeing the consequences of circumcision, I realized the extent to which women and girls suffered in terms of health, psychology and morale. So I am committed as a community focal point in the village of Waïlirdé and as a woman and mother to fight against this practice that is harmful to health.

My main responsibility is to share information and knowledge with members of my community.  Informing people about the consequences of female circumcision allows those who suffer to seek the help they need and help prevent future occurrences.  Additionally this can help people understand the link between current health issues and circumcision.  Above all, I work to raise everyone’s awareness of the danger of the practice to spare young girls from facing this torture.  

–Fatouma, Waïlirdé village, Mali

In the Mopti region of central Mali, about 88% of women aged 15-49 have undergone female circumcision–or female genital mutilation (FGM); almost 69% of these women were circumcised by the time they were five years old (Mali DHS, 2012-2013). As such practices are deeply rooted in the cultural, religious, economic, and social heritage of Mopti, ending them requires strong and concerted community engagement and action.

The FCI Program of MSH mobilizes leaders and communities in Mopti to advance women’s and girls’ health and rights and to end sexual and gender-based violence (SGBV) and harmful practices such as female genital mutilation (FGM) and child marriage. With funding from the Embassy of the Netherlands in Bamako, and in partnership with the Malian non-governmental organization Conseils et Appui pour l’Education à la Base (CAEB), the FCI Program of MSH leads the Debbo Alafia Consortium of multi-sectoral, national, and international organizations to carry out social and behavior change activities and to provide essential medical and psychosocial support to women and girl survivors of gender-based violence, female genital mutilation, and other harmful practices. Leveraging political and religious leaders’ significant influence on public opinion and acceptance, Debbo Alafia also strengthens political commitment and recruits champions to publicly call for the end of harmful practices and promote sexual and reproductive rights for women and girls.

UNICEF and the SGBV Humanitarian Subcluster (awarded through UNFPA) have supported the FCI Program’s work with trained community volunteers, like Fatouma, to discourage the practice of FGM by informing community members about the harmful short-term and chronic health consequences, such as excessive bleeding, infections, swelling, menstrual problems, maternal health complications, even death. These volunteers also refer SGBV survivors to free medical, psychosocial, and legal support services; providers of these services work with the FCI Program of MSH to ensure they are giving respectful, confidential, and safe care to survivors of SGBV.

Community volunteers, forming protection teams that support SGBV prevention and response, have successfully stopped circumcision ceremonies. During a Debbo Alafia meeting of partners and government officials last year, FCI Program staff received news about a circumcision ceremony in progress in the village of Koro. Debbo Alafia partners and government officials went to the ceremony site to convince the circumciser to stop and the parents to take their girls home. Although several girls had already been cut, several more were spared.

As women and girls in the North and surrounding regions remain particularly vulnerable to sexual and gender-based violence (SGBV) and often do not seek or receive appropriate care, the FCI Program of MSH is leading a study, with support from Amplify Change, to investigate the barriers that deter SGBV survivors from accessing care. Using the findings from this study, the FCI Program of MSH will bring together local actors to develop advocacy and program strategies to reduce these barriers to care.

Standing with Women and Girls to End AIDS

By Sarah Konopka

Sarah Konopka, MA, is Principal Technical Advisor for HIV & AIDS Management Sciences for Health’s (MSH) Global HIV & AIDS Program. Follow Sarah on Twitter . This article originally appeared on MSH’s Global Health Impact blog. 

Photo Credit: Mark Tuschman

There was an awkward silence and then soft giggling as the girls looked at each other. I had just finished talking about strategies for persuading sexual partners to use a condom. Laughter during these skills-building and girls empowerment sessions with 30+ secondary school students in Morogoro, Tanzania was not uncommon, particularly given the sometimes sensitive topics of discussion, but this time, the joke was lost on me. Continue reading “Standing with Women and Girls to End AIDS”