Ending gender-based violence and FGM in Mali, village by village

Martha Murdock is Technical Strategy Lead for regional programs at the FCI Program of Management Sciences for Health.

Communities in the Mopti region of central Mali—which is home to several ethnic groups and to many people displaced by 2012 violence in the country’s northern region—continue to grapple with widespread sexual and gender-based violence (SGBV), including forced and early marriage and other harmful practices. A majority of Malian girls are married by the time they reach 18, and 15% before the age of 15.  About 91% of women between 15 and 49 years old, as well as 69% of girls under 15, have undergone female genital mutilation (FGM). And, as is true in so many conflict-affected areas, widespread sexual violence has been a tragic and infuriating effect of war, dislocation, and migration.

After many years of work in Mali, both in the Mopti region and nationally, the FCI Program of Management Sciences for Health is committed both to reducing the incidence of SGBV and to mitigating its devastating effects on survivors. Because harmful practices are deeply rooted in the region’s cultural, religious, economic, and social heritage, ending them requires strong and concerted community engagement and action. But the impact of this work could not be any more powerful, as we learn again and again from the women whose strength, resolve, and resilience continue to inspire us.

An SGBV survivor arriving for medical and psychosocial care
Photo: Adama Sanogo/ Management Sciences for Health

Continue reading “Ending gender-based violence and FGM in Mali, village by village”

Uniting the Community to Prevent and Respond to Gender-Based Violence in Mali

Martha Murdock is Technical Strategy Lead for regional programs at the FCI Program of Management Sciences for Health. This post originally appeared on MSH’s Global Health Impact Blog

As a part of the international “16 Days of Activism Against Gender-Based Violence” campaign for the prevention and elimination of violence against women and girls, MSH is sharing its experience working to eradicate gender-based violence.

Photo credit: Adama Sanogo/MSH
Photo credit: Adama Sanogo/MSH

“We remember the hard times the women and girls of Douentza have experienced,” said Animata Bassama, a representative of the women of Douentza, referring to the fighting and ensuing gender-based violence (GBV) that plagued Mali in 2012.

Animata spoke to a crowd of 100 government officials, NGO representatives, health and finance officials, women’s advocates, and community members. A new center for GBV survivors, fortified by concrete and adorned in yellow and pink, was her backdrop. Continue reading “Uniting the Community to Prevent and Respond to Gender-Based Violence in Mali”

Supporting midwives for a better tomorrow

Martha Murdock is Vice President for Regional Programs at Family Care International.

Midwives save lives. It’s as simple as that. But the obstacles and barriers midwives face are anything but simple.

We all know that midwives have crucial clinical skills that help them care for women and their newborns everyday all over the world. If these lifesaving services were available and accessible to all the women and babies who need them, midwives could help avert two-thirds of the nearly 300,000 maternal deaths and half of the 3 million newborn deaths that occur every year. Midwives play an absolutely critical role in making progress on Millennium Development Goals 4 (reducing child mortality) and 5 (improving maternal health and achieving universal access to reproductive health). And without a well-supported, trained, and supplied midwifery cadre, we won’t be able to meet the maternal and child health targets that will be part of the post-2015 agenda. We’re delighted to join our colleagues at the International Confederation of Midwives (ICM) in celebrating the International Day of the Midwife today, 5 May. Continue reading “Supporting midwives for a better tomorrow”

A Price Too High to Bear: Showing Kenya the devastating costs of maternal death

Martha Murdock is FCI’s vice president for regional programs.

Last week in Nairobi, a range of partners — from the Kenyan government, UN agencies, donor countries, and many NGOs and research organizations from the national and county levels — came together for a presentation of new research that has the potential to increase the momentum of efforts to save the lives of nearly 300,000 women who die each year (5,500 of them in Kenya) from causes related to pregnancy and childbirth.

Each of these avoidable, premature deaths is a tragedy in its own right, and a terrible injustice. Each of these women — some of them barely more than girls — has a right to life and health, and to a standard of health care that protects her from preventable illness, injury, and death.

But we who work to improve maternal health have argued for years that each of these deaths also brings countless additional layers of loss, pain, and destruction. The tragic, sudden death of a woman in the prime of life — in many cases already a mother and often the most economically productive member of the family — begins a cascade of loss and pain that upends the lives of those around her: her newborn baby (if it survives) and her older children, husband, parents, and other members of her family and community.

Up until now, however, we haven’t had the hard data to support our case, to help us persuade governments, donors, and policy makers that investments in maternal health are also investments in children, in stable families, in education and community development, and ultimately in stronger national economies. Now, thanks to a study conducted in Kenya by FCI, the International Center for Research on Women (ICRW), and the KEMRI-CDC Research and Public Health Collaboration, we know that the data behind that argument is very powerful indeed.

Based on interviews and focus group discussions with every family, across a poor rural area in Siaya County in western Kenya, that had lost a family member to maternal death over a two-year period, we found that:

  • When a mother dies in or around childbirth, her newborn baby is unlikely to survive.
    • Of 59 maternal deaths in the study, only 15 babies survived their first two months of life.
  • A mother’s death harms the educational and life opportunities of her surviving children.
    • Many children had to leave school because the loss of a mother’s income meant that they couldn’t pay tuition fees, needed to work for a living, or had to take up essential household chores.
  • The cost of emergency care (even when unsuccessful), combined with high funeral costs, puts families under a crushing economic burden.
    • Families spent more on funerals than their total annual expenditure on food, housing, and other household costs, after having already spent 1/3 of their annual consumption expenditure on medical costs.
  • Loss of income and high, unexpected costs send many families into a spiral of debt, poverty, and instability.
    • Many families, under desperate financial pressure, had to sell household property, borrow from moneylenders, or move children out of the family home.

When this moving and compelling report was launched in Nairobi last Friday, I was proud to stand at the dais and introduce eminent leaders of efforts to improve women’s and children’s health in Kenya, including the U.K. High Commissioner for Kenya, Dr. Christian Turner (representing the U.K. Government, which funded this important research together with the John D. and Catherine T. MacArthur Foundation and the Partnership for Maternal, Newborn & Child Health). Dr. Turner, in turn, introduced Kenya’s Cabinet Secretary for Health, Hon. James Macharia. With us in the room were important policy makers from the Ministry of Health, national parliamentarians, and high-level representatives from UNICEF, WHO, UNFPA, USAID, and a range of other agencies and organizations.

We came together that morning, I said, “because we are all resolved, together with so many colleagues and partners here in Kenya and around the world, to work together to finally put an end to a tragic toll of maternal and newborn death that goes back to the beginnings of human history.” We have long known that far too many women were dying.  What we lacked, until now, was hard data to help us fully understand the financial and social impact of a mother’s death — the costs to the health and well-being of thousands of surviving children, families, and communities. We and our partners undertook this study because we saw that filling this critical knowledge gap will offer advocates and policy makers a powerful tool for bringing further attention and investment to maternal health.

The messages that emerge from this research were expressed clearly and succinctly by Hon. James Macharia as he presided over the official launch of the report:

A mother’s death ignites a chain of disruption, economic loss, and emotional pain that often leads to the death of her baby, diminished educational and life opportunities for her surviving children, and a deepening cycle of poverty for her family.

The cost of a maternal death is, quite literally, a price too high to bear.

 

(An excellent in-depth news report on the study and its launch, by a leading Kenyan television network, can be viewed here:

Assessing and improving the quality of maternal health care in LAC

Martha Murdock is FCI’s Vice President of Regional Programs.

Last week in Arusha, Tanzania, scientists, researchers, advocates, and policy-makers came together to share knowledge and experiences at the Global Maternal Health Conference 2013.  The conference was co-sponsored by the Maternal Health Task Force (based at the Harvard School of Public Health) and Management and Development for Health (in Dar es Salaam, Tanzania).

Each day of this 4-day conference started with a plenary session; there were then  3 sets of parallel session, during which there were a daily total of 13 concurrent sessions — a wealth of fascinating content and information about technologies and strategies for eradicating preventable maternal mortality and morbidity and improving quality of care.

At the conference, I presented a Rapid Assessment of Skilled Birth Attendants in Eight Latin American & Caribbean Countries, a study examining the role of skilled birth attendants in reducing maternal mortality. The rapid assessment gathered information on who is providing maternal and newborn care in selected health care facilities in Guatemala, Honduras, Bolivia, Panama, Peru, Colombia, Chile, and Guyana, and assesses the quality of that care. The study was conducted in 2011 with funding from UNFPA and UNICEF.

The assessment found that midwife performance rated highest overall in quality and competency, a finding that is consistent with the outcomes of prior studies of midwives and others with midwifery skills. However, study results indicate a need to increase quality of care across all maternal and newborn health care providers. Recommendations for improving quality of care included the following:

  • developing and using a uniform definition of skilled birth attendant
  • promoting maternal-infant bonding and immediate and exclusive breastfeeding
  • reviewing and promoting hand washing
  • promoting the increased availability and use of clean equipment, especially in the absence of potable water
  • establishing mechanisms to systematically monitor and improve the quality of care in the LAC region

Partnering to promote reproductive health for Latin America’s indigenous women

Martha Murdock is FCI’s vice president for regional programs.

I have just arrived in Lima, Peru, where — together with Alexia Escobar and Maritza Segura, FCI’s national coordinators in Bolivia and Ecuador — I will be attendingthe High Level Meeting on Reproductive Health and Intercultural Care in Latin America.

This meeting, hosted by the Peruvian Ministry of Health and the Organismo Andino de Salud as part of  a regional framework sponsored by the Spanish Agency for International Development (AECID) and the UN Population Fund—UNFPA, will bring together high-level health officials from the health ministries of Bolivia, Chile, Colombia, Ecuador, Guatemala, Honduras, Peru, and Venezuela. FCI, a partner in this regional program, is one of the few NGOs invited to the meeting.

In Latin American and the Caribbean, maternal mortality was reduced by 41% between 1990 and 2008. Looking at overall regional and national data, the many countries in the region seem to be on track to achieve the Millennium Development Goal(MDG) 5 target of reducing maternal mortality by ¾ over 20 years. However, when the data is disaggregated by ethnicity,there remain substantial gaps in access to reproductive health services, information, and commodities among indigenous women. Surveys in countries like Guatemala have shown that maternal mortality is up to 3 times higher among indigenous women (211 maternal deaths per 100,000 live births) than among non-indigenous women (70 per 100,000).

In seeking to address these gaps and achieve MDG 5 among all population groups, governments in the region recognize the need to adopt an intercultural approach to maternal and reproductive health services. Since 2009, FCI has been working to strengthen the advocacy capacity of indigenous women’s organizations to demand culturally-appropriate health care, and to promote their direct participation in the design and monitoring of maternal health care services that are sensitive to their cultural traditions. We also work with ministries of health across the region to advance maternal health policies and programs that better respond to indigenous women’s cultural expectations and needs.

This week’s meeting will review the progress that has been made so far, share lessons learned, and set a path to define and agree upon a basic set of indicators of culturally-friendly maternal health services. One expected, and important, outcome of the meeting will be the adoption by all of the Ministers of Health of a joint statement that commits to strengthening and further intensifying measures to make maternal health services more culturally acceptable to indigenous women, in order to improve their health status. Follow The FCI Blog to read their final statement, and to stay up to date as FCI closely monitors its implementation.

Meeting with Maternal Health Champions

Martha Murdock is Vice President, Regional Programs at Family Care International.

About a year ago, the global change organization Ashoka partnered with the Maternal Health Task Force to launch a program called the Ashoka Young Champions for Maternal Health. Fourteen young social entrepreneurs, from 12 countries around the world, were selected through a rigorous online competition to be the first of “a new generation of global leaders dedicated to improving maternal health.” The Young Champions have spent the past nine months as interns gaining hands-on knowledge about maternal health and change-making, mentored by Ashoka Fellows in Asia, Latin America and Africa.

Last week, I had the good fortune to spend some time with the Young Champions, at their end-of-program conference (the “Young Champions Future Forum”) in Accra, Ghana. I heard about the incredible range of innovative social ventures that they had the opportunity to develop  — from a program that reintegrates obstetric fistula survivors using community-based credit schemes, to a project that develops links between traditional birth attendants and skilled obstetric care providers in rural areas where use of institutional delivery care is low. Over three days of fellowship and robust debate, these young innovators discussed how to ensure community ownership of social change initiatives in isolated rural areas, the most effective strategies for conducting advocacy and outreach using social media, and the challenges faced by new professionals as they enter the maternal health field. As someone who’s been doing this work for more than two decades, I found the experience — the energy and commitment of my young colleagues, and the originality and quality of their thinking — to be frankly inspiring. I’m looking forward to seeing a lot more of these Young Champions, whose work I expect will make real impact in our field.

After the Ghana conference, I moved onto Ouagadougou, where I spent four days meeting with the team at FCI-Burkina Faso. They are doing exciting work, and I’ll report on developments there in a follow-up post.

  • Read blogs by the Ashoka Young Champions for Maternal Health