A door-to-door campaign for antenatal care

This story originally appeared on the Management Sciences for Health website.

When her rapist was arrested, 16-year old Brigitte* thought the worst was behind her. But when she discovered she was pregnant, she had little choice but to drop out of school and work the family fields in her village, in the Manika health zone of the Democratic Republic of Congo (DRC). She certainly could not afford antenatal care (ANC) visits.

The DRC government has made maternal health one of its highest priorities, and partners like the USAID-funded Integrated Health Project Plus (IHPplus) have collaborated with the Ministry of Health to make that vision a reality. Knowing that ANC visits are out-of-reach for many women, IHPplus subsidizes free and reduced-cost care for expectant mothers. And knowing that many women are not aware of the benefits of ANC visits, IHPplus has organized a variety of campaigns to educate mothers-to-be. Continue reading “A door-to-door campaign for antenatal care”

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— in 1984, when the policy was first put into effect by President Reagan, and then in 1993, 2001, and 2009, when it was repealed, reinstated, and repealed again.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”

A new chapter for FCI’s lifesaving mission!

Amy Boldosser-Boesch is the Senior Technical Director for the FCI Program of Management Sciences for Health (MSH). To receive updates in your inbox from the FCI Program and other MSH programs, please subscribe here.

Photo: Catherine Lalonde
Photo: Catherine Lalonde

A lot has happened since we first announced, a couple of months ago, the exciting news that a new chapter has begun for FCI’s mission to save women’s lives!

Now a part of Management Sciences for Health, the FCI Program of MSH has hit the ground running. Continue reading “A new chapter for FCI’s lifesaving mission!”

Maternal and newborn health in the hands of midwives

Amy Boldosser-Boesch is the Interim President and CEO at Family Care International. This article originally appeared on the Maternal Health Task Force blog as part of a series for the Global Maternal and Newborn Health Conference, October 2015 in Mexico City.

The year 2015 has been one of dramatic movement for global maternal and newborn health—from the end of the Millennium Development Goals to the beginning of a universal and even more ambitious global agenda. The Global Maternal and Newborn Health Conference is a key moment to examine how the Sustainable Development Goals will help ensure and improve quality of care, integration and equity. I’m pleased to see on the conference program a focus on midwives, a key partner in turning the conference themes and focus into a reality for women and their families everywhere.

At this crossroads moment in global development, it’s a travesty that the countries burdened with 92% of the world’s maternal and newborn deaths have only 42% of the world’s midwives, nurses and doctors. Even though we have the medicines and the technology to make sure no woman or newborn dies from preventable causes, a person’s place of residence often still determines whether–and how–she will live or die. This is simply unacceptable. Fortunately, skilled midwives can prevent up to two-thirds of maternal and newborn deaths, and in doing so can turn around health care in their communities, according to UNFPA’s State of the World’s Midwifery Report 2014.

Burkinabé midwives gather to discuss advocacy for supportive midwifery policies using data from the State of the World’s Midwifery Report 2014.
Burkinabé midwives gather to discuss advocacy for supportive midwifery policies using data from the State of the World’s Midwifery Report 2014.

Continue reading “Maternal and newborn health in the hands of midwives”

VIDEO- Countdown to 2015: A decade of tracking progress for maternal, newborn, and child survival

This new video looks at the past and to the future of Countdown to 2015, a global movement of academics, governments, international agencies, health-care professional associations, donors, and nongovernmental organizations to stimulate and support country progress towards achieving the health-related Millennium Development Goals (MDGs).

Countdown launched its last report of the MDG era—a final accounting of progress and remaining gaps in the 75 countries that have more than 95% of all maternal, newborn and child deaths—at the Global Maternal Newborn Health Conference in Mexico City.

FCI is proud to be the co-lead communications and advocacy partner in Countdown to 2015.

Interview with Sékou Traoré, Mali peer educator

Sékou Traoré, 26, became one of FCI Mali’s youth peer educators, or un educateur-leadeur, two years ago. He works as a mechanic at a garage in Bamako, making him one of many Malian youths who work in the economy’s informal sector. Youth in the informal sector have been, and remain, difficult to reach with health awareness and advocacy messages, because they take jobs rather than attend school where these youth health messages are concentrated.

While Sékou maintains his job, he works for FCI as a peer educator as often as time allows, sometimes once a week for a few hours, and sometimes two or three times a week. Sékou dedicates most of his free time to FCI.

Sekou Traore
Photo by Catherine Lalonde

Continue reading “Interview with Sékou Traoré, Mali peer educator”

New advocacy tool: briefing cards on SRHR and the post-2015 development agenda

Amy Boldosser-Boesch is the Interim President and CEO at Family Care International. This article originally appeared on the MDG456Live Hub, curated coverage of women and children during the UN General Assembly.

SRHRAs we move into the intergovernmental negotiations for defining the post-2015 development agenda, continued advocacy will be needed to link sexual and reproductive health and rights (SRHR) to sustainable development. Do you have the talking points you need to make the case that governments must ensure the comprehensive inclusion of sexual and reproductive health and rights within the post-2015 development framework?

A new tool Briefing Cards: Sexual and Reproductive Health and Rights (SRHR) and the Post-2015 Development Agenda can help. The briefing cards detail the linkages between SRHR and other key development issues including environmental sustainability, gender equality, economic growth, educational attainment, and broader health goals. Produced by FCI, with support from the UN Foundation, and co-authored by partners in the Universal Access Project, each one page card provides advocates with succinct arguments and key Facts at a Glance about the impact of SRHR on the broader development agenda. Each card also includes recommendations for inclusion of SRHR in the post-2015 development framework in a cross-cutting way, for example, by encouraging targets and indicators that address and measure the strong connections between girls’ education and their sexual and reproductive health and rights. All of the partners involved in developing the Briefing Cards hope that they will be a useful tool for advocates worldwide working to shape the social, economic and environmental aspects of the post-2015 sustainable development agenda. The cards are available for free download; please share them with your partners and help us make the case with governments and other stakeholders in the post-2015 process that sexual and reproductive health and rights are integral to the achievement of all shared development goals.

For more information, please email contact[at]familycareintl.org or womenandgirls[at]unfoundation.org

 

 

 

Forgotten women: UNAIDS, PEPFAR, and ‘keeping mothers alive’

Ann Starrs is president and co-founder of Family Care International. This article has been cross-posted on RH Reality Check, the Kaiser Daily Global Health Policy Report, and the Maternal Health Task Force blog.

Two years ago, in July 2011, UNAIDS  launched a joint initiative with PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief, to help achieve the goal of an AIDS-free generation. The ambitious, if clumsily named, “Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive” included two global targets:

  • Reduce the number of new HIV infections among children by 90%
  • Reduce the number of AIDS-related maternal deaths by 50%

Today, UNAIDS and PEPFAR released a new report on progress in this important initiative. The report and accompanying press release highlight the very welcome news that seven countries (Botswana, Ethiopia, Ghana, Malawi, Namibia, South Africa and Zambia)have reduced mother-to-child-transmission of HIV by 50% or more, with two additional countries (Tanzania and Zimbabwe) close to achieving that rate of reduction.

UNAIDS, PEPFAR, and all of their global and country partners deserve sincere congratulations for this tremendous accomplishment, achieved in a relatively short span of time. Progress toward the Global Plan’s first target has been truly impressive.

But their report almost completely ignores the plan’s second target, and in fact the second part of its long title — “…and keeping their mothers alive.” Perhaps a more accurate title for the initiative, at least as reflected in this report, would have been “Global plan towards the elimination of new HIV infections among children, and keeping their mothers alive just as long as they are pregnant or breastfeeding  (but after that, not our concern…)”

Ok, maybe I’m being a bit too harsh. But in the report’s 15 pages of text, there is at best one glancing reference (being generous) to the fact that women with HIV who are eligible for treatment should receive antiretrovirals because they have a right to treatment for the sake of their own lives and health. And the target for reducing maternal deaths is not even mentioned in the report’s text (though, to be fair, it is included as an indicator in the country profiles that make up the second part of the report).

What gives?

Well, the report makes it clear. “Many more women,” it states, have access to antiretroviral medicines to reduce the risk of HIV transmission to their children  than four years ago [my emphasis, here and below].” And again, “Special attention is needed in all countries to ensure access to and retention on antiretroviral medicines for pregnant and breastfeeding women living with HIV to cut these numbers of children acquiring HIV infection.” The report betrays, alarmingly, a view of women exclusively as bearers and feeders of children.

It does, at a couple of points, vaguely acknowledge that women’s lives have value even when they are not carrying or breastfeeding babies.  “The number of women acquiring HIV infection has to be reduced,” the report states, “and all women living with HIV eligible for antiretroviral therapy must have access to it for their own health.” But this commitment, for which many advocates have fought long and hard, must be translated into concrete action to prioritize ARV treatment for HIV-positive women who are not pregnant, or who have finished breastfeeding. Too often, still, these women do not have access to the life-saving medicines they need, or are dropped from programs when they no longer qualify through their children.

The report does, thankfully, acknowledge the significance of access to family planning as a means of preventing unintended pregnancy, and thereby of preventing infants from being born with HIV:

Reducing unmet need for family planning will reduce new HIV infections among children and improve maternal health. Increasing access to voluntary and noncoercive family planning services for all women, including women living with HIV, can avoid unintended pregnancies. Family planning enables women to choose the number and spacing of their children, thereby improving their health and wellbeing.

Kudos to UNAIDS and PEPFAR for being forthright about this crucial element of PMTCT programs, even though family planning is still far too rarely included in HIV/AIDS prevention efforts.

But in other respects, the agencies need to do better, both in their programs and in the messages they send through reports like this one. Michel Sidibé and Eric Goosby, the heads of UNAIDS and PEPFAR, have both, in many speeches and statements, acknowledged the importance of women, and the right of women living with HIV to get ARV treatment for their own health. This report should have reflected that awareness, and that principle (as, for instance, this one in 2012 did). I hope and expect that the next progress report for the Global Plan will include a clear discussion of the link between HIV infection, maternal mortality, and women’s health more generally, and what the agencies are doing to address it.

Halting the spread of HIV in Ecuador’s indigenous communities

Maritza Segura is FCI’s national coordinator in Ecuador.

On October 18 and 19, 2012, in Quito, Ecuador, in partnership with the Spanish NGO Interarts, FCI is organizing a national advocacy event — Our Life, Our Rights: HIV Prevention for the Good Life — to strengthen political commitment and support for implementation of specific HIV prevention and treatment strategies for indigenous peoples and communities. We have seen firsthand that access to accurate information is critically important for preventing the spread of HIV among indigenous populations, and especially among young people in indigenous communities. To be effective in helping young people embark on safe and healthy adult lives, this information must be provided in way that is culturally appropriate and relevant to their cultural context.

Much of FCI’s work in Ecuador in recent years has focused on preventing HIV among young people and women in indigenous communities. In the villages of the Amazon jungle, young people’s access to information about their reproductive health, including HIV and AIDS, is limited. Even though these communities are seeing more and more cases of HIV each year, national surveillance systems — which don’t record ethnicity — don’t reflect the magnitude of the problem among the indigenous population.

FCI and Interarts are working with indigenous organizations in Ecuador to train young indigenous people on HIV prevention. The training uses a participatory, youth-centered methodology, adapted to the local culture, to provide information on a range of critically important topics, including how HIV is transmitted, means of prevention, and correct use of a condom. Participants also learn about the importance of solidarity, about non-discrimination, and about their sexual and reproductive rights.

To date, FCI has trained more than 5,000 young people in five Ecuadorian provinces. In 2011, at the request of the Ministry of Public Health, we implemented a pilot project on sexuality and vulnerability to HIV among the indigenous Shuar and Achuar peoples; we also proposed the development and implementation of  a national strategy to respond to HIV and AIDS among the country’s indigenous populations. The October event in Quito will help to build support for this strategy.

This initiative is implemented with support from Interarts Foundation, through a grant from the Spanish Agency for International Development Cooperation (AECID).

You can directly support FCI’s work educating young people in Ecuador’s indigenous communities! Visit catapult.org to learn how.

La prevención del VIH en jóvenes y mujeres indígenas del Ecuador

 

Maritza Segura es la coordinadora nacional de FCI en Ecuador.

El 18 y 19 de octubre de 2012, a Quito, Ecuador, FCI y la ONG española Interarts están organizando un evento de incidencia nacional —  Nuestra Vida , Nuestros Derechos: Prevenir el VIH para el buen vivir — para fortalecer los compromisos políticos en respuesta al VIH, asegurando estrategias específicas para pueblos y nacionalidades indígenas.

FCI ha visto de primera mano la importancia del acceso a información verídica y completa en la prevención de la propagación de la epidemia del VIH en poblaciones indígenas, especialmente jóvenes, y la pertinencia de material culturalmente adecuado para fortalecer la construcción de un proyecto de vida saludable, en un contexto cultural diverso.

En los últimos años, FCI ha centrado sus esfuerzos en la prevención del VIH en jóvenes y mujeres indígenas del Ecuador. A menudo, en lugares remotos del país, adolescentes y jóvenes tienen acceso limitado a información y educación sobre salud reproductiva, incluido el VIH/SIDA. Trágicamente, aunque cada año se identifican más y más casos de VIH en estas mismas poblaciones, los sistemas nacionales de vigilancia no permiten un registro por pertenencia étnica por lo tanto las estadísticas no reflejan la magnitud de este problema. Como parte de un proyecto con Interarts, FCI trabaja con organizaciones indígenas de Ecuador para capacitar a jóvenes indígenas en la prevención del VIH utilizando una metodología participativa centrada en la juventud: El recorrido participativo para la prevención del VIH, que incluye los temas de formas de transmisión, el camino de la protección, el uso correcto del condón, solidaridad, no discriminación y derechos. Hasta la fecha, FCI ha capacitado a más de 5.000 jóvenes en cinco provincias. En 2011, y a solicitud del Ministerio de Salud Pública, FCI desarrolló un estudio en una provincia piloto sobre la sexualidad y la vulnerabilidad al VIH en población Shuar y Achuar y realizó una propuesta de estrategia para dar respuesta al problema del VIH/SIDA entre las poblaciones indígenas.

Esta iniciativa es posible en coordinación con la fundación Interarts, y a través de fondos de la Agencia Española de Cooperación Internacional para el Desarrollo (AECID).

New publication fosters country accountability, supports Global Strategy

For the past five years, FCI has been a key partner in Countdown to 2015, a global coalition of academics, governments, international agencies, health-care professional associations, donors, and NGOs that uses country-specific data to stimulate and support country progress towards achieving the health-related MDGs. FCI shares (with the secretariat of the Partnership for Maternal, Newborn & Child Health—PMNCH) overall responsibility for Countdown’s advocacy and communications, working with partners to ensure that Countdown’s data, analysis, and key messages are seen and used by policy makers  to effect real change.

Accountability for Maternal, Newborn & Child Health: An update on progress in priority countriesThis week, Countdown released a new publication, Accountability for Maternal, Newborn & Child Survival: An update on progress in priority countries, which contains updated profiles on high-burden priority countries that account for over 95% of the world’s maternal and child deaths.  The report will be launched at the 126th Assembly of the Inter-Parliamentary Union, which takes place in Kampala, Uganda next week. These profiles highlight how well each country is doing in increasing coverage of high-impact interventions — key elements of the reproductive, maternal, newborn, and child health (RMNCH) continuum of care — that can save the lives of millions of women and children. The charts and graphs in each country profile provide an easy-to-read, attractive, and succinct portrait of whether these high-burden countries are making progress (or not) in increasing women’s and children’s access to essential services like antenatal care, skilled attendance during childbirth, immunization, and prevention of mother-to-child transmission of HIV.

This publication is one of the significant contributions that Countdown is making to the global accountability agenda around the Global Strategy for Women’s and Children’s Health, an unprecedented plan to save the lives of 16 million women and children by 2015, which was launched by UN Secretary-General Ban Ki-moon in September 2010. The country profiles in this publication, customized to showcase the core indicators selected by the Commission on Information and Accountability for Women’s and Children’s Health, are adapted from the full, two-page Countdown country profile, which Countdown produces on a roughly two-year cycle. Full country profiles will be included in Countdown’s 2012 Report, which will be published in June 2012.

Sample country profile from Countdown Accountability report: Burkina Faso
A Countdown country profile, from the Accountability report

FCI is also working on a number of other Countdown initiatives, including the launch of a new Countdown website and the development of a toolkit to assist high-burden countries in developing their own country-level Countdown conferences and publications.