On March 15, 2017, Management Sciences for Health (MSH), the Ministry of Foreign Affairs of Denmark, Women Deliver, Novo Nordisk, and the NCD Alliance, of which MSH is a steering committee member, 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.”
Global health investments should target strategies that incorporate a lifecycle approach, so that health systems deliver comprehensive care for every woman, at every stage of life. For instance, MSH works with governments and partners to strengthen health systems that can deliver services to meet the physical and mental health needs for all women.
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. For example, through the USAID-funded Ethiopia Network for HIV/AIDS Treatment, Care and Support, MSH found that a majority of clients diagnosed with gestational diabetes responded well to simple behavioral interventions, such as changes in diet and exercise.
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.”
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 are more than their reproductive and maternal health. To value their health and lives, investments, strategies, and programs must address their entire life course.
“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: