Beyond reproductive and maternal health: Non-communicable diseases and women’s health

On March 15, 2017, Management Sciences for Health, the Ministry of Foreign Affairs of Denmark, Women Deliver, Novo Nordisk, and the NCD Alliance hosted a panel discussion during the Commission on the Status of Women to call for the integration of the prevention and treatment of non-communicable diseases (NCDs) into the reproductive, maternal, newborn, child, and adolescent health continuum of care. The following post summarizes the key messages from the side event and offers recommendations for further action.

Women are essential to a vibrant, healthy economy. Women are producers, caretakers, and consumers–and when they are oppressed and devalued, the economy stalls. Women’s full participation in the workforce is contingent on their ability to realize their fundamental human rights, including the right to health.

“We must empower women and girls with information, health services, and outreach,” said Amy Boldosser-Boesch, Senior Director of the FCI Program of MSH. “Empowerment of women is crucial to achieving improved outcomes for all.”

About 18 million women die every year from non-communicable diseases (NCDs), such as diabetes and cervical cancer, and many of these women come from lower and middle-income countries. Although largely preventable and treatable, non-communicable diseases are on the rise, and adolescents are increasingly at risk. According to the Global Strategy for Women’s, Children’s, and Adolescent’s Health (2016-2030), 70 percent of NCDs-related adult deaths are linked to risk factors that begin during adolescence. To prevent premature adult death from NCDs, Sustainable Development Goal 3.4 calls for the reduction of “noncommunicable diseases through prevention and treatment and the [promotion of] mental health and well-being,” while the Global Strategy recommends integrating NCDs prevention and treatment with women’s, children’s, and adolescents’ health care.

“We need to break down traditional silos to address the NCD burden,” said Karen Ellemann, Minister for Equal Opportunities and interim Minister for Health of Denmark. “An integrated approach supported by innovative financing and partnerships can help fortify investments.”

Even in countries with relatively promising maternal, newborn, and child health indicators, inequities in health coverage can exacerbate the impact of NCDs. In Sri Lanka, isolated tea plantation communities experience high rates of cervical cancer, mental health problems, and substance abuse, according to Sarah Soyosa, Women Deliver Young Leader and Sexual and Reproductive Health Coordinator for Asia Doctors of the World. Young people lack access to mental health counseling as well as sexual and reproductive health services. And young women often feel uncomfortable getting tested or treatment for sexually transmitted infections (STIs) or human papillomavirus (HPV), which can lead to cervical cancer.

Dr. Bulbul Sood, Country Director of Jhpiego in India, leads a project in partnership with Novo Nordisk to implement gestational diabetes guidelines in antenatal services in the state of Madhya Pradesh. The project’s baseline survey revealed that only 50 percent of 170 facilities were testing blood sugar levels–and most of these tests were done randomly. Gestational diabetes is easily treatable; almost 90 percent of all women diagnosed with gestational diabetes can manage their condition with lifestyle modifications and nutrition, and only 1 percent of women need insulin. Yet, if gestational diabetes remains undiagnosed, women might have pregnancy or childbirth complications or develop Type 2 diabetes, and babies might experience health challenges as well.

“If I can just promote one thing, it would be universal screening for gestational diabetes for all women,” Dr. Sood said. “Then we can prevent needless deaths of many women and babies.”

Recommendations

The panelists offered lessons from their projects and recommendations to civil society organizations (CSOs). Priya Kanayson, Advocacy Officer from the NCD Alliance, framed these recommendations as the four “As” of action:

Advocacy:  Make the case to governments for integration of NCDs prevention and treatment at all levels, in a language they can understand.  Advocate for simple interventions (gestational diabetes test and HPV vaccine) that work.

Awareness:  Work with women and girls to educate their communities on NCDs prevention, informing them of risk factors and recommending nutritious foods, physical activities, and preventive care such as vaccines. Engage religious leaders, government ministries, health care providers, adolescents and youth, and media on NCD issues, including mental health.
Use mobile phone applications to reach young people.

Access: Train health care providers to offer judgment-free and youth-friendly sexual and reproductive health information and services. Work with schools and youth programs to provide comprehensive sexuality education to adolescents and youth. Mobilize community health volunteers to encourage young women to get tested for STIs and HPV. Provide regular screenings for high blood pressure, diabetes in pregnancy and cervical cancer. Offer access to high-quality, affordable, and respectful treatment and care for NCDs, such as high blood sugar treatments during routine antenatal visits.

Accountability: Establish partnerships with the private sector to move from policy to actual implementation. Communicate! Share updates on progress for NCD integration; seek and incorporate feedback. Engage grassroots advocates and health workers, as they best understand the problems women face in their communities.

“Women and girls carry more than babies–or water,” said Katja Iversen, President and CEO of Women Deliver. “They carry families. They carry businesses. They carry potential. And investing in their health, rights, and wellbeing creates a positive ripple effect that can lift up communities, and even entire countries.”

To learn more about integrating NCDs into the RMNCAH continuum of care:

Universal  Health Coverage and  Non-Communicable  Diseases:  A Mutually Reinforcing Agenda

Gestational Diabetes: A Risk Factor for Maternal Death in Tigray, Ethiopia

 

Global and national maternal mortality targets for the Sustainable Development Goals

By: Rima Jolivet, Maternal Health Technical Director, Maternal Health Task Force; Sarah Hodin, Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public Health

This post originally appeared on the MHTF Blog.

There has been some confusion recently about the Sustainable Development Goals (SDG) target for reducing global maternal mortality. The SDG global target is to reduce the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births by 2030. In addition to this global target, there are separate country-level targets: The primary national target is that by 2030, every country should reduce its MMR by at least two-thirds from its 2010 baseline. The secondary target, which applies to countries with the highest maternal mortality burdens, is that no country should have an MMR greater than 140 deaths per 100,000 live births by 2030.

Continue reading “Global and national maternal mortality targets for the Sustainable Development Goals”

Universal health coverage and gender

By Stacy Lu

This interview with Kiley Workman Diop originally appeared on the blog for Systems for Improved Access to Pharmaceuticals and Services (SIAPS), a program funded by USAID and implemented by Management Sciences for Health. This interview has been edited for length. 

Kiley Workman Diop is a Technical Advisor for SIAPS, and Stacy Lu is a Technical Writer for SIAPS.

A pharmacist with a client at the pharmacy for the the Hospital Notre Dame des Palmistes, Ile la Tortue, Haiti  (Photo credit: Jean Jacques Augustin)

How does attention to gender figure into the work SIAPS does in strengthening pharmaceutical systems?
In public health, when you’re designing an intervention you’re trying to think broadly about what’s going to help the whole population. But you also need to pay special attention to vulnerable groups, including groups that derive their vulnerability from their gender. In a broad sense, it’s about equity—if half the population (whether men or women, boys or girls) isn’t being served appropriately by our interventions, that dilutes SIAPS’s success and we miss out on achieving equitable access to medicines and services that help save lives. We have to think about gender to ensure equitable access to quality care.

Continue reading “Universal health coverage and gender”

PROGRES requires a keen gender perspective

By Alanna Savage and Andrew Gaydos

Alanna Savage is a Senior Communications Specialist for the FCI Program of Management Sciences for Health (MSH) and Andrew Gaydos is a Project Support Associate at MSH.

In our ambitious vision to reach all people, everywhere, it is ever more necessary to examine the varying life experiences–the actual realities–of the people whose health we work to improve. Part of this examination requires a critical look at how gender plays out in the power structures of society, the daily lives of people, and more concretely, in the “who, what, where, when, and how” of health-seeking behavior and access to essential reproductive and maternal health care.

Maternal mortality in Mali remains high–587 women die for every 100,000 live births–but only 28 percent of sexually active women of reproductive have satisfied their demand for family planning.  Women and girls continue to confront widespread sexual and gender-based violence, including female genital mutilation/cutting (FGM/C); in 2015, about 126,000 women and girls received prevention services, protection, and care related to FGM/C. And thanks to the work of the FCI Program of MSH, traditional and faith leaders are advocating for family planning and coming together to provide support to survivors of gender-based violence and to identify early warning signs of imminent violence.

Gender inequality undoubtedly plays a role in high maternal mortality and unmet need for family planning and the continuance of sexual and gender-based violence. As long as women and girls must continue to fight for equal voice and an equal share of opportunity and power, their lives and health will remain under threat. Gender influences health outcomes, access to care, providers’ treatment of patients, relationships among health workers and supervisors, and health career barriers and opportunities.

Photo by Catherine Lalonde

Continue reading “PROGRES requires a keen gender perspective”

We are fearless. #FearlessFeb

Photo by Joey O’Loughlin

We are celebrating Fearless February to rally the global community around advocacy for reproductive, maternal, newborn, child and adolescent health!

This month, the FCI Program of MSH will feature stories about fearless champions, powerful evidence, and advocacy wins from the Rights & Realities archive. Follow #FearlessFeb on Twitter and Facebook to read the story of the day.

Join us on Twitter and Facebook, and tell us:
What makes you fearless? What does “fearless” mean to you?
Subscribe to Rights & Realities (on the homepage, right column) to receive emails of new posts.

 

Trump’s global gag rule silences doctors and midwives and harms their patients

By Catharine Taylor

Catharine Taylor is Vice President for health programs at Management Sciences for Health. This post originally appeared on STAT News

Midwifery students in Sierra Leone, which has one of the highest maternal mortality rates in the world. Funding for safe pregnancy and delivery worldwide is threatened by President Trump’s reinstatement of the global gag rule. (Photo by MARCO LONGARI/AFP/Getty Images)

President Trump’s reinstatement of the Mexico City Policy, better known as the global gag rule, came as no surprise to anyone working in the field of global health. We have been through this before — in 1984, when the policy was first put into effect by President Reagan, and then in 1993, 2001, and 2009, when it was repealed, reinstated, and repealed again.

The Mexico City Policy is called a gag rule because it limits not just what organizations and health providers do but what they are permitted to say. It prevents foreign organizations that receive US government funding from performing abortions — even if they are using funds from non-US government sources and even if abortion is completely legal in their countries.

The global gag rule also steps right between a woman and her doctor, nurse, or midwife, preventing these frontline health providers from telling their patients about the full, legal range of health options available to them. It forbids trusted advisers from giving honest, comprehensive health advice and information. I started my career as a nurse-midwife, and then worked in maternal and newborn health programs in Africa and Asia, so I know what this will mean for the lives and health of women and their families. Continue reading “Trump’s global gag rule silences doctors and midwives and harms their patients”

Counting every maternal death: Strengthening maternal mortality surveillance and response in the Caribbean

By Aishling Thurow

Aishling Thurow is a Project Support Associate at Management Sciences for Health. 

Every maternal death must be documented to prevent the next one. In the Caribbean, where 175 women die for every 100,000 live births (WHO, 2015), understanding the reasons they died is essential to preventing more unnecessary maternal deaths in the future.

In 2013, the World Health Organization developed guidelines for maternal death surveillance and response (MDSR) to capture the number and systemic causes of maternal deaths and to strengthen policies and programs that will better respond to maternal health needs.

Delegates and organizers from the Technical Consultation on the Maternal Death Surveillance and Response Guidelines (MDSR): Region of the Americas. Dec. 9, 2016. Montego Bay, Jamaica. Photo by Aishling Thurow/MSH

In December 2016, the Latin America and Caribbean Regional Task Force for the Reduction of Maternal Mortality (GTR for its Spanish acronym), of which MSH is an Executive Committee member, hosted a technical consultation on guidelines for maternal death surveillance and response systems in the Caribbean. Held in Montego Bay, Jamaica, the workshop welcomed 20 delegates−Ministry of Health officials, as well as prominent maternal mortality surveillance experts−from Jamaica, Belize, Suriname, Guyana, and Trinidad and Tobago. The workshop aimed to strengthen maternal mortality surveillance and response systems in the sub-region, to improve maternal mortality data quality, and to strengthen policy development and implementation capacities at the national level.

Continue reading “Counting every maternal death: Strengthening maternal mortality surveillance and response in the Caribbean”

Emergency contraception is a simple part of post-rape care: Why is it not routinely provided?

By Melissa Garcia and Sarah Rich

Melissa Garcia is Senior Technical Officer for the International Consortium for Emergency Contraception and Sarah Rich is Senior Program Officer at Women’s Refugee Commission. This post originally appeared on the blog for the Sexual Violence Research Initiative

Emergency contraception (EC) can reduce the risk of pregnancy after unprotected sex, including in cases of sexual violence. Global guidance is clear that EC should be offered to women and girls within 120 hours of sexual violence to prevent the traumatic consequences of pregnancy resulting from rape.

Yet women and girls who have experienced unprotected sex, including through sexual violence, do not routinely have access to EC. The global aid communities must work together to increase access to EC for sexual violence survivors around the world, including for women and girls who are the most marginalized, like those living in crisis-affected settings. A range of strategies can be implemented to improve access to EC. Further research is also needed to identify, evaluate, and invest in new and innovative solutions. Continue reading “Emergency contraception is a simple part of post-rape care: Why is it not routinely provided?”

Webinar presentation – Misoprostol for PPH: Innovations for Impact

On December 15, MSH, Gynuity Health Projects and Jhpiego hosted a one-hour webinar to share innovations – interventions, technologies, and distribution approaches – that have the potential to increase access to and use of misoprostol for postpartum hemorrhage (PPH), the leading cause of maternal death. This webinar:

  • Highlighted innovative ways that countries are expanding access to and use of misoprostol for PPH
  • Showed how successful innovations can be scaled up for national impact

PRESENTERS
Esther Azasi
Knowledge Management Specialist & Associate Program Manager, One Million Community Health Workers Campaign-Millennium Promise, Ghana

Holly Anger
Program Associate, Gynuity Health Projects, USA

Gail Webber
Saving Mothers Project, Mara Region, Tanzania and University of Ottawa, Canada

Partamin Manalai
Monitoring, Evaluation and Research Director, Jhpiego, Afghanistan

MODERATOR
Shafia Rashid
Senior Technical Advisor, FCI Program of Management Sciences for Health (MSH)

Listen to the webinar and download the presentation slides here.