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.
“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.
SMNLW participant Maria Fernandez Elorriaga is the principal investigator and technical coordinator of a study investigating the use of the World Health Organization (WHO) Safe Childbirth Checklist to improve the quality of institutional delivery in Mexico. Maria is also co-investigator on two more studies of implementation science in maternal and perinatal care. In addition, Maria has worked as a primary and community care nurse in Spain, as a regional nutrition coordinator in Malawi and as child health and nutrition coordinator in the Sahrawi refugee camps in Tindouf, Algeria. Continue reading “Global Leaders in Maternal Newborn Health: Maria Fernandez Elorriaga (Mexico)”
Nongma Evariste Sawadogo is a trained midwife. He joined Family Care International (FCI) two years ago as a program officer and managed Burkina Faso’s reproductive, maternal, newborn and child health (RMNCH) projects. He will soon join Management Sciences for Health (MSH) as a member of the recently launched FCI Program.
Nongma is passionate about improving RMNCH in his country and community. He works with community-based organizations, leads workshops, provides technical support to community health facilities, and evaluates projects to advance RMNCH and to ensure the greatest impact for women and children.
What happens when a mother dies? In the West, the most ready and obvious answer is grief – the harrowing emotional and psychological toll of losing a loved one. A mother’s death is largely viewed as a private tragedy that will grow more manageable in time.
But in many developing countries, a mother’s death is much more than an emotional crisis, often leading to long-term social and economic breakdown, both for her immediate family and the wider community. This topic is explored in new depth, in a special issue launched today in Reproductive Health (an open-access journal).
We have the largest generation of young people ever.
The world must listen to young people’s voices. It must ensure that we have the opportunity to influence policies that affect us, especially in setting the new development agenda for the era beyond 2015. It must understand that young people know what they want and need, and are committed to safeguarding their sexual and reproductive health and rights (SRHR).
Too often, the voices of young people are drowned out by those of adult policymakers who think they know what young people need and assume young people are “too young” to articulate their issues effectively. For many years, these assumptions have limited the opportunities and constricted the space for young people to participate meaningfully in the creation of the development programs and policies that will have a direct impact on their lives.
At a recent side event during the Commission on Population and Development, young people voiced their concerns, shared best practices, and discussed key issues with other stakeholders. The event was hosted by Simavi (an NGO based in the Netherlands), the permanent mission of Ghana to the UN, and SRHR Alliances from Ghana, Kenya, Uganda, and Malawi, and was attended by representatives, including youth, from country delegations; SRHR advocates; policy makers; and young people.
“Involving young people in SRHR is a basic right enshrined in the laws of many countries, and it is therefore incumbent for countries to observe the same,” explained Edith Asamani, a youth representative from Curious Minds Ghana.
Aisha Twalibu, a youth representative from YECE in Malawi, explained to the group that young people are a diverse group with different needs, and that listening to their voices will help governments, CSOs and development agencies tailor SRHR programs to their needs.
Three other young Africans shared case studies on youth SRHR programs. First, Chris Kyewe from Family Life Education Programme described his peer education program in Uganda, in which youth peer educators (YPEs) are trained to give SRHR information and education to their peers and refer young people to local health centers where trained healthcare providers offer youth-friendly services. In addition to education, YPEs also provide their peers with condoms and oral contraceptive pills, together with instructions on how to use them. This example showed how young people are meaningfully engaged in the implementation of the program.
Then Hellen Owino from the Centre for the Study of Adolescents in Kenya shared that comprehensive sexuality education programs in Kenya empower young people to make informed choices about their health and sexuality. CSA and the Kenya SRHR Alliance have been engaged in advocacy to include comprehensive sexuality education in the national curriculum of Kenya. She also shared that CSE programs should be appealing and interactive, for example by using ICT and social media, to capture the attention of young people. Justine Saidi, the Principal Secretary for Youth in Malawi also called for the active involvement of parents in demanding that young people have access to sexuality information.
Charles Banda from YONECO shared the last case study that focused on preventing child marriage in Malawi. He shared his experience in working with youth-led organizations to build awareness on the negative impact of child marriages on girls and communities, creating a more enabling environment for young girls to exercise their rights. He also described how civil society organizations in Malawi have advocated successfully to raise the legal age of marriage to 18 years, which was recently made into law by the President of Malawi.
Highlighting lessons from the women’s movement, the side event concluded with a discussion of key strategies for youth advocates, including:
Mobilizing a critical mass of young people
Holding governments accountable for fulfilling their national and international commitments
Investing in ensuring that health data can be disaggregated by age group, especially for young people aged 10 to 14
Identifying champions at all levels to advance the youth and SRHR agenda
It is time that young people’s views and concerns are incorporated into the new development agenda. Without listening to young people, no country will be able to realize the potential of the demographic dividend that comes with this generation.
Adama Sanogo is Program Officer at Family Care International in Mali, working at the national office in Bamako and supervising FCI’s programs in Mopti. Adama authored a post on gender-based violence last year.
Lire la version française ci-dessous.
Samira [not her real name], a married Burkinabe woman, took a vacation to Mali to visit her sister. One evening, they attended the Balani Show, a cultural festival of traditional music and dance, in Mopti. Samira’s sister decided to go home early, but Samira opted to stay out a little later. Later that evening, Samira walked back to her sister’s house alone when a group of young men—residents in her sister’s neighborhood—attacked and gang-raped her. The next morning, Samira contacted Family Care International for care and took her case to the police. Her attackers and their families immediately began to pressure her to drop the case. As the social intimidation mounted, even Samira’s own sister, afraid of conflict with her neighbors, advised Samira to stop pursuing the case. Despite encouragement from social workers and legal counsel provided by Family Care International (FCI), Samira eventually abandoned the case against her rapists. Although Samira wasn’t able to pursue justice, she found support, and allies, at FCI.
On October 7, 2014, a panel of experts in maternal health—moderated by Dr. Ana Langer, the Director of the Maternal Health Task Force—gathered at the Harvard School of Public Health to discuss the socioeconomic impact of a maternal death on her family and community. Several studies were summarized and priorities for how to use this research were discussed by the panel and audience at “Women’s Lives Matter: The Impact of Maternal Death on Families and Communities.”
What does the research say?
In many countries around the world, the household is the main economic unit of a society. At the center of this unit is the mother and the work—both productive and reproductive—that she provides for her family. A study in Kenya, led by Aslihan Kes of the International Center for Research on Women (ICRW) and Amy Boldosser-Boesch of Family Care International (FCI), showed great indirect and direct costs of a mother losing her life. This cost is often accompanied by the additional cost and care-taking needs of a newborn. “Once this woman dies the household has to reallocate labor across all surviving members to meet the needs of the household. In many cases that meant giving up other productive work, loss of income, hiring an external laborer, girls and boys dropping out of school or missing school days to contribute [to household work],” shared Kes. In addition, the study done in Kenya determined that families whose mother died used 30% of their annual spending for pregnancy and delivery costs; a proportion categorized by the WHO as catastrophic and a shock to a household.
Similar research was conducted in South Africa, Tanzania, Ethiopia, and Malawi by Ali Yamin and colleagues. In addition to similar socioeconomic findings to those in Kenya, Yamin found that less than 50% of children survived to their fifth birth if their mother died compared to over 90% of children whose mothers lived. An even more dramatic relationship was found in Ethiopia with 81% of children dying by six months of age if their mother had died. In South Africa, mortality rates for children whose mothers had died were 15 times higher compared to children whose mothers survived.
Increasing the visibility of maternal death
While a family is grappling with grief they are also making significant changes in roles and structure to meet familial needs. Dr. Klugman emphasized this point when she said, “Quantifying [the] effects [of maternal death]… and the repercussions down the line—in terms of poverty, dropping out of school, bad nutrition, and future life prospects—I think are all tremendously powerful. [This] additional information [is] very persuasive—to take to the ministries of finance, to take to donors, to take to stakeholders—to help mobilize action for the interventions that are needed.”
Apart from the economic and social costs, is a foundation of human rights violations and gender inequalities. The high rate of preventable maternal mortality is no longer a technical issue, but a social issue. “Maternal mortality it is a global injustice. It is the indicator that shows the most disparities between the North and the developing world in the South. It’s not a technical problem, it’s because women lack voice and agency at household, community, and societal levels and because their lives are not valued. Through this research of showing what happens when those women die, it shows in a way how much they do [and how it] is discounted,” said Dr. Yamin, whose research focuses on the human rights violations in maternal health.
Leveraging this research for improved reproductive, maternal, newborn, and child health
The research findings are clear: prevention of maternal mortality is technically feasible, the right of every woman, and significantly important for the well-being of a family and a community. Boldosser-Boesch provided three reasons why making the case for preventing maternal mortality is critical at this time.
These findings strengthen our messaging globally and in countries with the highest rates on the importance of preventing maternal mortality, by increasing access to quality care, which includes emergency obstetric and newborn care.
This research supports integration across the reproductive, maternal, newborn, and child health (RMNCH) continuum to break down current silos in funding and programs.
“We are at a key moment… for having new information about the centrality of RMNCH to development, because… the countries of the world are working now to define a new development agenda, beyond the MDGS, post-2015. And that agenda will focus a lot on sustainable development… and we see in these findings… , connections to the economic agenda…, questions of gender equality, particularly what this means for surviving girl children, who… may experience earlier marriage or lack of access to education,” shared Boldosser-Boesch.
In order to move the agenda forward on preventing maternal mortality and ensuring gender equality, ministries of health and development partners must be engaged. In addition, donors can fund the action of integration to address a continuum approach and media outlets should be leveraged to disseminate these findings and hold governments accountable for keeping promises and making changes. The prevention of maternal mortality is a human rights-based, personal, and in the socioeconomic interest of a family, community, and a society.
This panel included:
Ana Langer, Director of the Maternal Health Task Force
Alicia Yamin, Lecturer on Global Health at the Harvard School of Public Health
Amy Boldosser-Boesch, Interim President & CEO, Family Care International
Jeni Klugman, Senior Adviser at The World Bank Group
Aslihan Kes, Economist and Gender Specialist, International Center for Research on Women